三角肌挛缩症的手术治疗

Surgical treatment of deltoid contracture

目的探讨儿童三角肌挛缩症的病因及手术治疗效果。方法回顾性研究1999年9月至2010年3月手术治疗的23例三角肌挛缩患儿，23例患儿中双侧3例，发病年龄2个月至11岁，手术时平均年龄：9岁（5～14岁）。8例有反复三角肌肌肉注射史。手术行挛缩带松解，采用近端的横行或T形切口，或中远段的纵弧形切口，彻底松解粘连及挛缩组织，术后第二天开始主被动功能锻炼。结果术中发现挛缩条带多位于三角肌中后部，部分深达关节囊，术后全组病例肩关节活动度完全恢复，肩关节外展畸形消失，三角肌肌力正常，2例残留轻度翼状肩胛（8％），11例出现瘢痕肥大（42％）。结论三角肌挛缩症为多因素致病，手术松解效果良好，手术应考虑尽量减少瘢痕，增加患儿满意程度。

Objective To evaluate the causes and clinical results of surgical treatment for deltoid eontracture in children. Methods The results of surgical treatment for deltoid contracture in 23 chil- dren （26 shoulders） over 2. 2 years period were reviewed. The causes and clinical results were ana lyzed. Results The disease was first noticed between 2 months to 11 years old in the 23 patients. Mul- tiple intra-muscular injections were found in 8 patients. Surgical treatment was performed to complete- ly release the eontractures fibrous band. Either curved longitudinal incision or transverse incision or T shape incision was used. Passive and active exercise was done 2na day postoperatively. Fibrous band contractures were mostly found in mid-posterior part of deltoid. All shoulders achieved a full range of motion and power, and the abduction deformity disappeared postoperatively. Two patients had mild residual winged scapular （80//00）. Eleven patients had hypertrophy scar （42%）. Conclusions Contrac- ture of deltoid muscle may be caused by multiple factors. Surgical release of the contractures can a- chieve good results. The surgeon should take care to try reduce hypertrophy scar formation.