outcome analysis of modified teres major and latissimus dorsi transfer in the treatment of obstetric...
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Outcome analysis of modified teres major and latissimus dorsi transfer in the treatment of
obstetric brachial plexus palsy shoulder sequelae
Gong Xu, Lu Lai Jin, Cui Jian Li, Sun Ru Tao
Department of Hand Surgery
The First Hospital of Ji Lin University
Chang Chun, Ji Lin Province
130021
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obstetric brachial plexus palsy
Incidence : 0.1-0.4%
Incomplete Recovery : 49%-66%
Indication of Microsurgical Neural Reconstruction : dysfunction of elbow flexion at the age of 3 month
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Sequelae of shoulder
C5 , C6 injuries ( Erb’s palsy ) C5 , C6 , +C7 injuries ( Erb’s palsy+C7 )
loss of active ER
loss of shoulder elevation
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Loss of active shoulder elevation and ER can lead to simple tasks, such as shaking hand, combing, brushing teeth, becoming impossible due to the inability of controlling the spatial positioning of the arm .
Sequelae of shoulder
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PathomechanicsInternal
Rotator 4
Pectoralis Major
Subscapularis
Teres Major
Latissimus Dorsi
External
Rotator 2
Infraspinatus
Teres Minor
Fibrosis , Contracture
Loss of Passive ER
PalsyInability of active ER
40%
Walch G, et al. The ‘dropping’ and ‘hornblower’s’ signs in evaluation of rotator-cuff tears. JBJS-Br .1998
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Shoulder ReconstructionL’Episcopo Transfer ( 1934)
Anterior Approach : Releasing Pectoralis Major and Subscapularis Muscles
Posterior Approach : Transfer Teres Major & Latissimus Dorsi muscles
Reinserting conjoint tendon on humeral shaft
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Nath (2007)
Axillary Approach
Releasing Pectoralis Major and Subscapularis Muscles
Conjoint tendon suturing to Teres Minor
Shoulder Reconstruction
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Background
We modified Teres Major & Latissimus Dorsi transfer, from original L’Episcopo’s and
Nath’s procedures, to reconstruct shoulder function.
The deltopectoral approach to release contracted subscapularis, pectoralis major and
conjoint tendon of the teres major and latissimus dorsi
The posterior approach to reinsert the conjoint tendon to the belly of the teres minor
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Background
To retrospectively analyze the outcomes and related factors of modified teres major and
latissimus dorsi transfer in the treatment of obstetric brachial plexus palsy (OBPP)
shoulder sequelae.
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Materials and Methods
General Conditions
From 2008 to 2011
six patients with OBPPs, aged from 16 months of age to 16 years of age.
2 males and 4 females
Left: 3, Right: 3
No primary microsurgical reconstruction
Diagnosis: C5+C6 (n=5)
C5+C6+C7 (n=1)
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Materials and Methods
The pre- and postoperative active shoulder abduction and ER were recorded and
evaluated according to Mallet’s classification.
Comparison between the pre- and postoperative was performed by t-test.
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Operative methods
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Operative methods
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Operative methods
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Operative methods
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The upper extremities were immobilized for 6-8 weeks in the position of
abduction 90 degrees and ER 45 degrees except for two patients in the
position of adduction and internal rotation.
All patients were followed for 3 to 22 months.
Postoperative Management
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Results
Pre- Post-
Shoulder Abduc-tion
55±35.6°
130±24.5°
75°
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Pre- Post-
External Rotation
48.3±22.73°
48°
Results
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Pre- Post-
Mallet Score (ER)
2.5
4.3
Results
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Preoperative: Abduction 70°, ER 0°( Mallet Score 3)
Postoperative: Abduction 130°, ER 45°( Mallet Score 4)
Typical Cases
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Typical Cases
Preoperative: Abduction 90°, ER 0°( Mallet Score 3)
Postoperative: Abduction 160°, ER 90°( Mallet Score 5)
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Typical Cases
Preoperative: Abduction 50°, ER 0°( Mallet Score 3)
Postoperative: Abduction 130°, ER 45°( Mallet Score 5)
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The position of postoperative Immobilization can influence outcomes of ER
2 patients were immobilized in shoulder adduction and internal rotation
Abduction ER
Pre- 30 0
Post- 150 20
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Abduction ER
Pre- 0 0
Post- 90 45
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Conclusion
Modified teres major & latissimus dorsi transfer can improve shoulder
abduction and ER by increasing stability of the glenohumeral joint.
The postoperative immobilization position can influence the improvement
of shoulder ER.
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谢 谢