Kirby David J, Buchalter Daniel B, Santiesteban Lauren, Garcia Mekka R, Berger Aaron, Hacquebord Jacques, Grossman John A I, Price Andrew E
Department of Orthopedic Surgery, NYU Langone Health, New York, New York, United States.
Department of Neurology, NYU Langone Health, New York, New York, United States.
J Brachial Plex Peripher Nerve Inj. 2024 Jun 12;19(1):e13-e19. doi: 10.1055/s-0044-1786817. eCollection 2024 Jan.
Brachial plexus birth injury results in deficits in strength and motion, occasionally requiring surgery to restore power to the deficient external rotators of the shoulder in these patients. This is a retrospective analysis of the long-term results of an isolated latissimus dorsi transfer to the rotator cuff in patients with brachial plexus birth injury. This is a retrospective review of prospectively collected data for patients undergoing isolated latissimus dorsi transfer into the infraspinatus in addition to release of the internal rotation contracture of the shoulder with greater than 5 years' follow-up. Preoperative and postoperative shoulder elevation and external rotation were documented. Failure of surgery was defined as a return of the internal rotation contracture and a clinically apparent clarion sign. A total of 22 patients satisfied the inclusion criteria: 9 global palsies and 13 upper trunk palsies. The average follow-up was 11 years, ranging from 7.5 to 15.9 years. There was a trend for improved external rotation in the global palsy cohort at final follow-up ( = 0.084). All nine global palsies maintained adequate external rotation without a clarion sign. Five of the 13 upper trunk palsies failed the latissimus dorsi transfer and subsequently required either teres major transfer and/or rotational osteotomy. In these five failures, the period from initial transfer to failure averaged 6.6 years, ranging from 3.4 to 9.5 years. The results of this study indicate that patients with global palsy have sustained long-term improved outcomes with isolated latissimus dorsi transfer while patients with upper trunk palsy have a high rate of failure. Based on these results, we recommend isolated latissimus dorsi transfer for global palsy patients who have isolated infraspinatus weakness. Case series - Level IV.
臂丛神经产伤会导致力量和运动功能障碍，这些患者有时需要手术来恢复肩部外旋功能不足的肌肉力量。本文对臂丛神经产伤患者进行背阔肌单独转移至肩袖手术的长期效果进行了回顾性分析。
这是一项回顾性研究，对前瞻性收集的接受背阔肌单独转移至冈下肌并松解肩部内旋挛缩且随访超过5年的患者数据进行分析。记录术前和术后的肩部抬高和外旋情况。手术失败定义为内旋挛缩复发且出现明显的“号角征”。
共有22例患者符合纳入标准：9例全臂丛麻痹，13例上干麻痹。平均随访时间为11年，范围为7.5至15.9年。在全臂丛麻痹组，末次随访时外旋有改善趋势（P = 0.084）。所有9例全臂丛麻痹患者均保持了足够的外旋且未出现“号角征”。13例上干麻痹患者中有5例背阔肌转移手术失败，随后需要进行大圆肌转移和/或旋转截骨术。在这5例失败病例中，从初次转移到失败的平均时间为6.6年，范围为3.4至9.5年。
本研究结果表明，全臂丛麻痹患者通过单独背阔肌转移可获得长期改善效果，而上干麻痹患者的失败率较高。基于这些结果，我们建议对仅有冈下肌无力的全臂丛麻痹患者进行单独背阔肌转移手术。
病例系列 - 四级。
