摘要
目的介绍一种治疗产瘫后肩外展、外旋受限的手术方法并总结其疗效。方法2005年2月-2008年8月,采用肩胛下肌起点剥离、背阔肌及大圆肌移位术治疗11例产瘫后肩外展、外旋受限患儿。男6例,女5例;年龄1～15岁,平均6岁。主要临床表现为肩关节呈内收、内旋挛缩畸形,主动、被动外旋受限,主动外展功能严重受限,被动外展均>90°。根据Gilbert肩关节功能分级:1级7例,2级4例。根据Mallet肩关节功能评分:5分3例,6分3例,7分5例。三角肌、冈上肌、冈下肌、大圆肌及背阔肌肌力均达3～4级。结果术后1例出现血肿,对症处理后切口愈合;余切口均Ⅰ期愈合。11例均获随访,随访时间12～37个月,平均17个月。肩关节主动外展及外旋功能恢复满意。根据Gilbert肩关节功能分级:2级1例,3级1例,4级9例;根据Mallet肩关节功能评分:10分1例,11分2例,12分4例,13分3例,14分1例;与术前比较差异均有统计学意义(P<0.01)。三角肌、冈上肌、冈下肌、大圆肌及背阔肌肌力较术前增加1级,达4～5级。结论采用肩胛下肌起点剥离、背阔肌及大圆肌移位术可在治疗肩关节内收、内旋挛缩的同时,增强外展、外旋肌力,是治疗产瘫后肩关节外展、外旋受限的有效方法之一。
Objective To study the treatment method and effect of abduction and lateral rotation limitation of the shoulder in obstetric brachial plexus palsy（OBPP）.Methods From February 2005 to August 2008,11 patients with abduction and lateral rotation limitation of the shoulder in OBPP were treated with dissection of the origin of subscapular muscle,transfer of the tendons of latissimus dorsi and teres major muscle to the tendons of supraspinous and infraspinous muscles.Among them,there were 6 males and 5 females with a mean age of 6 years（1-15 years）.The main clinical manifestations showed adduction,internal rotation contracture deformity of shoulder,limited active and passive external rotation and severely restricted active abduction of shoulder.The passive abduction was more than 90°.According to Gilbert grading,there were 7 cases of grade 1 and 4 cases of grade 2.Based on Mallet score systems,the scores were 5 points in 3 cases,6 points in 3 cases,and 7 points in 5 cases.The muscle strength of deltoid,supraspinatus,infraspinatus,teres major muscle and latissimus dorsi all reached 3-4 grades.Results One patient developed postoperative hematoma,wound healed after symptomatic management.Other patients achieved incision healing by first intention.All patients were followed up for 12 to 37 months（17 months on average）.The active abduction and external rotation of the shoulder joints recovered obviously.The Gilbert grading were grade 2 in 1 case,grade 3 in 1 case,and grade 4 in 9 cases;the Mallet scores were 10 points in 1 case,11 points in 2 cases,12 points in 4 cases,13 points in 3 cases,and 14 points in 1 case;showing significant differences when compared with those before operation （P0.01）.The muscle strength of deltoid,supraspinatus,infraspinatus,teres major muscle and latissimus dorsi increased to 4-5 grades.Conclusion The dissection of the origin of subscapular muscle,transfer of the tendons of latissimus dorsi and teres major muscle to the tendons of supraspinous and infraspinous muscles can resolve shoulder adduction,internal rotation contracture,and can enhance abduction,external rotation strength.It is an effective operation for abduction and lateral rotation limitation of the shoulder in OBPP.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2010年第4期443-445,共3页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
产瘫
肩关节
功能重建
Obstetric brachial plexus palsy Shoulder joint Function reconstruction
