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1.
To evaluate the effects of transfer of the trapezius and/or latissimus dorsi with the teres major for treatment of dysfunction of the shoulder in obstetrical brachial plexus palsy (OBPP), 34 patients with paresis of the abductors and external rotators, as well as co-contraction of the adductors in abduction, who had undergone reconstructive operations, were followed-up for at least 1 year. Of these, transfer of the latissimus dorsi with attached teres major to the insertion of the infraspinatus (single procedure), was performed in 25 cases, and transfer of both latissimus dorsi with teres major and trapezius (to the humerus) in nine (combined procedure). Gilbert's grading system was used for evaluation. The results showed that in spite of improvement of external rotation in most of the cases, abduction was improved in only 13 of the 25 cases with a single procedure, and that eight of nine cases with a combined procedure gained improvement of both external rotation and abduction. These results indicated that, for improvement of both abduction and external rotation of the shoulder in OBPP, transfer of the latissimus dorsi with the teres major can be performed only when abduction is > or =90 degrees; otherwise, transfer of the trapezius should be added.  相似文献   

2.
旋转截骨矫形手术在分娩性臂丛损伤治疗中的应用   总被引:3,自引:1,他引:2  
目的 评价肱骨及桡骨旋转截骨术治疗分娩性臂丛损伤(产瘫)肩肘后遗症的价值。方法 1999年8月至2000年12月,对8例产瘫肩肘后遗症患儿(肩关节外旋挛缩2例,内旋挛缩1例,前臂旋后挛缩并发桡骨小头脱位5例)施行肱骨内旋截骨、外旋截骨、及前臂旋前截骨等手术,并经术后3~16个月(平均8个月)的随访。术后肩关节功能采用Mallet评分、前臂功能采用旋前位置角度的改善作为评价标准。结果 2例行肱骨内旋截骨者,1例按Mallet评分,术前术后的改变为肩外展3→3,外旋4→4,手到颈后4→3,手到背2→4,手到嘴2→4;另1例因感染及螺钉断裂致骨不连行内固定手术后尚在康复中。1例行肱骨外旋截骨者,按Mallet评分,术前术后改变为肩外展2→3,外旋2→4,手到颈后2→3,手到背4→3,手到嘴2→3。5例行桡骨旋前截骨者,术后前臂均处于旋前30°位置,功能及外观均获得改善。结论 肱骨及桡骨旋转截骨矫形手术在产瘫肩肘挛缩后遗症的治疗中具有一定的应用价值。  相似文献   

3.
 目的 探讨手术治疗肩部创伤致肩胛上神经与腋神经同时损伤的疗效。方法 回顾性分析2003年7月至2011年9月,手术治疗13例男性肩部创伤后诊断为肩胛上神经与腋神经同时损伤的患者资料,年龄8~59岁,平均28 岁;受伤至手术时间为2~7个月,平均3.7个月。其中肩胛颈和锁骨同时骨折2例,浮肩损伤3例,肱骨颈及关节盂骨折1例,锁骨骨折3例,肩峰骨折1例,肩胛骨骨折2例,寰枢椎骨折1例。13例临床检查均示单纯肩外展、外旋功能完全丧失,三角肌及冈上、下肌肌力均为0级。电生理检查示腋神经、肩胛上神经完全失神经支配。肩胛上神经断裂10例,其中6例通过1股腓肠神经移植修复,1例通过1股颈丛浅支移植修复,3例因远端撕脱而放弃神经修复;另3例肩胛上神经仅进行松解。腋神经断裂12例,其中10例采用2~3股腓肠神经移植修复,2例采用正中神经束支移位修复;另1例腋神经于四边孔处进行松解。13例患者中,10例患者的肩胛上神经及腋神经同时断裂。结果 13例患者随访时间36~134个月,平均85个月;7例肩关节上举恢复正常达180°,该7例的三角肌力均为4级,肩外旋40°~70°,平均56°;5例肩外展达30°~50°,平均38°;该5例肩外旋为-40°~30°,平均10°,三角肌肌力4级1例,3级2例,2级2例;另1例无恢复。结论 对于肩部创伤后出现的单纯肩关节外展、外旋功能完全丧失,应考虑肩胛上神经与腋神经同时损伤的可能。此种类型的神经损伤修复后的效果满意,应尽早进行神经移植修复。  相似文献   

4.
目的评价带蒂大圆肌双板移位重建分娩性臂丛神经损伤(产瘫)后肩外展功能的疗效及临床应用前景。方法对9例产瘫后肩外展功能障碍的患儿行带血管神经蒂大圆肌双极移位术重建肩外展功能,并经术后1年以上的随访,观察其临床应用效果。结果9例患儿术前肩外展平均11.2°(0°-30°),术后肩外展平均75.4°(45°~95°)。按照顾玉东的评定标准评价:优3例,良4例,可2例,优良率为77.8%。结论对于产瘫后肩外展功能障碍者,用带血管神经蒂大圆肌双极移位术重建其肩外展功能是有效而值得临床推广的治疗方法。  相似文献   

5.
产瘫的分型分度   总被引:6,自引:4,他引:2  
目的 提出新的产瘫分类方法。方法 通过对358例产瘫的诊治,研究,按照损伤的解剖部位进行分型;按照损伤的程度进行分度。结果 本组358例产瘫均可用新的分型分度法进行,共分5型4度。结论 分型分度法是一种切实可行的新的产瘫分类方法,可以更好地指导产瘫的医,教,研工作。  相似文献   

6.
产瘫后肩关节内旋挛缩畸形的手术治疗   总被引:6,自引:1,他引:5  
目的:介绍用肩胛下肌起点剥离术及前路松解术,治疗产瘫后肩关节内旋挛缩后遗症的方法及疗效。方法:对36例经盂肱角测定、肩关节中立位被动外旋及X线诊断为肩关节内旋挛缩的患儿,采用肩胛下肌起点剥离或止点延长、关节复位及继发性畸形纠正等手术进行治疗。用Malet评分及Gilbert分级两项定量评价系统来评价术前、术后功能。结果:术后随访半年,32例有效,有效率为88.8%。年龄愈小疗效愈佳。4例无效者,3例术前无屈肘功能,提示臂丛上干恢复差;1例肩胛下肌止点切断后未作重建。结论:肩胛下肌起点剥离术或前路松解术,是治疗产瘫后肩内旋挛缩的有效方法,疗效与患儿年龄及臂丛上干的恢复程度密切相关  相似文献   

7.
Objective:to introduce an operation of subscapularis slide from its origin and anterior release from its insertion for treatment of medial rkotation contracture,subluxation and dislocation of the shoulder caused by obstetric brachial plexus palsy(OBPP).Methods:Thirty-six cases with medial rotation contracture of the shoulder were diagnosed by measurement of the inferior glenohumeral angle,passive lateral rotation of the shoulder and plain radiographs.Subscakpularis slide was performed in 24 cases with simple medial rotation contracture,and anterior release in 12 cases with complex contracture-medial rotation contracture combined with subluxation,dislocationm,or other deformities of the shoulder joint.systems of Mallet scoring and Gilbert grading for the shoulder were used to evaluate the postoperative shoulder function.Results:with follow up for a minimum of six months,32 cases got apparent gains from operations,accounting for 88.8% of the total orerated on.The younger the child was,the better the result.Of 4 cases with no operative effects,3 has no flexion of the elbow preoperatively,suggesting a poor recovery of the upper trunk of the brachial plexus;the rest one had no repair of the severed subscapularis tendon.conclusions:subscapularis slide and anterior release of the shoulder are effective for treatment of medial rotation contracture as well as its consequence of subluxation and dislocation of the shoulder in OBPP.The operative effect is related to children‘s age and the recovery extent of the upper trunk of the brachial plexus.  相似文献   

8.
产瘫肩关节挛缩后遗症的诊断   总被引:5,自引:3,他引:2  
目的:对产瘫患儿肩关节功能作定量和定性检查,以明确肩关节功能障碍是因主动肌的无力抑或是拮抗肌和关节囊的挛缩所致。方法:对40例肩关节功能障碍而肱二头肌肌力达M3以上的产瘫患儿,采用Malet评分,Gilbert分级,盂肱角测量,肩关节中立位被动外旋,翼状肩胛检查,肌电图及X线诊断等检查手段,综合评价其肩关节功能。结果:38例肩关节功能障碍是由于拮抗肌或关节囊挛缩引起,其中内旋挛缩35例(合并肩关节后关节囊挛缩14例),肩关节下部挛缩3例。另2例肩外展不能是因主动肌无力所致。结论:产瘫患儿有较好的但不同步的神经恢复是产生各种肩关节挛缩后遗症的主要原因。早期诊断有助于及时治疗和预防肩关节继发性病变的发生  相似文献   

9.
In the management of upper type of brachial plexus injury, reconstruction to restore shoulder function is accomplished by multiple nerve transfers. We used the accessory nerve to neurotize the suprascapular nerve in 12 patients (11 men, 1 woman) from 1989 to 2003. The average age at the time of operation was 28.1 years (range 16 to 53). The mean preoperative time was 3.6 months. The type of paralysis was C5-C6 type in four cases, C5-C7 type in five cases, and C5-C8 type in three cases. The average time of follow-up was 28.5 months. All the patients showed reinnervation of the supraspinatus and infraspinatus muscles that was confirmed by electromyogram. At the time of final followup, the average shoulder flexion was 70.4 degrees and abduction was 77.1 degrees. However, average shoulder external rotation was only 16.7 degrees. We compared the shoulder flexion and abduction in patients with or without paralysis of the serratus anterior muscle and found significantly better functional outcome in the latter group of patients. We, therefore, conclude that repair of long thoracic nerve is mandatory for achieving optimum shoulder function.  相似文献   

10.
Altmann S  Fansa H  Schneider W 《Der Orthop?de》2006,35(4):450-1, 453-5
INTRODUCTION: After brachial plexus injuries, shoulder function is frequently impaired or lost. For reconstruction of the most important functions muscle transfers are indicated. To restore abduction and external rotation of the shoulder the trapezius muscle transfer is mainly used. PATIENTS AND METHODS: We demonstrate 16 patients with insufficient abduction of the shoulder joint. All patients were treated with the transfer of trapezius muscle (pars horizontalis). We used a modification of the technique of Saha. After the operation, the arm was immobilized in 80 degrees abduction for 6 weeks followed by 10 degrees adduction of the shoulder per week. Afterwards physiotherapy was started. Evaluation was done by the DASH score and Gilbert score. RESULTS: In all cases, an improvement of shoulder mobility was seen, assessed clinically and individually by the patient. The average DASH score was 37.4. For ten patients the results of the operation were very good, good, or satisfactory. Active abduction increased from 15 degrees (0-30 degrees) to 54 degrees (35-80 degrees) postoperatively. The external rotation was 9 degrees (-20-40 degrees) preoperatively and 19 degrees (0-70 degrees ) postoperatively. DISCUSSION: Trapezius muscle transfer for reconstruction of abduction is an easy and practicable method without serious complications. We achieved good stability and functionality of the shoulder. Intensive pre- and postoperative physiotherapy may provide greater improvement of mobility.  相似文献   

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