分娩性臂丛损伤后的肩外展及外旋功能重建

Analysis of effects of reconstruction of abduction and lateral rotation of the shoulder for obstetric brachial plexus palsy (OBPP)

目的 评价斜方肌和 (或 )背阔肌移位术重建分娩性臂丛神经损伤 (产瘫 )后肩外展及外旋功能的疗效及临床应用前景。方法 对 34例产瘫后肩外展及外旋功能障碍的患儿行斜方肌和(或 )背阔肌移位术并经术后 1年以上的随访。 34例中 2 5例行单纯背阔肌移位术以重建肩袖功能 ,另 9例行背阔肌及斜方肌的组合式移位以同时重建三角肌功能。采用Gilbert肩关节功能 5级评定法作术后评价。结果 2 5例行单纯背阔肌移位者 ,肩外旋功能均有较明显的改善 ,但外展功能仅13例有明显改善 ,另 12例改善不显著 (Gilbert分级无进步 ) ;9例行斜方肌背阔肌组合式移位者 ,8例肩外展及外旋功能均有明显的改善 ,仅 1例无效。结论 对于产瘫的肩外展及外旋功能障碍者 ,若术前外展达到 90°以上 ,则可仅行背阔肌移位术 。

Objective To evaluate the effect of transposition of trapezius and/or latissimus dorsi muscles for the reconstruction of abduction and lateral rotation of the shoulder for obstetric brachial plexus palsy.Methods 34 cases who had the paresis of abductors and lateral rotators of the shoulder, underwent operations of transposition of trapezius and/or latissimus dorsi muscles for reconstruction of abduction and lateral rotation of the shoulder. Of these 34 patients, transposition of latissimus dorsi muscle to the rotator cuff to reconstruct the function of abduction and lateral rotation was performed in 25 cases, and transposition of latissimus dorsi (to rotator cuff) and trapezius (to the humerus) was done in the other 9 cases. Postoperative evaluation was performed by using Gilbert's Shoulder Grading system, and all of them were followed up for at least one year.Results In cases of single latissimus dorsi transfer, the lateral rotation function was significantly improved, but abduction of the shoulder was only improved in 13 cases; in the other 9 cases with transposition of both latissimus dorsi and trapezius, the lateral rotation and abduction of the shoulder was significantly improved in 8 patients.Conclusions For reconstructive operation for the abduction and external rotation of the shoulder in patients with OBPP, latissimus dorsi transfer alone can be performed when the abduction of the shoulder is 90 degrees or greater. Otherwise, transfer of both latissimus dorsi and trapezius should be carried out.