三角肌中部纤维束带致旋肩外展畸形

AbductionandRotationDeformityoftheShoulderJiontCausedbyFibrousBandintheMiddlePortionoftheDeltoidMuscle

作者在１９９０年７月～１９９４年５月共收治６例肩外展旋转畸形患者，４男２女．双侧３例，单侧３例。平均年龄１１岁。发病年龄１～２岁。主要病理特点是：患肩向前下低垂旋转；内收障碍；肩胛骨呈翼状。Ｘ线摄片显示：肩关节脱位，肩峰肥大，肩胛盂及肱骨头发育不良。５例年龄较小患者接受手术治疗。术中见患肩三角肌中部有一紧张、硬韧性纤维束带，起于肩峰，止于三角肌粗隆。切除束带关节松解后畸形矫正，患肩功能活动恢复正常。随访最长４年４个月，无１例复发。本组患者发病前无诱因，大多数患肩无肌肉注射史，无外伤及感染史，无产伤。作者认为，畸形的产生及骨关节病理改变的主要原因是纤维束带的牵拉限制了肩部骨骼肌肉的同步发育；是慢性进行性过程。发病时间愈长，病理改变愈严重。早期手术切除纤维束带，解除患肩骨骼肌肉发育的桎梏，是矫正畸形恢复关节功能最有效的治疗方法。

SixcasesofabductionandrotationdeformityoftheshoulderjointwereadmitedfromJuly1990toMay1994.Therewere4malesand2females.Threehadbilaterallesionsandthreeunilat-eral.Theirageinaveragewas11years.Theperiodofilnessvariedfrom1～2years.Theclinicalfea-turesweredroppingforwardwithrotationoftheshoulderjoint,hypertrophyoftheshoulderhumpanddysplasiaoftheglenoidcavityandthehumeralhead.Onecaseof27yearsofagerefusedsurgicaltreat-mentandtheother5caseswerealtreatedwithsurgery.Taut,rigid,tenaciousfibrousbandswerefoundinthemiddleportionofthedeltoidmuscles.Theybeganattheacromionprocessandendedatthedeltoidtuberosity.Folowingresectionofthefibrousband,theshoulderjointwasrelaxed.Thedefor-mitywasthencorectedandthefunctionoftheshoulderjointbecamenormal.Norecurrencewasseenduringthefolow-upperiodof4yearsand4months.Inthepatient'scasehistoriesnocausalfactorscouldbetraceddirectlytotheformationoftheseconditions.