肱骨旋转截骨治疗大龄产瘫后肩关节内旋挛缩畸形

Rotation osteotomy of the humerus for treatment of medial rotation contracture of the shoulder in obstetric brachial plexus palsy(OBPP)

目的初步探讨肱骨旋转截骨治疗大龄产瘫后肩关节内旋挛缩畸形的疗效。方法2000年10月起,对17例肩胛下肌挛缩型大龄产瘫后肩关节内旋挛缩畸形的患者,采用肱骨旋转截骨术进行治疗。并用Mallet评分及Gilbert分级两项评价系统来评价术前、术后的功能。结果术后17例获得1年以上的随访。按改良Mallet评分法评分:7～8分3例,9～10分4例,11～14分10例;平均得分从术前的8.5分上升到11.0分。术后按Gilbert分级:1级1例,2级2例,3级4例,4级10例;平均级别由术前的2级上升到术后的4级。结论肱骨旋转截骨术是治疗大龄产瘫后肩关节内旋挛缩畸形的有效方法。

Objective To evaluate treatment outcomes of rotation osteotomy of the humerus for medial rotation contracture of the shoulder in obstetric brachial plexus palsy in elder children. Methods Seventeen cases of medial rotation contracture of the shoulder due to subscapular muscle contracture in OBPP were treated since October 2000. Rotation osteotomy of the humerus was done to correct the deformity. Shoulder function was evaluated pre- and post-operatively using Mallet and Gilbert score. Results All cases were followed-up for more than one year. Compared with preoperative evaluation, Mallet score improved from 8.5 to 11, while Gilbert score improved from grade 2 to grade 4. Mallet score at final follow-up was 7-8 in 3 cases, 9-10 in 4 cases, and 11-14 in 10 cases. Gilbert score at final follow-up was grade 1 in 1 case, grade 2 in 2 cases, grade 3 in 4 cases, and grade 4 in 10 cases. Conclusion Rotation osteotomy of the humerus is an effective treatment for medial rotation contracture of the shoulder in obstetric brachial plexus palsy.