Triangle tilt and humeral surgery:Meta-analysis of efficacy and functional outcome

AIM: To systematically review and analyze the overall impact and effectiveness of bony surgical procedures, the triangle tilt and humeral surgery in a comparative manner in permanent obstetric brachial plexus injury(OBPI) patients.METHODS: We conducted a literature search and identified original full research articles of OBPI patients treated with a secondary bony surgery, particularly addressing the limitation of shoulder abduction and functions. Further, we analyzed and compared the efficacy and the surgical outcomes of 9 humeral surgerypapers with 179 patients, and 4 of our secondary bony procedure, the triangle tilt surgical papers with 86 patients. RESULTS: Seven hundred and thirty-one articles were identified, using the search term "brachial plexus" and obstetric or pediatric(246 articles) or neonatal(219 articles) or congenital(188 articles) or "birth palsy"(121 articles). Further, only a few articles were identified using the bony surgery search, osteotomy "brachial plexus" obstetric(35), "humeral osteotomy" and "brachial plexus"(17), and triangle tilt "brachial plexus"(14). Of all, 12 studies reporting pre- and postoperative or improvement in total Mallet functional score were included in this study. Among these, 9 studies reported the humeral surgery and 4 were triangle tilt surgery. We used modified total Mallet functional score in this analysis. Various studies with humeral surgery showed improvement of 1.4, 2.3, 5.0 and 5.6 total Mallet score, whereas the triangle tilt surgery showed improvement of 5.0, 5.5, 6.0 and 6.2.CONCLUSION: The triangle tilt surgery improves on what was achieved by humeral osteotomy in the management of shoulder function in OBPI patients.

Comparing the Surgical Outcomes of Modified Quad and Triangle Tilt Surgeries to other Procedures Performed in Obstetric Brachial Plexus Injury

Purpose: To compare results from our surgical treatment experiences in children with obstetric brachial plexus injuries (OBPI), to those who have had other surgical treatments. Methods: We conducted a retrospective study in our medical records consisting of two groups of OBPI patients. Group 1: 26 OBPI children (16 girls and 10 boys), age range between 2.0 and 12.0 (mean age 6.9), who have undergone surgical treatments at other institutions between 2005 and 2010. Group 2: 45 OBPI children (20 boys and 25 girls), age between 0.7 and 12.9 (mean age 3.7), who have had modified Quad and triangle tilt surgical treatment between 2005 and 2010 at our institution. In both groups Mean modified Mallet scores and radiological scores were measured and compared. All measurements were made at least one year post surgery in both groups. Results: Post-operative mean modified Mallet score was 11.8 ± 2.4 in group 1 patients, whereas post-mean modified Mallet score was 20 ± 2.7 (P 0.0001) following modified Quad and triangle tilt surgeries in group 2 patients. Further, their radiological scores such as posterior subluxation, and glenoid version were 13.4 ± 21.3 and ﹣30.2 ± 19.1 in group 1, whereas 32.1 ±13.5 (P 0.0004), and ﹣16.3 ± 11.5 (P 0.008) in group 2 patients, when compared to normal values of 50, and 0 respectively. Conclusion: Patients who have had mod Quad and triangle tilt for OBPI obtained significantly better functional outcomes in modified total Mallet score as well as in radiological scores, when compared to those OBPI children, who underwent other procedures such as posterior glenohumeral capsulorrhaphy, biceps tendon lengthening, humeral osteotomy, anterior capsule release, nerve transfer/graft, botox and muscle/tendon transfer and release.

万通筋骨片联合曲安奈德治疗肩关节周围炎的疗效观察

目的探讨万通筋骨片联合曲安奈德注射液治疗肩关节周围炎的临床疗效。方法选取2015年9月—2016年9月在河南科技大学第一附属医院新区医院接受治疗的肩关节周围炎患者88例,按照治疗方法的差别分成对照组和治疗组,每组各44例。对照组于压痛点注射曲安奈德注射液,80 mg/次,1次/周。治疗组在对照组基础上口服万通筋骨片,2片/次,3次/d。两组患者均治疗8周。观察两组的临床疗效,比较两组的VAS评分、Mallet评分和肩关节活动度。结果治疗后,对照组和治疗组的总有效率分别为77.27%、95.45%,两组比较差异有统计学意义(P<0.05)。治疗后,两组VAS评分均显著降低,而Mallet评分均明显升高,同组治疗前后比较差异有统计学意义(P<0.05);且治疗组这些观察指标的改善程度明显优于对照组,两组比较差异具有统计学意义(P<0.05)。治疗后,治疗组患者上肢外展、前屈、后伸角度均好于对照组,两组比较差异具有统计学意义(P<0.05)。结论万通筋骨片联合曲安奈德注射液治疗肩关节周围炎具有较好的临床疗效,可明显缓解患者肩关节疼痛,改善肩关节功能,具有一定的临床推广应用价值。

人工全肩关节置换术患者术后生存质量和肩关节功能调查研究

目的：评估人工全肩关节置换术（TSA）术后疗效及患者的生存质量状况，为无锡市人民医院继续开展此手术治疗提供临床疗效依据。方法：采用回顾性调查的研究方法，应用生存质量MOSSF-36量表（对符合纳入标准的研究对象（手术纽20例、保守对照组20例）进行评价，同时应用Mallet评分对肩关节功能进行辅助评价。结果：TSA术后患者生存质量在MOSSF-36量表评分和Mallet评分上明显高于保守治疗组。结论：TSA术能为患者解除疼痛、恢复肩关节功能、提高生存质量。

平衡针配合体外冲击波治疗肩周炎疗效观察

目的:观察平衡针配合体外冲击波疗法对肩周炎的疗效。方法:该资料共收集本中心医务室和体育医院门诊2017年9月~2019年3月收治的肩周炎患者182例,按接诊顺序随机分成观察组和对照组各91例。观察组采用平衡针联合体外冲击波治疗,对照组采用局部痛点封闭治疗。观察两组患者治疗前后的视觉模拟评分(VAS)、Constant-Murley评分(C-M评分)和Mallet评分及临床疗效。结果:治疗后,两组患者的VAS、C-M、Mallet评分均较治疗前改善(P<0.01),且观察组治疗后的VAS、C-M、Mallet评分均优于对照组(P<0.01)。观察组总有效率高于对照组(P<0.05)。结论:平衡针联合体外冲击波治疗肩周炎能有效改善肩周炎患者的肩关节活动度和疼痛程度。