Arrigoni Chiara, Facchi Roberto, Catena Nunzio
Hand Surgery and Reconstructive Microsurgery, IRCCS Istituto Giannina Gaslini, Via Gerolamo GAslini 5, 16147 Genova, Italy.
Department of Orthopedics and Traumatology, IRCCS San Martino, University of Genoa, 16147 Genova, Italy.
J Clin Med. 2025 Aug 8;14(16):5610. doi: 10.3390/jcm14165610.
The treatment of shoulder dysplasia resulting from brachial plexus birth injury (BPBI) remains a matter of debate within pediatric orthopedic and neurosurgical communities. Various approaches have been proposed to address the muscular imbalance and joint incongruity that develop in affected children, with special attention paid to the roles of humeral head reduction and tendon transfers. : These procedures aim to correct the disproportionate strength between internal and external rotators of the shoulder. However, the specific contribution of skeletal procedures such as glenoid osteotomy to restoring shoulder mechanics remains controversial. Glenoid osteotomy, a technique that involves surgically reorienting the glenoid cavity, is hypothesized to promote better containment of the humeral head and allow more physiological joint development. On one hand, altering the glenoid axis could enhance joint congruency and facilitate remodeling during growth. On the other hand, there is limited evidence supporting its efficacy and safety. : This review aims to assess the available literature to determine whether glenoid osteotomy represents a safe and effective procedure for patients with BPBI-associated shoulder dysplasia. A comprehensive literature search yielded 1380 titles. After excluding studies focused on adults and those failing to meet inclusion criteria, only three studies were selected for final analysis. Due to the limited data and variability in study design, no statistical meta-analysis could be performed. : Findings suggest that glenoid osteotomy, particularly when combined with tendon transfers, may lead to improvements in shoulder abduction and external rotation. However, outcomes are often difficult to interpret in isolation, and the specific benefits attributable to the osteotomy remain unclear. The lack of standardized imaging, follow-up, and scoring systems limits the strength of current conclusions. : Further multicenter, prospective studies are needed to evaluate the long-term efficacy of glenoid osteotomy, its role in skeletal remodeling, and its contribution to overall shoulder stability and function. Such studies would help clarify the true potential of this surgical technique in the broader context of BPBI treatment.
臂丛神经产伤（BPBI）所致肩关节发育不良的治疗在小儿骨科和神经外科领域仍存在争议。针对受影响儿童出现的肌肉失衡和关节不协调问题，人们提出了各种治疗方法，其中特别关注肱骨头复位和肌腱转位的作用。这些手术旨在纠正肩部内旋肌和外旋肌之间不成比例的力量。然而，诸如肩胛盂截骨术等骨骼手术对恢复肩部力学的具体作用仍存在争议。肩胛盂截骨术是一种通过手术重新调整肩胛盂腔方向的技术，据推测该技术可促进对肱骨头更好的包容，并使关节发育更符合生理状态。一方面，改变肩胛盂轴可增强关节的一致性，并促进生长过程中的重塑。另一方面，支持其疗效和安全性的证据有限。本综述旨在评估现有文献，以确定肩胛盂截骨术对患有BPBI相关肩关节发育不良的患者而言是否是一种安全有效的手术。全面的文献检索共得到1380个标题。在排除针对成人的研究以及不符合纳入标准的研究后，仅选择了三项研究进行最终分析。由于数据有限且研究设计存在差异，无法进行统计荟萃分析。研究结果表明，肩胛盂截骨术，尤其是与肌腱转位联合使用时，可能会改善肩部外展和外旋功能。然而，结果往往难以单独解读，截骨术的具体益处仍不明确。缺乏标准化的影像学检查、随访和评分系统限制了当前结论的可信度。需要进一步开展多中心、前瞻性研究，以评估肩胛盂截骨术的长期疗效、其在骨骼重塑中的作用以及对整体肩部稳定性和功能的贡献。此类研究将有助于在BPBI治疗的更广泛背景下阐明这种手术技术的真正潜力。
