Ahmed Abdulaziz F, Lohre Ryan S, Elhassan Bassem T
Missouri Orthopaedic Institute, Department of Orthopaedic Surgery, University of Missouri School of Medicine, Columbia, Missouri.
Massachusetts General Hospital, Department of Orthopedic Surgery, Harvard Medical School, Boston, Massachusetts.
JB JS Open Access. 2025 Mar 21;10(1). doi: 10.2106/JBJS.OA.24.00108. eCollection 2025 Jan-Mar.
Most patients with congenital shoulder girdle abnormalities receive treatment in childhood, with limited treatment reports in older populations. The aim of this study was to describe the surgical treatment and outcomes for adolescents and adults with Sprengel's deformity (SD).
A retrospective review was conducted on patients treated for SD, a congenital shoulder girdle abnormality, by a single surgeon between 2011 and 2018. Patient demographics, surgical findings, procedures, complications, active range of motion, visual analog scale (VAS) pain scores, Single Assessment Numeric Evaluation (SANE), and 5-point Likert scale satisfaction were recorded. Univariate statistics were used to compare preoperative and postoperative outcomes.
Fourteen patients with an average age of 23.9 ± 10.1 years and a mean follow-up of 5.4 years (range 1-9 years) were included for analysis. All patients had unilateral pathology. Mean VAS pain scores improved from 6.3 ± 2.6 to 1.2 ± 0.9 (p < 0.001). The SANE score improved from 36.8% ± 9.6% to 77.5% ± 6% (p < 0.001). Average postoperative satisfaction was 4.8 ± 0.4. Forward elevation improved from 97° ± 18.1° to 137° ± 14° (p < 0.001), while abduction, external rotation, and internal rotation remained similar. Surgical treatments included reattachment of the lower trapezius to its anatomical insertion (N = 13), latissimus dorsi transfer to the medial scapular spine (N = 13), medial scapular border resection (N = 12), split pectoralis major transfer (N = 12), rhomboid and/or levator scapulae advancement (N = 12), anlage excision (N = 6), excision of a coracoclavicular ligament bony bridge (N = 1), and upper serratus advancement to the superomedial scapular border (N = 1). Only 1 patient underwent scapulothoracic fusion.
In children, treatment of SD focuses on scapular distalization due to greater soft-tissue plasticity, while in older individuals, this was unfeasible due to stiffer soft-tissue and multiple periscapular muscular deficiencies. This series demonstrates treatment strategies in older patients, involving osseous resections and tendon transfers, resulting in significant improvements over a mean 5.4-year follow-up. Given the rarity of SD in older populations, multicenter studies are warranted to further validate this approach.
Case Series; Level IV. See Instructions for Authors for a complete description of levels of evidence.
大多数先天性肩胛带异常患者在儿童期接受治疗，老年人群的治疗报告有限。本研究的目的是描述青少年和成人Sprengel畸形（SD）的手术治疗及结果。
对2011年至2018年间由同一外科医生治疗的SD（一种先天性肩胛带异常）患者进行回顾性研究。记录患者的人口统计学资料、手术发现、手术操作、并发症、活动范围、视觉模拟量表（VAS）疼痛评分、单项评估数字评价（SANE）以及5级李克特量表满意度。采用单因素统计方法比较术前和术后结果。
纳入14例患者进行分析，平均年龄23.9±10.1岁，平均随访5.4年（范围1 - 9年）。所有患者均为单侧病变。VAS疼痛评分均值从6.3±2.6改善至1.2±0.9（p < 0.001）。SANE评分从36.8%±9.6%提高至77.5%±6%（p < 0.001）。术后平均满意度为4.8±0.4。前屈从97°±18.1°改善至137°±14°（p < 0.001），而外展、外旋和内旋保持相似。手术治疗包括将下斜方肌重新附着于其解剖学止点（n = 13）、背阔肌转移至肩胛内侧缘（n = 13）、肩胛内侧缘切除（n = 12）、胸大肌劈开转移（n = 12）、菱形肌和/或肩胛提肌前移（n = 12）、原基切除（n = 6）、切除喙锁韧带骨桥（n = 1）以及上锯肌前移至肩胛上内侧缘（n = 1）。仅1例患者接受了肩胛胸壁融合术。
在儿童中，SD的治疗由于软组织可塑性较大而侧重于肩胛远移，而在年龄较大的个体中，由于软组织较僵硬和肩胛周围多处肌肉缺陷，这种方法不可行。本系列研究展示了老年患者的治疗策略，包括骨切除和肌腱转移术，在平均5.4年的随访中取得了显著改善。鉴于老年人群中SD的罕见性，有必要开展多中心研究以进一步验证这种方法。
病例系列；IV级。有关证据水平的完整描述，请参阅作者指南。
