产瘫后肩关节内旋挛缩畸形的手术治疗

Operative treatment for the medial rotation contracture of the shoulder in obstetric brachial plexus palsy

目的：介绍用肩胛下肌起点剥离术及前路松解术，治疗产瘫后肩关节内旋挛缩后遗症的方法及疗效。方法：对３６例经盂肱角测定、肩关节中立位被动外旋及Ｘ线诊断为肩关节内旋挛缩的患儿，采用肩胛下肌起点剥离或止点延长、关节复位及继发性畸形纠正等手术进行治疗。用Ｍａｌｅｔ评分及Ｇｉｌｂｅｒｔ分级两项定量评价系统来评价术前、术后功能。结果：术后随访半年，３２例有效，有效率为８８．８％。年龄愈小疗效愈佳。４例无效者，３例术前无屈肘功能，提示臂丛上干恢复差；１例肩胛下肌止点切断后未作重建。结论：肩胛下肌起点剥离术或前路松解术，是治疗产瘫后肩内旋挛缩的有效方法。

Objective:We introduce subscapularis recession and anterior release for release of the medial rotation contracture of the shoulder in obstetric brachial plexus palsy(OBPP).Methods:36 cases of medial rotation contracture of the shoulder were diagnosed by measurement of the glenohumeral angle,passive external rotation of the shoulder joint and X ray.Subscapularis recession was performed in 24 cases of single contracture and anterior release was carried out in 12 cases of complex contracture(medial rotation contracture combined with subluxation, dislocation etc).The Mallet score and Gilbert grading systems were used to assess the postoperative shoulder function.Results:After half a year follow up,32 cases appeared to have an effective result. The effective rate was 88.8%.The younger the child,the better the result.4 cases had no operative effects.3 of them had no elbow flexion preoperatively,suggesting a poor recovery of the upper trunk of the brachial plexus. In the other one,the divided subscapularis was not reconstructed. Conclusions:Subscapularis recession and anterior release of the shoulder are effective operations for medial rotation contracture of the shoulder in OBPP.The operative effect is related to the child's age and the recovery of the upper trunk of the brachial plexus.