分娩性臂丛神经麻痹后遗肩关节内旋挛缩致盂肱关节畸形的Waters分型

The Waters classification of glenohumeral joint deformity secondary to shoulder internal rotational contracture of brachial plexux birth palsy

目的对分娩性臂丛神经麻痹(产瘫)后遗肩关节内旋挛缩导致的盂肱关节畸形进行CT或MR检查并按照Waters进行分型,探讨Waters分型与术前肩关节被动外旋角度的相关性。方法33例产瘫后遗肩关节内旋挛缩患儿,男12例,女21例;年龄10个月￣16岁,平均4.5岁。产瘫类型:TassinⅡ型19例,Ⅲ型13例,Ⅳ型1例。在肩关节横断面CT或MRI扫描图像上,按照Friedman的标准测量关节盂的后倾角及肱骨头向后脱位的比率。按照Waters分型标准对盂肱关节的畸形进行分型,同时测量患侧肩关节中立位被动外旋角度,对二者之间的相关性进行统计学分析。结果按照Waters分型标准,33例患儿中Ⅰ型4例,Ⅱ型4例,Ⅲ型7例,Ⅳ型6例,Ⅴ型5例,Ⅵ型7例。Ⅰ、Ⅱ型患儿肩关被动外旋多能超过中立位;Ⅲ、Ⅳ型患儿肩关节多不固定在内旋位,但被动外旋很难超过中立位;Ⅴ、Ⅵ型患儿肩关节多固定在内旋位,被动外旋角度平均>-30°。盂肱关节畸形的程度与肩关节被动外旋受限的角度呈直线正相关。结论Waters分型较准确地提示盂肱关节的畸形程度,盂肱关节畸形越严重其肩关节被动外旋受限越明显。

Objective To evaluate the correlation between the Waters classification based on shoulder CT or MRI scan and passive shoulder external rotational angle before operation in the glenohumeral joint deformity caused by shoulder internal rotational contracture secondary brachial plexus birth palsy.Methods 33 patients suffered the shoulder internal rotational contracture secondary brachial plexus birth palsy (Tassin classification Ⅱ 19, Ⅲ 13, Ⅳ 1) including 12 girls and 21 boys, ranging from 10 months to 16 years old with an average of 4.5 years old, underwent either CT or MR examination in shoulder joint. The retroversion of the glenoid (glenoscapular angle) and the ratio of humeral head posterior subluxation were measured on the CT or MRI images according to the method described by Friedman. The deformity of glenohumeral joint was classificated according to the Waters criteria, while the passive shoulder external rotational angle was measured at neutral position in involved shoulder joint. The correlation between the external rotation and the deformity was analysed. Results 33 cases with shoulder internal rotational contracture secondary brachial plexus birth palsy were evaluated according to the Waters criteria. 4 cases were classified as typeⅠdeformity, 4 cases as typeⅡ, 7 cases as type Ⅲ, 6 cases as type Ⅳ; 5 cases as typeⅤ; 7 case as type Ⅵ. The type of glenohumeral deformity was significantly associated with the limited range of passive external rotation of the shoulder joint. Conclusion The Waters classification of the glenohumeral deformity according to the Waters criteria can accurately demonstrated the deformity of the glenohumeral joint caused by shoulder internal rotational contracture secondary to brachial plexus birth palsy.