Van Heest A, Waters P M, Simmons B P
Department of Orthopaedic Surgery, University of Minnesota Hospital, Minneapolis 55455, USA.
J Hand Surg Am. 1998 Nov;23(6):1063-70. doi: 10.1016/S0363-5023(98)80017-8.
The purpose of this study was to analyze our results of surgical treatment of arthrogryposis of the elbow and to compare our tendon transfer results using range of motion (ROM) criteria versus functional use criteria. Eighteen tendon transfers for elbow flexion in 14 children with arthrogryposis with an average follow-up period of 4 years (range, 1-14 years) and 6 elbow capsulotomies with triceps lengthening in 6 children with arthrogryposis with an average follow-up period of 5 years (range, 2-9 years) were evaluated. Each child was assessed by a questionnaire regarding functional use of the upper extremity, physical examination of ROM and strength, and a videotaped activities of daily living evaluation. Tendon transfer results were classified and compared using 2 methods of evaluation: postoperative strength and ROM and effective functional use of the tendon transfer to perform activities of daily living. The 6 elbow capsulotomies improved from an average preoperative arc of 17 degrees of motion (average extension, -2 degrees; average flexion, 19 degrees) to an average final follow-up arc of 67 degrees (average extension, -25 degrees; average flexion, 92 degrees). The 18 tendon transfers evaluated by strength and ROM criteria showed 9 triceps to biceps transfers in 9 arms (7 good, 1 fair, and 1 poor), 5 pectoralis to biceps transfers in 4 arms (1 good, 3 fair, and 1 poor), and 4 latissimus dorsi to biceps transfers in 3 arms (2 good and 2 fair). Evaluation by functional use criteria gave the same result in 13 transfers and downgraded the result in 5; the downgraded results were due to resultant flexion contracture or limited functional use because the transfer was in the nondominant arm. Based on this review, optimal surgical candidates for tendon transfer are children older than 4 years, who have full passive ROM of the elbow in the dominant arm, and at least grade 4 strength of the muscle to be transferred.
本研究的目的是分析我们对肘关节挛缩症的手术治疗结果，并使用活动范围（ROM）标准与功能使用标准比较我们的肌腱转移结果。对14例患有关节挛缩症的儿童进行了18次肘关节屈曲肌腱转移，平均随访期为4年（范围1 - 14年），对6例患有关节挛缩症的儿童进行了6次肘关节囊切开术并延长三头肌，平均随访期为5年（范围2 - 9年）。通过一份关于上肢功能使用的问卷、ROM和力量的体格检查以及日常生活活动的录像评估对每个儿童进行评估。使用两种评估方法对肌腱转移结果进行分类和比较：术后力量和ROM以及肌腱转移在进行日常生活活动中的有效功能使用。6例肘关节囊切开术的平均术前活动弧从17度（平均伸展，-2度；平均屈曲，19度）改善到平均最终随访弧为67度（平均伸展，-25度；平均屈曲，92度）。根据力量和ROM标准评估的18次肌腱转移显示，9例手臂进行了9次三头肌至二头肌转移（7例良好，1例一般，1例差），4例手臂进行了5次胸大肌至二头肌转移（1例良好，3例一般，1例差），3例手臂进行了4次背阔肌至二头肌转移（2例良好，2例一般）。根据功能使用标准评估，13次转移结果相同，5次结果降级；结果降级是由于导致的屈曲挛缩或功能使用受限，因为转移是在非优势手臂上。基于本次综述，肌腱转移的最佳手术候选者是4岁以上的儿童，其优势手臂肘关节具有完全被动ROM，且待转移肌肉至少为4级力量。
