Kirkos J M, Papadopoulos I A
Kilkis General Hospital, Greece.
J Bone Joint Surg Am. 1998 Oct;80(10):1477-83. doi: 10.2106/00004623-199810000-00009.
We retrospectively reviewed the results of rotational osteotomy that had been performed distal to the surgical neck of the humerus in twenty-two patients who had sustained an injury of the brachial plexus at birth. Eighteen patients had a lesion of the superior trunk of the brachial plexus (the fifth and sixth cervical nerve roots), and four had involvement of the entire brachial plexus. The patients ranged in age from four to seventeen years old (average age, ten years and three months old) at the time of the operation. The average duration of follow-up was fourteen years (range, two to thirty-one years). Preoperatively, the patients had been unable to perform self-care activities, such as grooming, feeding, and washing themselves, because of limited active external rotation or fixed internal rotation of the shoulder. All patients had decreased strength of the lateral rotator and abductor muscles and normal strength of the subscapularis and pectoralis major muscles. Radiographs showed some flattening of the humeral head, and four patients had posterior subluxation of the humeral head. A lateral rotational osteotomy of the proximal part of the humerus was performed between the insertions of the subscapularis and pectoralis major muscles. The site of the osteotomy was stabilized with catgut sutures in the periosteum in ten patients and with one or two staples in twelve. The extremity was immobilized in a plaster shoulder-spica cast for six weeks. At the latest follow-up evaluation, the average increase in active abduction was 27 degrees (range, 0 to 60 degrees) and the average increase in the arc of rotation was 25 degrees (range, 5 to 85 degrees). Supination of the forearm also had increased commensurate with the increase in external rotation. The appearance of the extremity had improved as well.
我们回顾性分析了22例出生时臂丛神经损伤患者在肱骨外科颈远端进行旋转截骨术的结果。18例患者为臂丛神经上干（第5和第6颈神经根）损伤，4例患者为整个臂丛神经受累。手术时患者年龄为4至17岁（平均年龄为10岁3个月）。平均随访时间为14年（范围为2至31年）。术前，由于肩部主动外旋受限或固定内旋，患者无法进行自我护理活动，如梳理、进食和洗澡。所有患者的肩外旋肌和外展肌力量均减弱，肩胛下肌和胸大肌力量正常。X线片显示肱骨头有一些扁平，4例患者有肱骨头后脱位。在肩胛下肌和胸大肌止点之间对肱骨近端进行外侧旋转截骨术。10例患者的截骨部位用肠线缝合固定于骨膜，12例患者用1或2个吻合钉固定。肢体用石膏肩人字石膏固定6周。在最近的随访评估中，主动外展平均增加27度（范围为0至60度），旋转弧平均增加25度（范围为5至85度）。前臂旋后也随着外旋增加而增加。肢体外观也有所改善。
