Reconstruction of shoulder abduction and external rotation with latissimus dorsi and teres major transfer in obstetric brachial plexus palsy
| Autor: | Murat Bülbül, Semih Ayanoglu, Cem Dinçay Büyükkurt, Cem Zeki Esenyel, Kahraman Ozturk, Bilal Demir |
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| Rok vydání: | 2010 |
| Předmět: |
Male
medicine.medical_specialty Contracture Adolescent Tendon Transfer Rotator Cuff Health Care Sciences and Services Birth Injuries medicine Humans Orthopedics and Sports Medicine Rotator cuff Birth injuries brachial plexus neuropathies/surgery child contracture/surgery paralysis/etiology/surgery shoulder joint tendon transfer/methods Sağlık Bilimleri ve Hizmetleri Range of Motion Articular Brachial Plexus Neuropathies Child Plexus Palsy business.industry Shoulder Joint General Medicine medicine.disease Birth injury Surgery body regions medicine.anatomical_structure Child Preschool Shoulder joint Female medicine.symptom business Range of motion Brachial plexus |
| Zdroj: | Volume: 44, Issue: 3 186-193 Acta Orthopaedica et Traumatologica Turcica |
| ISSN: | 2589-1294 1017-995X |
| Popis: | Objectives: We evaluated the results of latissimus dorsi and teres major tendon transfer to the rotator cuff together with musculotendinous lengthening of the subscapularis and/or pectoralismajor muscles in patients with internal rotation contracture and decreased external rotation and abduction secondary to obstetrical brachial plexus palsy.Methods: Thirty patients (18 boys, 12 girls; mean age 9 years; range 4 to 15 years) with internal rotation contracture and loss of external rotation and abduction of the shoulder secondary to obstetrical brachial plexus palsy underwent transfer of the latissimus dorsi/teres major tendons to the rotator cuff. In addition, musculotendinous lengthening of the subscapularis and pectoralis major (n=15), pectoralis major (n=9), and subscapularis (n=6) were performed. Nine patients had upper plexus involvement (C5-6), 14 had C5-7 involvement, and seven had complete plexus involvement (C5-T1). According to the Waters and Peljovich classification, all the patients had a congruent glenohumeral joint, which was classified as type 1 in one patient, type 2 in 15 patients, and type 3 in 14 patients. Pre- and postoperative range of motion values of the patients were measured and their motor functions were evaluated with the Mallet scoring system. The mean follow-up period was 47.8 months (range 9 to 84 months).Results: Preoperatively, the mean active abduction was 75.8°, and the mean active external rotation was 25.2°. Postoperatively, the mean abduction and external rotation increased to 138.3° (by 62.5°, 82.5%) and 76.4 degrees (by 51.2°, 203.2%), respectively. Improvements in the degrees of abduction and external rotation were significant (p=0.000). According to the Mallet scoring system, the mean preoperative global abduction and global external rotation scores were 2.97 and 2.43, respectively; the mean Mallet scores for the ability to move the hand to the mouth, neck, and back were 2.50, 2.17, and 2.67, respectively. Postoperatively, the mean global abduction score increased to 3.97 (by 33.7%, p=0.000), and the mean global external rotation score increased to 3.77 (by 55.1%, p=0.000). The mean scores for the ability to move the hand to the mouth, neck, and back were 3.30 (increased by 32%, p=0.000), 3.73 (increased by 71.9%, p=0.000), and 2.30 (decreased by 13.9%, p=0.003), respectively. Postoperative changes in the Mallet scores were all significant. Improvements in abduction and external rotation were not significant between patients ≤9 years and >9 years of age (p>0.05).Conclusion: Transfer of the latissimus dorsi and teres major tendons to the rotator cuff combined with musculotendinous lengthening of the subscapularis and/or pectoralis major provides satisfactory increases in shoulder abduction and external rotation, regardless of the age, in patients with no or minimal glenohumeral joint incongruency. |
| Databáze: | OpenAIRE |
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