评估关节弯曲患者将背阔肌转位至肩膀肱二头肌位置结果的神经生理学相关性

封面


如何引用文章

全文:

开放存取 开放存取
受限制的访问 ##reader.subscriptionAccessGranted##
受限制的访问 订阅或者付费存取

详细

论证：肘关节缺乏主动屈曲是关节弯曲患者的主要问题之一。在肘关节缺乏主动屈曲的情况下，自助选择是有限的，所以为了矫正这种情况，他们将自体肌肉移植物移到肩膀肱二头肌的位置。背阔肌最常用于此目的。

目的是确定评估关节弯曲患者将背阔肌转位至肩膀肱二头肌位置结果的神经生理学相关性。

材料与方法。从2011年到2018年，联邦政府预算机构H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery 俄罗斯联邦卫生部检查和治疗了30例关节弯曲的儿童，其通过单极移植背阔肌到上肢（共44条上肢）恢复了他们的肘关节主动屈曲。患者在手术前进行了检查，以及术后从1个月到96个月时间内（中位数—7个月，四分位数范围—2—24.5个月）。
对14例先天性多关节弯曲患者（23条上肢）术前后的临床、神经生理综合检查结果进行统计分析。
患儿手术时年龄为1至10岁，（平均年龄为4.89 ± 2.42岁）。

结果。我们的研究表明，手术时儿童的年龄对背阔肌共活化作用的变化没有显著影响。术后晚期背阔肌共活化作用指标的下降与移位肌力量的增加以及肘关节主动屈曲的改善有关，这证明了手术和随后康复的有效性。当背阔肌的共活化作用小于等于42%时，术后肌力达到4分。背阔肌的共活化作用指标并不取决于脊髓损伤的程度。然而，脊髓损伤程度影响肌肉强度：C6-C7和C6损伤水平的患者术后背阔肌强度最大，最小的是C5-C7。

结论。基于表面神经肌电图数据确定肌肉共活化作用指标，可用于评估关节弯曲患者将背阔肌转位至肩膀肱二头肌位置的结果，从而评估康复效果。背阔肌的共活化作用指标不超过42%，可作为确认手术良好功能结果的标准。

全文:

受限制的访问

作者简介

Olga Agranovich

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

编辑信件的主要联系方式.
Email: olga_agranovich@yahoo.com
SPIN 代码: 4393-3694
http://www.rosturner.ru/kl10.htm

MD, PhD, D.Sc., Supervisor of the Department of Arthrogryposis

俄罗斯联邦, 64, Parkovaya str., Saint-Petersburg, Pushkin, 196603

Margarita Savina

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: drevma@yandex.ru

MD, PhD, Head of the Laboratory of Physiological and Biomechanical Research

俄罗斯联邦, 64, Parkovaya str., Saint-Petersburg, Pushkin, 196603

Dmitry Ivanov

Kazan State Medical University

Email: i.dmitry1988@gmail.com

MD, assistant of the Department of Public Health and Health Organization

俄罗斯联邦, 49, Butlerov street, Kazan, 420012

Alexey Boyko

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: ex.trol@mail.ru

MD, resident

俄罗斯联邦, 64, Parkovaya str., Saint-Petersburg, Pushkin, 196603

Yevgeny Blagoveshchenskiy

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery; Higher School of Economics

Email: eblagovechensky@hse.ru

research associate at the Laboratory of Physiological and Biomechanical Research; PhD, senior research associate 

俄罗斯联邦, 64, Parkovaya str., Saint-Petersburg, Pushkin, 196603; 20, Myasnitskaya str., Moscow, 101000

参考

  1. Kroksmark AK, Kimber E, Jerre R, et al. Muscle involvement and motor function in amyoplasia. Am J Med Genet A. 2006;140(16):1757-1767. https://doi.org/10.1002/ajmg.a.31387.
  2. Basheer H, Zelic V, Rabia F. Functional scoring system for obstetric brachial plexus palsy. J Hand Surg Br. 2000;25(1):41-45. https://doi.org/10.1054/jhsb.1999.0281.
  3. Van Heest A, Waters PM, Simmons BP. Surgical treatment of arthrogryposis of the elbow. J Hand Surg Am. 1998;23(6):1063-1070. https://doi.org/10.1016/S0363-5023(98)80017-8.
  4. Ezaki M. Treatment of the upper limb in the child with arthrogryposis. Hand Clin. 2000;16(4):703-711.
  5. Zargarbashi R, Nabian MH, Werthel JD, Valenti P. Is bipolar latissimus dorsi transfer a reliable option to restore elbow flexion in children with arthrogryposis? A review of 13 tendon transfers. J Shoulder Elbow Surg. 2017;26(11):2004-2009. https://doi.org/10.1016/ j.jse.2017.04.002.
  6. Boven ETW. Latissimus dorsi to biceps transfer in children with arthrogryposis: influence of preoperative volume on outcome and comparison to reference values.
  7. Агранович О.Е., Коченова Е.А., Трофимова С.И., и др. Использование широчайшей мышцы спины для восстановления активного сгибания в локтевом суставе у больных с артрогрипозом // Ортопедия, травматология и восстановительная хирургия детского возраста. – 2018. – Т. 6. – № 3. – C. 5–11. [Agranovich OE, Kochenova EA, Trofimova SI, et al. Restoration of elbow active flexion via latissimus dorsii transfer in patients with arthrogryposis. Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2018;6(3):5-11. (In Russ.)]. https://doi.org/10.17816/PTORS6273-75.
  8. Агранович О.Е., Лахина О.Л. Клинические варианты деформаций верхних конечностей у больных с артрогрипозом // Травматология и ортопедия России. – 2013. – № 3. – С. 125–129. [Agranovich OE, Lakhina OL. Clinical variants of upper limbs deformities in children with arthrogryposis multiplex congenita. Traumatology and Orthopedics of Russia. 2013;(3):125-129. (In Russ.)]. https://doi.org/10.21823/2311-2905-2013--3-125-129.
  9. Aoki M, Okamura K, Fukushima S, et al. Transfer of the latissimus dorsi for irreparable rotator-cuff tears. J Bone Joint Surg Br. 1996;78(5):761-766.
  10. Gerber C. Latissimus dorsi transfer for the treatment of irreparable tears of the rotator cuff. Clin Orthop Rel Res. 1992;(275):152-160.
  11. Gerber C, Vinh TS, Hertel H, Hess CW. Latissimus dorsi transfer for the treatment of massive tears of the rotator cuff. A preliminary report. Clin Orthop Rel Res. 1988;(232):51-61.
  12. Ianotti JP, Hennigan S, Herzog R, et al. Latissimus dorsi tendon transfer for irreparable posteriosuperior rotator cuff tears. J Bone Joint Surg Am. 2006;88(2):342-348. https://doi.org/10.2106/JBJS.D.02996.
  13. Irlenbusch U, Bernsdorf M, Born S, et al. Electromyographic analysis of muscle function after latissimus dorsi tendon transfer. J Shoulder Elbow Surg. 2008;17(3):492-499. https://doi.org/10.1016/ j.jse.2007.11.012.
  14. Plath JE, Seiberl W, Beitzel K, et al. Electromyographic activity after latissimus dorsi transfer: testing of coactivation as a simple tool to assess latissimus dorsi motor learning. J Shoulder Elbow Surg. 2014;23(8):1162-1170. https://doi.org/10.1016/j.jse.2013.11.005.

补充文件

附件文件
动作
1. JATS XML
下载

版权所有 © Agranovich O., Savina M., Ivanov D., Boyko A., Blagoveshchenskiy Y., 2020

Creative Commons License
此作品已接受知识共享署名 4.0国际许可协议的许可
СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ № ФС77-54261 от 24 мая 2013 г.