Russo Stephanie A, Nice Emily M, Chafetz Ross S, Richards James G, Zlotolow Dan A, Kozin Scott H
Department of Orthopedic Surgery, Akron Children's Hospital, Akron, OH, USA.
Department of Research, Shriners Children's, Philadelphia, PA, USA.
J Shoulder Elbow Surg. 2025 Apr;34(4):e227-e238. doi: 10.1016/j.jse.2024.06.027. Epub 2024 Aug 14.
Tendon transfers are often utilized to improve shoulder external rotation and abduction in children with brachial plexus birth injuries and are designed to improve glenohumeral (GH) joint motion. However, changes in scapulothoracic (ST) and GH joint function after tendon transfer are not well defined. The purpose of this study was to quantify changes in GH, ST, and humerothoracic (HT) joint function before and after tendon transfer, and we hypothesized that tendon transfers would reorient the arc of motion into more external rotation and abduction, but not increase GH motion.
Motion analysis was performed in 15 children (ages 3-16) before and after transfer of teres major and/or latissimus dorsi. ST, GH, and HT joint angles were measured in a neutral, resting position and each of the modified Mallet positions. Joint angular displacements from the neutral position and the total arc of internal-external rotation for each joint were also calculated. Relevant joint angles, joint angular displacements, and internal-external rotation arcs were compared using multivariate analyses of variance with repeated measures and univariate posthoc analyses.
Glenohumeral and HT external rotation were significantly increased in all positions postoperatively. The arc of GH internal-external rotation was unchanged, but oriented in more external rotation after surgery. Only 6 patients gained active external rotation. Glenohumeral and HT internal rotation were significantly decreased after surgery, but ST internal rotation was significantly increased. Two patients had loss of midline function. In the abduction position, GH elevation joint angles were unchanged, but ST and HT elevation increased.
Only 4 patients gained active GH external rotation and maintained their internal rotation. Each of those patients underwent isolated tendon transfer without concomitant joint release. Seven patients maintained their preoperative internal rotation, which was attributed to increased ST internal rotation. The other half of patients lost internal rotation and gained external rotation through reorientation of the arc of rotation. Nine patients gained HT elevation, with 3 attributed to increased ST upward rotation, 5 attributed to a combination of increased ST upward rotation, and increased GH elevation, and 1 attributed to increased GH abduction contracture. These findings challenge the dogma that teres major/latissimus dorsi tendon transfers augment GH motion and highlight the importance of ST function for outcome determination.
肌腱转移术常用于改善臂丛神经产伤患儿的肩部外旋和外展功能，旨在改善盂肱（GH）关节活动度。然而，肌腱转移术后肩胛胸壁（ST）关节和GH关节功能的变化尚不明确。本研究的目的是量化肌腱转移术前和术后GH、ST和肱胸（HT）关节功能的变化，我们假设肌腱转移术会将运动弧重新定向为更多的外旋和外展，但不会增加GH关节活动度。
对15名3至16岁儿童在转移大圆肌和/或背阔肌之前和之后进行运动分析。在中立、休息位以及每个改良的马利特位测量ST、GH和HT关节角度。还计算了每个关节从中立位的关节角位移以及内外旋转的总弧度。使用重复测量的多变量方差分析和单变量事后分析比较相关关节角度、关节角位移和内外旋转弧。
术后所有位置的GH和HT外旋均显著增加。GH关节内外旋转弧度未改变，但术后向外旋转方向改变。只有6名患者获得了主动外旋。术后GH和HT内旋显著降低，但ST内旋显著增加。两名患者中线功能丧失。在外展位，GH抬高关节角度未改变，但ST和HT抬高增加。
只有4名患者获得了主动GH外旋并保持了内旋。这些患者中的每一位都接受了单纯的肌腱转移术，未同时进行关节松解。7名患者保持了术前内旋，这归因于ST内旋增加。另一半患者失去了内旋并通过旋转弧的重新定向获得了外旋。9名患者获得了HT抬高，其中3名归因于ST向上旋转增加，5名归因于ST向上旋转增加和GH抬高增加的组合，1名归因于GH外展挛缩增加。这些发现挑战了大圆肌/背阔肌腱转移术可增加GH关节活动度的教条，并突出了ST功能对结果判定的重要性。
