分娩麻ひにおける肩関節機能再建術

Abstract

Disturbance of the shoulder joint results from the uncoordinated movement of the shoulder girdle muscle and contracture of these shoulder muscles. The purpose of this study is to evaluate patients with birth palsy who were treated surgically to improve the shoulder function.9 shoulders of 9 patients with birth palsy were operated on. The average age at surgery was 12.8 years (range; 4 months to 12 years). The follow-up period was 4 months to 12 years with the average of 4 years 11 months. The reconstructions of shoulder functions were performed by muscle transfer in 7 patients and rotation osteotomy of the humerus in 2 patients. Muscle transfer operation was performed in patients who desired more elevation of the arm. Rotational osteotomy of the humerus was also performed on those who had reasonable elevation but with the arm in the internal rotation position due to muscle contracture. We transferred m. latissimus dorsi in 1 patient out of the 7 patients, m. pectoralis major and m. latissimus dorsi in 1 patient, m. trapezius and m. levator scapulae in 1 patient, and m. trapezius, m. levator scapulae and m. latissimus dorsi in 4 patients out of the 7. The range of motion of the shoulder joint was investigated pre and post operatively.The average preoperative flexion, abduction, and external rotation angles were 74.4°, 72.8° and 3.3°. At the final follow-up these improved to 106.7°, 95.6° and 16.1° respectively. In this series, most of the patients were satisfied with the results.