【摘要】 目的观察肩关节前路松解复位、后路关节囊紧缩及关节盂后路截骨治疗产瘫肩关节内旋挛缩畸形伴肩关节后脱位的临床效果。方法经CT或MRI检查确诊为盂肱关节脱位的7例产瘫并发肩关节内旋挛缩畸形患者,男2例,女5例,年龄1.4～4岁,平均2岁2个月。盂肱关节畸形按照Water的标准进行分型,Ⅳ型5例,Ⅴ型2例。2例行肩关节前路松解复位,肩关节最大外旋位固定6周;5例同时行后路关节囊松解、紧缩及关节盂截骨,将后倾的关节盂向前掀起,取三角形髂骨块植骨,术后行石膏固定4周。结果2例单纯行前路松解复位者术后分别随访48,60个月,Mallent评分分别由术前6分至术后10分;CT及X线平片复查示,肱骨头前脱位,关节盂后侧部分仍后倾。5例同时后路行关节盂截骨,术后随访36～49个月,平均3年4个月,Mallant评分由术前平均5.4分至术后8.6分;经CT及X线平片复查,盂肱关节复位良好,关节盂包容良好,关节盂后倾纠正。结论对于产瘫肩关节内旋挛缩导致的肩关节脱位,前路松解复位、后路关节囊松解、紧缩及关节盂后路截骨,可使脱位的盂肱关节复位并恢复关节盂的包容同时改善其肩关节功能。更多还原

【Abstract】 Objective To observe the outcome of glenoid osteotomy through the posterior approach and reduction the humeral head by soft tissue release through the anterior approach to treat the posterior dislocation of the shoulder secondary to internal rotation contracture deformity associated with brachial plexus birth palsy.Methods Seven children ranging in age from 1.4 to 4 years suffered posterior dislocation of the shoulder secondary to internal rotation contracture deformity associated with brachial plexus birth palsy were classified as tape Ⅳ deformity in 5 cases and tape Ⅴ deformity in 2 cases according to the water’s criteria.2 cases were treated simply by soft tissue releasing through the anterior approach and the humeral head was reduced by external rotation the arm, the arm was fixed 6 weeks at the most lateral rotation. The capsule separated with the pseudoglenoid was retighten and glenoid osteotomy was performed through the posterior approach simultaneously in another 5 cases, the retroverted glenoid was lifted forward,a piece of triangular iliac crest was grafted to the gap of the osteotomy. A plaster cast was used to fix the shoulder for 4 weeks. Results Through 36 to 49 months follow up after operation, the dislocated shoulder was reduced and the coverage of gleno-humeral joint was recover by CT examination in 5 patients treated by glenoid osteotomy through the posterior approach and soft tissue release through the anterior approach, the Mallent score of the shoulder was from 5.4 before operation to 8.6 after operation. The Mallent score of the shoulder in another 2 patients treated by soft tissue release through the anterior approach was from 6 before operation to 10 respectively after operation through 48 and 60 months follow up individually, but the humeral head was dislocated from posterior to anterior by CT and X-ray examination. Conclusions The capsule separated with the pseudoglenoid was retighten and glenoid osteotomy was performed through the posterior approach, and reduction of the humeral head by soft tissue release through the anterior approach can recover the concentric relationship of gleno-humeral joint and improve the function of shoulder with posterior dislocation secondary to internal rotated contracture deformity associated with brachial plexus birth palsy .更多还原