Chuang D C, Ma H S, Wei F C
Department of Plastic and Reconstructive Surgery at the Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan.
Plast Reconstr Surg. 1998 Mar;101(3):686-94. doi: 10.1097/00006534-199803000-00015.
Cross-innervation (caused by misdirection of regenerated axons), muscular imbalance (caused by muscle paresis or earlier recovery), and growth are the three main causes of shoulder deformity due to obstetric brachial plexus palsy. If perioperative studies demonstrate the existence of muscle recovery by cross-innervation, a new strategy of muscle transposition to minimize the influence of cross-innervation is used. Release of antagonistic muscles (pectoralis major and teres major muscles) and augmentation of paretic muscles (transferring teres major to the infraspinatus muscle, reinserting both ends of the clavicular part of the pectoralis major muscle laterally) are performed for reconstruction. Since 1993, 29 patients having shoulder deformity caused by obstetric brachial plexus palsy underwent reconstruction utilizing this strategy of muscle transposition. The timing for the reconstruction was at an average of 8.5 years (range, 4 to 21 years). The average shoulder abduction following the muscle transposition was 151 degrees (i.e., average gain 104 percent, or 77 degrees) and that of external rotation was 72 degrees (average gain 200 percent, or 48 degrees). Compared with the patients who had no surgery for shoulder deformity caused by obstetric brachial plexus palsy and early nerve surgery for the infant obstetric brachial plexus palsy, the results of the strategy seem to be significantly impressive.
交叉神经支配（由再生轴突误向引起）、肌肉失衡（由肌肉麻痹或早期恢复引起）和生长是产瘫导致肩部畸形的三个主要原因。如果围手术期研究表明存在通过交叉神经支配实现的肌肉恢复，则采用一种新的肌肉转位策略，以尽量减少交叉神经支配的影响。进行拮抗肌（胸大肌和大圆肌）松解以及麻痹肌增强（将大圆肌转移至冈下肌，将胸大肌锁骨部两端向外重新附着）以进行重建。自1993年以来，29例因产瘫导致肩部畸形的患者采用这种肌肉转位策略进行了重建。重建的平均时间为8.5年（范围为4至21年）。肌肉转位后肩部外展平均为151度（即平均增加104%，或77度），外旋平均为72度（平均增加200%，或48度）。与未对产瘫导致的肩部畸形进行手术以及未对婴儿产瘫进行早期神经手术的患者相比，该策略的效果似乎非常显著。
