Gokaraju Kishan, Mahmoud Ahmed, Williams Daniel, Duke Phillip Fr, Ross Mark
Brisbane Hand and Upper Limb Research Institute, Brisbane, Queensland, Australia.
Orthopaedic Department, Princess Alexandra Hospital, Brisbane, Australia.
Shoulder Elbow. 2024 Jul;16(3):274-284. doi: 10.1177/17585732231174178. Epub 2023 May 11.
Winging of the scapula occurs due to dysfunction of its stabilising muscles, most commonly serratus anterior and/or trapezius, for example in facioscapulohumeral muscular dystrophy. Resultant loss of scapular control and abnormal kinematics can decrease shoulder function due to glenohumeral joint instability, loss of range of motion and pain. Previously described treatment for cases resistant to physiotherapy includes scapulothoracic arthrodesis which involves risk of non-union and metalwork failure, as well as reduced respiratory function due to immobilisation of a segment of the adjacent chest wall.
We present a novel surgical approach to the management of problematic scapular winging by using hamstring graft to achieve a scapulothoracic tenodesis.
We believe this technique provides an adequately stable scapula for improved shoulder movement and function, a sufficiently mobile chest wall for improved lung function and avoidance of complications specifically associated with arthrodesis.
肩胛翼状畸形是由于其稳定肌功能障碍所致，最常见的是前锯肌和/或斜方肌，例如在面肩肱型肌营养不良症中。由于肩胛盂肱关节不稳定、活动范围丧失和疼痛，肩胛控制能力的丧失和异常的运动学改变会导致肩部功能下降。先前描述的针对物理治疗无效病例的治疗方法包括肩胛胸壁关节固定术，该手术存在不愈合和金属植入物失败的风险，以及由于相邻胸壁节段固定导致呼吸功能下降。
我们提出一种新颖的手术方法，通过使用腘绳肌腱移植来实现肩胛胸壁腱固定术，以治疗有问题的肩胛翼状畸形。
我们认为该技术可为改善肩部运动和功能提供足够稳定的肩胛骨，为改善肺功能提供足够活动的胸壁，并避免与关节固定术相关的并发症。
