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目的 评价肱骨及桡骨旋转截骨术治疗分娩性臂丛损伤 (产瘫 )肩肘后遗症的价值。方法 1999年 8月至 2 0 0 0年 12月 ,对 8例产瘫肩肘后遗症患儿 (肩关节外旋挛缩 2例 ,内旋挛缩 1例 ,前臂旋后挛缩并发桡骨小头脱位 5例 )施行肱骨内旋截骨、外旋截骨、及前臂旋前截骨等手术 ,并经术后 3～ 16个月 (平均 8个月 )的随访。术后肩关节功能采用Mallet评分、前臂功能采用旋前位置角度的改善作为评价标准。结果 2例行肱骨内旋截骨者 ,1例按Mallet评分 ,术前术后的改变为 :肩外展 3→ 3 ,外旋 4→ 4,手到颈后 4→ 3 ,手到背 2→ 4,手到嘴 2→ 4;另 1例因感染及螺钉断裂致骨不连行内固定手术后尚在康复中。 1例行肱骨外旋截骨者 ,按Mallet评分 ,术前术后改变为 :肩外展 2→ 3 ,外旋 2→ 4,手到颈后 2→ 3 ,手到背 4→ 3 ,手到嘴 2→ 3。 5例行桡骨旋前截骨者 ,术后前臂均处于旋前 3 0°位置 ,功能及外观均获得改善。结论 肱骨及桡骨旋转截骨矫形手术在产瘫肩肘挛缩后遗症的治疗中具有一定的应用价值。
Objective To evaluate the value of humeral and radial rotation osteotomy for the treatment of shoulder and elbow sequelae in labor brachial plexus injury (paraplegia). Methods From August 1999 to December 2000, 8 children with paralysis and shoulder-elbow sequela were included in this study (2 cases of external rotation contracture, 1 case of internal rotation contracture and 5 cases of radial head dislocation after pronation and contracture) Internal humeral osteotomy, external rotation osteotomy, and forearm pronation osteotomy and other surgery, and after 3 to 16 months (average 8 months) follow-up. Postoperative shoulder function Mallet score, forearm function using pronation position angle improvement as the evaluation criteria. Results 2 cases of internal fixation of the humerus osteotomy, Mallet score in 1 case, preoperative and postoperative changes: shoulder abduction 3 → 3, external rotation 4 → 4, hands to the back of the neck 4 → 3, hands to the back 2 → 4, hand to mouth 2 → 4; the other 1 case due to infection and screw fracture caused by non-interlocking internal fixation surgery is still recovering. 1 case of humeral external rotation osteotomy, according to Mallet score, before and after surgery changed: shoulder abduction 2 → 3, external rotation 2 → 4, hands to the back of the neck 2 → 3, hands to the back 4 → 3, hand To mouth 2 → 3. 5 cases of radial prerenal osteotomy who forearm were in pronation 30 ° position, function and appearance were improved. Conclusion The humeral and radial rotation osteotomy surgery in the treatment of paraplegia shoulder elbow contracture sequelae has a certain value.