THE RESULTS OF SURGICAL TREATMENT OF SPRENGEL'S DEFORMITY DEPENDING ON THE PATIENTS’ AGE

Abstract

Introduction. Despite the developments, up to now, such questions as the effectiveness of surgical treatment of Sprengel's deformity in children older than 7 years; elimination of the cosmetic defect caused by scapular hypoplasia and shoulder girdle shortening; and prevention of neurological disorders caused by the brachial plexus compression remain debatable.Objective. Effectiveness evaluation of surgical treatment of Sprengel's deformity in patients of various age groups, and the improvement of the results of surgical correction of high scapula.Materials and methods. Treatment data of 14 patients with high scapula were analyzed. To compare the effectiveness evaluation of surgical treatment, patients were divided into 2 groups: I group - 6 children (42.8 %) aged 4 to 8 years; II group - 8 children (57.2 %) aged 9 to 16 years. During examination, the active and passive shoulder abduction alongside with its rotation was measured in degrees. Shoulder girdles length and the size of transverse and longitudinal scapula bodies were measured in the radiographs of both shoulders. Diameters of the articular surface and the head of the shoulder were determined.Results. Analysis of the clinical manifestations of the disease showed that diagnosis in children under 2 years of age was noted only in 2 (14.3 %) cases with a bone form of the disease. Deformity in other patients was regarded as a manifestation of scoliosis, an anomaly in the development of the cervical spine according to the Clinnel-Feil type, the presence of cervical ribs, and a benign bone tumor. Restriction of shoulder abduction was a symptom that drew parents’ attention. All patients underwent surgery. Analysis of the results of surgical treatment of two groups of patients showed that the scapula position along its lower corner corresponded to the opposite side in the first group of patients. There was symmetry in the position of the spine of the scapula. All patients of the first group had shortening of the shoulder girdle due to the decrease of scapula lateral size, which ranged from 2.5 to 3 cm, depending on the age of the patient. Further observation over the next 2 years showed that the difference in the scapula transverse size decreased to 1.2-1.5 cm in 5 (35.7 %) cases. Scapula transverse size before surgery was reduced from 3.1 up to 4.5 cm. in patients of the second group, depending on the form of Sprengel's deformity. 6 months after the operation, scapula position in its lower corner was equal to the indices of a healthy half of the body. Therefore, a comparative analysis of the anatomical data during the follow-up period after surgery up to 2 years showed that patients of the first age group had a tendency to improve indicators of scapular size and shoulder length. Analysis of the shoulder joint function in the form of shoulder abduction showed that its average increase was 700 in patients of the first group, and only 500 in patients of the second group.Conclusions. Surgical treatment of high scapula gives a positive result in children older than 7-8 years in the form of cosmetic defect elimination and some improvement in the range of shoulder joint motion. Functional indicators in children of a younger age group are better, however, lagging in scapula growth and shortening of the shoulder girdle is possible. Sharp shortening of the shoulder girdle while pulling shoulders back can be corrected by lengthening the spine of the scapula with the help of osteotomy method and replacing the defect with a bone allograft.