分娩性臂丛神经损伤后肩关节外展外旋功能重建的疗效分析课件

Outcomeanalysisofmodifiedteresmajorandlatissimusdorsitransferinthetreatmentofobstetricbrachialplexuspalsyshouldersequelae GongXu LuLaiJin CuiJianLi SunRuTaoDepartmentofHandSurgeryTheFirstHospitalofJiLinUniversityChangChun JiLinProvince130021 obstetricbrachialplexuspalsy Incidence 0 1 0 4 IncompleteRecovery 49 66 IndicationofMicrosurgicalNeuralReconstruction dysfunctionofelbowflexionattheageof3month Sequelaeofshoulder C5 C6injuries Erb spalsy C5 C6 C7injuries Erb spalsy C7 lossofactiveERlossofshoulderelevation LossofactiveshoulderelevationandERcanleadtosimpletasks suchasshakinghand combing brushingteeth becomingimpossibleduetotheinabilityofcontrollingthespatialpositioningofthearm Sequelaeofshoulder Pathomechanics InternalRotator4PectoralisMajorSubscapularisTeresMajorLatissimusDorsi ExternalRotator2InfraspinatusTeresMinor Fibrosis Contracture LossofPassiveER Palsy InabilityofactiveER 40 WalchG etal The dropping and hornblower s signsinevaluationofrotator cufftears JBJS Br 1998 ShoulderReconstruction L EpiscopoTransfer 1934 AnteriorApproach ReleasingPectoralisMajorandSubscapularisMusclesPosteriorApproach TransferTeresMajor LatissimusDorsimusclesReinsertingconjointtendononhumeralshaft Nath 2007 AxillaryApproachReleasingPectoralisMajorandSubscapularisMusclesConjointtendonsuturingtoTeresMinor ShoulderReconstruction Background WemodifiedTeresMajor LatissimusDorsitransfer fromoriginalL Episcopo sandNath sprocedures toreconstructshoulderfunction Thedeltopectoralapproachtoreleasecontractedsubscapularis pectoralismajorandconjointtendonoftheteresmajorandlatissimusdorsiTheposteriorapproachtoreinserttheconjointtendontothebellyoftheteresminor Background Toretrospectivelyanalyzetheoutcomesandrelatedfactorsofmodifiedteresmajorandlatissimusdorsitransferinthetreatmentofobstetricbrachialplexuspalsy OBPP shouldersequelae MaterialsandMethods GeneralConditionsFrom2008to2011sixpatientswithOBPPs agedfrom16monthsofageto16yearsofage 2malesand4femalesLeft 3 Right 3NoprimarymicrosurgicalreconstructionDiagnosis C5 C6 n 5 C5 C6 C7 n 1 MaterialsandMethods Thepre andpostoperativeactiveshoulderabductionandERwererecordedandevaluatedaccordingtoMallet sclassification Comparisonbetweenthepre andpostoperativewasperformedbyt test Operativemethods Operativemethods Operativemethods Operativemethods Theupperextremitieswereimmobilizedfor6 8weeksinthepositionofabduction90degreesandER45degreesexceptfortwopatientsinthepositionofadductionandinternalrotation Allpatientswerefollowedfor3to22months PostoperativeManagement Results 55 35 6 130 24 5 75 48 3 22 73 48 Results 2 5 4 3 Results Preoperative Abduction70 ER0 MalletScore3 Postoperative Abduction130 ER45 MalletScore4 TypicalCases TypicalCases Preoperative Abduction90 ER0 MalletScore3 Postoperative Abduction160 ER90 MalletScore5 TypicalCases Preoperative Abduction50 ER0 MalletScore3 Postoperative Abduction130 ER45 MalletScore5 ThepositionofpostoperativeImmobilizationcaninfluenceoutcomesofER 2patientswereimmobilizedinshoulderadductionandinternalrotation Conclusion Modifiedteresmajor latissimusdorsitran