K S Gowda Aditya, Singh Vivek, Mishra Rahul, Sharma Cury, Maheshwari Vikas, Regmi Anil
All India Institute of Medical Sciences Rishikesh, Rishikesh, India.
Int Orthop. 2025 Aug 7. doi: 10.1007/s00264-025-06630-0.
Shoulder deformities and impaired function in individuals with birth brachial plexus injury (BBPI) are often caused by internal rotator (IR) contractures and abductor weakness, which may progress to glenohumeral dysplasia. Although subscapularis-complex release and tendon transfer is a time-tested procedure, there are controversies regarding the appropriate management of shoulder contractures, especially in preschool children. Therefore, this study examines the efficiency of arthroscopically done progressive controlled release of IR contracture combined with tendon transfer.
This study included 12 children who presented with shoulder soft tissue contractures and functional impairments, specifically, loss of shoulder abduction and external rotation, but with good deltoid function. They underwent a surgical intervention involving arthroscopy-assisted subscapularis-complex release and conjoint muscle transfer onto the infraspinatus footprint on the humeral head. The evaluation of shoulder function was conducted using the Mallet score system, and the range of motion was measured at preoperative and six month postoperative intervals. Statistical analyses were performed to determine the significance of the outcomes.
The average age of participants was 4.83 ± 2.1 years. Preoperatively, the mean Mallet score was 14.08 ± 1.4, which improved to 23.83 ± 1.2 postoperatively. The average gain in shoulder abduction was 66.4 ± 5.6°, and external rotation improved by 85.4 ± 16.6° at 18 months final follow-up. All patients exhibited improvements in shoulder function, with a significant correlation (p value = 0.037) between Naraka grading, and clinical outcomes.
The combined surgical approach of arthroscopic subscapularis-complex release with conjoint tendon transfer effectively enhances the shoulder function in the studied cohort. Further research and extended follow-up are needed to evaluate the long-term benefits.
Level IV (Therapeutic case series).
产瘫性臂丛神经损伤（BBPI）患者的肩部畸形和功能受损通常是由内旋肌（IR）挛缩和外展肌无力引起的，这可能会发展为盂肱关节发育不良。尽管肩胛下肌复合体松解和肌腱转移是一种经过时间考验的手术，但对于肩部挛缩的适当处理仍存在争议，尤其是在学龄前儿童中。因此，本研究探讨了关节镜下渐进性控制松解IR挛缩联合肌腱转移的疗效。
本研究纳入了12名出现肩部软组织挛缩和功能障碍的儿童，具体表现为肩部外展和外旋丧失，但三角肌功能良好。他们接受了一项手术干预，包括关节镜辅助下肩胛下肌复合体松解以及联合肌肉转移至肱骨头的冈下肌附着点。使用马利特评分系统对肩部功能进行评估，并在术前和术后6个月测量活动范围。进行统计分析以确定结果的显著性。
参与者的平均年龄为4.83±2.1岁。术前，平均马利特评分为14.08±1.4，术后提高到23.83±1.2。在最后一次随访的18个月时，肩部外展平均增加66.4±5.6°，外旋改善85.4±16.6°。所有患者的肩部功能均有改善，拿卡分级与临床结果之间存在显著相关性（p值 = 0.037）。
关节镜下肩胛下肌复合体松解联合联合肌腱转移的联合手术方法有效地改善了研究队列中的肩部功能。需要进一步的研究和延长随访时间来评估长期益处。
IV级（治疗性病例系列）。
