Nulty Stephanie A, Van Heest Ann, Georgiadis Andrew G
Department of Orthopaedic Surgery, University of Arizona-Phoenix, Phoenix, AZ, USA.
Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, MI, USA.
J Pediatr Soc North Am. 2025 Jun 24;12:100226. doi: 10.1016/j.jposna.2025.100226. eCollection 2025 Aug.
Children with amyoplastic arthrogryposis may have absent myotomes (e.g., biceps brachii, brachialis), leading to a lack of active elbow flexion and/or elbow extension contractures. In these cases, the long head of the triceps can be transferred through an extensile approach to the proximal volar ulna, improving both active and passive elbow flexion. Key technical considerations include patient selection, preservation of the long head's neurovascular pedicle, precise dissection of the radial and ulnar nerves, and safe tendon rerouting. This paper highlights technical details with a representative case example and an accompanying technique video. A 6-year-old patient with amyoplasia and absent active flexion underwent a long head of the triceps transfer. The procedure was documented with surgeon point-of-view high-definition footage to emphasize crucial technical steps. Passive and active elbow flexion improved at short-term follow-up and was sustained at 2 years.
(1)Elbow flexion can be improved through long head of triceps transfer in children with amyoplastic type of arthrogryposis.(2)Use of one head of the triceps adds elbow flexion and does not sacrifice elbow extension function as the medial and lateral heads of the triceps are preserved as elbow extensors.(3)Most children with arthrogryposis have demonstrated clinically that they can achieve selective control of the long head of the triceps to flex the elbow post-operatively, while relaxing the medial and lateral heads of the triceps for elbow extension.(4)The long head of the triceps originates from the scapula and has separate radial nerve branch proximal innervation allowing dissection away from the other two heads of the triceps.(5)Careful dissection and understanding of the anatomy of the three heads of the triceps is needed for successful surgical transfer of the long head of the triceps.
患有肌张力减退型关节挛缩症的儿童可能存在肌节缺失（例如肱二头肌、肱肌），导致主动肘关节屈曲缺乏和/或肘关节伸展挛缩。在这些情况下，可通过一种扩展性入路将肱三头肌长头转移至尺骨掌侧近端，改善主动和被动肘关节屈曲。关键技术要点包括患者选择、保留肱三头肌长头的神经血管蒂、精确解剖桡神经和尺神经以及安全的肌腱改道。本文通过一个典型病例及配套技术视频突出技术细节。一名6岁患有肌张力减退且无主动屈曲的患者接受了肱三头肌长头转移术。该手术过程采用外科医生视角的高清视频记录，以强调关键技术步骤。短期随访时被动和主动肘关节屈曲得到改善，并在2年时保持稳定。
（1）对于患有肌张力减退型关节挛缩症的儿童，可通过肱三头肌长头转移改善肘关节屈曲。（2）使用肱三头肌的一个头增加了肘关节屈曲，且不会牺牲肘关节伸展功能，因为肱三头肌的内侧头和外侧头作为肘关节伸肌得以保留。（3）大多数患有关节挛缩症的儿童在临床上已证明，他们术后能够选择性地控制肱三头肌长头来屈曲肘关节，同时放松肱三头肌的内侧头和外侧头以实现肘关节伸展。（4）肱三头肌长头起自肩胛骨，有独立的近端桡神经分支支配，这使得它可以与肱三头肌的另外两个头分离解剖。（5）成功进行肱三头肌长头的手术转移需要仔细解剖并了解肱三头肌三个头的解剖结构。
