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目的介绍一种治疗产瘫后肩外展、外旋受限的手术方法并总结其疗效。方法2005年2月-2008年8月,采用肩胛下肌起点剥离、背阔肌及大圆肌移位术治疗11例产瘫后肩外展、外旋受限患儿。男6例,女5例;年龄1～15岁,平均6岁。主要临床表现为肩关节呈内收、内旋挛缩畸形,主动、被动外旋受限,主动外展功能严重受限,被动外展均>90°。根据Gilbert肩关节功能分级:1级7例,2级4例。根据Mallet肩关节功能评分:5分3例,6分3例,7分5例。三角肌、冈上肌、冈下肌、大圆肌及背阔肌肌力均达3～4级。结果术后1例出现血肿,对症处理后切口愈合;余切口均Ⅰ期愈合。11例均获随访,随访时间12～37个月,平均17个月。肩关节主动外展及外旋功能恢复满意。根据Gilbert肩关节功能分级:2级1例,3级1例,4级9例;根据Mallet肩关节功能评分:10分1例,11分2例,12分4例,13分3例,14分1例;与术前比较差异均有统计学意义(P<0.01)。三角肌、冈上肌、冈下肌、大圆肌及背阔肌肌力较术前增加1级,达4～5级。结论采用肩胛下肌起点剥离、背阔肌及大圆肌移位术可在治疗肩关节内收、内旋挛缩的同时,增强外展、外旋肌力,是治疗产瘫后肩关节外展、外旋受限的有效方法之一。
Objective To introduce a surgical method for the treatment of postoperative paraplegia with shoulder abduction and external rotation limitation and to summarize its curative effect. Methods From February 2005 to August 2008, 11 cases of postoperative shoulder abduction and external rotation restricted children were treated with stripping of the subscapularis muscle, latissimus dorsi and the great circular muscle. 6 males and 5 females; aged 1 to 15 years old, average 6 years old. The main clinical manifestations of the adduction of the shoulder joint, internal rotation contracture deformity, active and passive external rotation limited, serious limitations of active abduction, passive abduction were> 90 °. According to Gilbert shoulder function grading: level 1 in 7 cases, level 2 in 4 cases. According to Mallet shoulder function score: 5 points in 3 cases, 6 points in 3 cases, 7 points in 5 cases. Deltoid, supraspinatus, suboccipital muscle, big round muscle and latissimus muscle strength up to 3 to 4. Results One patient had hematoma after operation, and healed after symptomatic treatment. All the incisions healed by first intention. Eleven patients were followed up for 12 to 37 months with an average of 17 months. Active shoulder outreach and external rotation function recovery satisfaction. According to Gilbert shoulder joint function classification: 1 in 2 cases, 1 in 3 cases and 9 in 4 cases. According to Mallet shoulder function score: 10 cases in 1 case, 11 cases in 2 cases, 12 cases in 4 cases, 13 cases in 3 cases, 14 cases Divided into 1 case; compared with the preoperative difference was statistically significant (P <0.01). The deltoid, supraspinatus, suboccipitus, big round muscle and latissimus dorsi muscle strength increased by 1 level compared with preoperative, reaching 4 to 5 levels. Conclusions It is an effective method to treat the shoulder joint abduction, lateral latissimus dorsi and the great circular muscle displacement in the treatment of shoulder adduction and internal rotation contracture, while enhancing the abduction and external rotation muscle strength. One of the effective ways to limit external rotation.