喙肱韧带紧缩联合斜方肌移位重建肩外展功能的疗效评价

Clinical effects evaluation on shoulder abduction reconstruction after coracohumeral ligament tightening combined with trapezius transfer

目的评价喙肱韧带紧缩联合斜方肌移位与异体肌腱移植重建肩外展功能的临床疗效。方法回顾分析2010年6月至2014年5月北京积水潭医院手外科采用复位半脱位肩关节并紧缩喙肱韧带,同时联合斜方肌移位与异体肌腱移植止点下移的方法重建肩外展功能32例。术后采用顾玉东关于臂丛神经损伤术后各关节功能评定标准、快速DASH评分(q DASH)和疼痛视觉模拟评分(VAS)来评价肩外展功能,同时进行患者满意度调查。结果其中男28例,女4例,平均年龄25.0(11~47)岁。左侧17例,右侧15例。臂丛神经上中干根性撕脱伤30例,颈椎骨折合并神经损伤2例。32例患者均得到了随访,平均随访2.2(1.6~3.5)年。依据顾玉东标准,术后肩外展功能5例(15.6%)优(外展≥90°);25例(78.1%)良(90°>外展≥60°);2例(6.3%)患者手术后提前自行去除外固定架,导致缝合肌腱断裂,施行了二次手术,最终外展功能达到中(60°>外展≥30°)。VAS评分术前为7.2±0.9,术后为2.5±0.6(P<0.01);q DASH评分术前为68.9±10.7,术后为34.2±8.2(P<0.01);患者主观评价满意28例(87.5%);不满意4例(12.5%);32例患者术后获得了平均35°(30°~40°)的肩关节旋前功能。结论喙肱韧带紧缩联合斜方肌移位与异体肌腱移植止点下移重建肩外展功能,方法简单实用且有效,具有一定的临床推广价值。

Objective To analyse the clinical effects of coracohumeral ligament tightening combined with trapezius transfer and tendon allografting for shoulder abduction function reconstruction. Methods From June 2010 to May 2014, 32 patients in Department of Hand Surgery in Beijing Jishuitan Hospital with different causes of shoulder abduction functional paralysis were included in the study. The shoulder joint abduction func-tion were reconstructed with the shoulder joint subluxation reduction and coracohumeral ligament tightening combined with trapezius muscle transfer and tendon allografting. Gu Yudong5s norm for the joint function evalu-ation for brachial plexus injury, quick DASH scores and VAS scores were applied for shoulder abduction evalu-ation and the patient satisfaction survey was also carried out. Results There were 28 males and 4 females. The mean age of patients was 25 years （range 11 to 47 years） old. Seventeen cases were left sides and 15 were right sides. There were 30 cases of brachial plexus root avulsion and 2 cases of cervical spine fracture combined with nerve injury. All 32 patients were with an average follow-up of 2. 2 years （ range, 1. 6 to 3. 5 years）. Ac-cording to Gu Yudong5s norm, 5 cases were excellent with shoulder abduction ≥90°,accounting for 15. 6% ;and good in 25 cases for ≥60°, accounting for 78. 1% and other 2 cases were fair for shoulder abduction ≥30°, accounting for 6. 3% . The VAS score improved from （7. 2 ±0. 9） points preoperatively to （2. 5 ±0. 6） points postoperatively （P 〈 0. 01）. The qDASH score improved from （68. 9 ± 10. 7 ） to （34. 2 ± 8. 2） points （P 〈0. 01） . Subjective satisfactions were 28 cases, accounting for 87. 5%,and dissatisfactions 4 cases, ac- counting for 12.5%. 32 cases obtained average 35°（range from 30° to 40°）of shoulder joint pronation func-tion. Conclusion The method for shoulder joint abduction function reconstruction with the shoulder joint sub-luxation reduction and coracohumeral ligament tightening combined with trapezius muscle transfer and tendon al-lografting is practical and effective. It is worthwhile for using widely in clinic.