Waters P M, Smith G R, Jaramillo D
Department of Orthopedic Surgery, Children's Hospital, Boston, Massachusetts 02115, USA.
J Bone Joint Surg Am. 1998 May;80(5):668-77. doi: 10.2106/00004623-199805000-00007.
Ninety-four patients who had brachial plexus birth palsy were entered into a prospective study to evaluate the association between persistent palsy, age-related musculoskeletal deformity, and functional limitations. Of these patients, forty-two had either computerized tomography or magnetic resonance imaging to assess the presence and degree of incongruity of the glenohumeral joint, deformity of the humeral head, and hypoplasia of the glenoid as part of the preoperative planning for a reconstructive operation. Functional ability was rated with use of the classification of Mallet, on a scale of 1 to 5. The mean glenoscapular angle (the degree of retroversion of the glenoid) on the affected side was -25.7 degrees compared with -5.5 degrees on the unaffected side. Twenty-six (62 per cent) of the forty-two shoulders had evidence of posterior subluxation of the humeral head, with a mean of only 25 per cent (range, 0 to 50 per cent) of the head being intersected by the scapular line. Progressive deformity was found with increasing age (p < 0.001). The natural history of untreated brachial plexus birth palsy with residual weakness is progressive glenohumeral deformity due to persistent muscle imbalance. The status of the glenohumeral joint must be addressed when the choice between tendon transfer and humeral derotation osteotomy for reconstruction of the shoulder is considered for these patients.
94例臂丛神经产瘫患者纳入一项前瞻性研究，以评估持续性麻痹、年龄相关的肌肉骨骼畸形和功能受限之间的关联。其中42例患者进行了计算机断层扫描或磁共振成像，以评估盂肱关节不协调的存在和程度、肱骨头畸形以及肩胛盂发育不全，作为重建手术术前规划的一部分。使用马利特分类法对功能能力进行评分，范围为1至5级。患侧的平均肩胛盂角度（肩胛盂后倾程度）为-25.7度，而未受影响侧为-5.5度。42个肩部中有26个（62%）有肱骨头后脱位的迹象，平均只有25%（范围为0至50%）的肱骨头被肩胛线穿过。随着年龄增长发现有进行性畸形（p<0.001）。未经治疗的伴有残留无力的臂丛神经产瘫的自然病程是由于持续的肌肉失衡导致盂肱关节进行性畸形。对于这些患者，在考虑选择肌腱转移和肱骨旋转截骨术重建肩部时，必须考虑盂肱关节的状况。
