胸大肌延长术治疗重度肩关节僵直

Releas and lengthening of pectoralis major for treatment of severe stiffness of the shoulder

目的探讨胸大肌延长解除挛缩胸大肌对肱骨上端的内收牵拉,恢复肩外展功能的手术方法.方法对16例因外伤后引起重度肩关节僵直的患者,应用胸大肌肌腱自身延长或加肩关节囊松解和肩胛下肌延长修复肩外展、上举功能.术后用外固定支架将肩关节固定于外展60°位,3～4周后拆除支架开始功能锻炼.结果术后随访6个月～6年,平均2.5年.肩外展功能恢复:180° 9例,≥150° 3例,≥90° 3例,≥60° 1例.术后肩关节内收功能无影响.结论胸大肌延长术对治疗肩周创伤后所致的重度肩关节挛缩,方法简单、有效.

Objective To introduce the surgical procedure of releasing the adduction tension of proximal humerus due to pectoralis major contracture and restoring abduction of the shoulder. Methods 16 cases of severe shoulder stiffness due to trauma to the shoulder region were treated with this procedure. Z plasty lengthening of the pactoralis major tendon insertion on the proximal humerus, capsulectomy, and infraspinatus release were carried out depending on severity of the contracture. A spica was applied post-operatively for 3 to 4 weeks to immobilize the shoulder to 60° of abduction. Exercise then began. Results All 16 cases were followed-up for 6 months to 6 years, the average follow up period being 2.5 years. Abduction of the shoulder returned to normal in 9 cases, 150° larger than normal in 3 cases, 90° in 3 cases, and 60° in 1 case. Conclusion Release and lengthening of pectoralis major is a satisfactory and simple procedure to treat severe post-traumatic shoulder contracture.