Gutierrez-Pereira Javier, Garcia-Lopez Antonio
Department of Orthopaedic Surgery, Hospital General Universitario de Alicante, Spanish National Reference Center for Brachial Plexus Surgery, Alicante, Spain.
Department of Orthopaedic Surgery, Hospital General Universitario de Alicante, Spanish National Reference Center for Brachial Plexus Surgery, Alicante, Spain.
J Hand Surg Am. 2025 Aug;50(8):1012.e1-1012.e8. doi: 10.1016/j.jhsa.2024.07.026. Epub 2024 Oct 2.
Flexion contracture of the elbow is a common deformity associated with brachial plexus birth palsy and is often managed with preventive night orthoses. For severe cases, however, surgical interventions may become necessary. This study evaluated the effectiveness of surgically releasing elbow flexion contractures exceeding 30° through partial tenotomy of the brachialis and biceps brachii muscles, along with a division of the lacertus fibrosus.
We performed 36 anterior elbow releases on patients with injury to the upper trunk (C5-C6) of the brachial plexus and elbow flexion contractures between 30° and 80°. All releases involved lacertus fibrosus section and partial lengthening of the distal portion of the brachialis tendon. In severe cases, biceps brachii tenotomy was also performed. All participants had a minimum follow-up of 12 months and preoperative elbow flexion strength of at least grade 4 on the British Medical Research Council scale, with no deformities in the shape of the ulnohumeral joint or radial head subluxation.
Following a mean follow-up of 41 months, the average extension gain was 31° (range, 10°-50°). All patients maintained their flexion strength. Except for two participants with weaker triceps, the mean elbow extension gain was sustained throughout the follow-up period. There were no major or minor complications or reinterventions in the study.
Partial tenotomy of the brachialis and biceps brachii muscles, coupled with lacertus fibrosus section, is an effective treatment for elbow contractures exceeding 30° flexion. This method is successful in individuals with a functioning triceps brachii and elbow extension strength of at least grade 3 on the British Medical Research Council scale.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
肘关节屈曲挛缩是臂丛神经产瘫常见的畸形，通常采用预防性夜间矫形器治疗。然而，对于严重病例，可能需要手术干预。本研究评估了通过肱肌和肱二头肌部分腱切断术以及肱桡肌筋膜切开术手术松解超过30°的肘关节屈曲挛缩的有效性。
我们对臂丛神经上干（C5-C6）损伤且肘关节屈曲挛缩在30°至80°之间的患者进行了36例肘关节前路松解术。所有松解术均包括肱桡肌筋膜切开术和肱肌肌腱远端部分延长。在严重病例中，还进行了肱二头肌腱切断术。所有参与者的随访时间至少为12个月，术前肘关节屈曲力量在英国医学研究委员会量表上至少为4级，尺肱关节形状无畸形或桡骨头半脱位。
平均随访41个月后，平均伸直增加31°（范围为10°至50°）。所有患者均保持其屈曲力量。除两名三头肌较弱的参与者外，平均肘关节伸直增加在整个随访期间得以维持。本研究中未出现重大或轻微并发症或再次干预情况。
肱肌和肱二头肌部分腱切断术，联合肱桡肌筋膜切开术，是治疗超过30°屈曲的肘关节挛缩的有效方法。该方法对于肱三头肌功能良好且肘关节伸直力量在英国医学研究委员会量表上至少为3级的个体是成功的。
研究类型/证据水平：治疗性IV级。
