部分单极胸大肌移植恢复关节挛缩患儿肘关节活动屈曲的结果研究

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详细

论证。关节挛缩症患者限制或不可能自我护理的主要问题之一是由于前臂屈肌发育不全（成形不全），尤其是肩部二头肌发育不全，导致肘关节缺乏主动屈曲。

研究目的是评估通过部分单极胸大肌移植恢复关节挛缩患儿前臂主动屈曲的可能性。

材料与方法。2011年至2020年，34例肘关节挛缩症患儿（39例上肢）在俄罗斯联邦卫生部联邦国家预算机构H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery接受了手术治疗。患者接受了手术治疗，将胸大肌部分单极移植到前臂屈肌的位置，并在自体移植中纳入腹直肌筋膜的片段。术前及术后6个月及以上对患者进行临床检查。统计数据处理采用Statistica 10和SAS JMP 11应用软件包。

结果。患者手术时年龄为1.5—15.5岁（平均年龄为6.24±4.24岁）。所有病例术后6—99个月（平均44.53±31.72个月）研究治疗结果。术后长期评估显示，肘关节被动屈曲无变化，范围为90—130° （平均为104.12±12.40°），主动屈伸为0—120°（平均为71.94±33.40°），肘关节伸展障碍为0—40°（平均为21.70±12.27），前臂屈肌力量为2—5点（平均为2.85±1.08点）。结果良好为15例（38.5%），满意为8例（20.5%），不满意为16例（41%）。

结论。通过将胸大肌部分单极移植到前臂屈肌位置，可以恢复肘关节的主动屈伸，并在超过一半的病例中改善关节挛缩患者的自我护理。在自体移植中加入腹直肌筋膜的片段，可以避免形成严重的肘关节屈曲挛缩。

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作者简介

Olga Agranovich

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

Email: olga_agranovich@yahoo.com
ORCID iD: 0000-0002-6655-4108
SPIN 代码: 4393-3694
Scopus 作者 ID: 56913386600
http://www.rosturner.ru/kl10.htm

MD, PhD, D.Sc., head of the department of arthrogryposis, member of the Paediatric Hand International Society Of Surgeons (PHISOS), Federation of European Societies for Surgery of the Hand (FESSH), The International study group on arthrogryposis

俄罗斯联邦, 64-68 Parkovaya str., Pushkin, Saint Petersburg, 196603

Ekaterina Petrova

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

Email: pet_kitten@mail.ru
ORCID iD: 0000-0002-1596-3358
SPIN 代码: 2492-1260
Scopus 作者 ID: 57194563255

MD, PhD

俄罗斯联邦, 64-68 Parkovaya str., Pushkin, Saint Petersburg, 196603

Sergey Batkin

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

Email: sergey-batkin@mail.ru
ORCID iD: 0000-0001-9992-8906
SPIN 代码: 5173-9340

MD, orthopedic surgeon

俄罗斯联邦, 64-68 Parkovaya str., Pushkin, Saint Petersburg, 196603

Evgeniya Ermolovich

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

Email: dr.lazareva@bk.ru
ORCID iD: 0000-0001-6716-1034
SPIN 代码: 6598-5653

MD, neurologist

俄罗斯联邦, 64-68 Parkovaya str., Pushkin, Saint Petersburg, 196603

Igor Komolkin

Saint Petersburg State Research Institute of Phthisiopulmonology

Email: igor_komolkin@mail.ru
ORCID iD: 0000-0002-0021-9008
SPIN 代码: 2024-2919

MD, PhD, D.Sc

俄罗斯联邦, Saint Petersburg

Vladimir Kenis

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

Email: kenis@mail.ru
ORCID iD: 0000-0002-7651-8485
SPIN 代码: 5597-8832
Scopus 作者 ID: 36191914200
Researcher ID: K-8112-2013

MD, PhD, D.Sc., Professor

俄罗斯联邦, 64-68 Parkovaya str., Pushkin, Saint Petersburg, 196603

Andrey Sapogovskiy

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

Email: sapogovskiy@gmail.com
ORCID iD: 0000-0002-5762-4477
SPIN 代码: 2068-2102
Scopus 作者 ID: 57193257532

MD, PhD

俄罗斯联邦, 64-68 Parkovaya str., Pushkin, Saint Petersburg, 196603

Evgeniy Blagoveschenskiy

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery; National Research University “Higher School of Economics”

编辑信件的主要联系方式.
Email: eblagovechensky@hse.ru
ORCID iD: 0000-0002-0955-6633
SPIN 代码: 2811-5723
Scopus 作者 ID: 6506349269
Researcher ID: B-5037-2014

PhD

俄罗斯联邦, 64-68 Parkovaya str., Pushkin, Saint Petersburg, 196603; Moscow

参考

  1. Hall JG. Arthrogryposis multiplex congenita: etiology, genetics, classification, diagnostic approach, and general aspects. J Pediatr Orthop B. 1997;6(3):159−166.
  2. Sarwark JF, MacEwen GD, Scott CI Jr. Amyoplasia (a common form of arthrogryposis). J Bone Joint Surg Am. 1990;72(3):465−469.
  3. van Heest A, Waters PM, Simmons BP. Surgical treatment of arthrogryposis of the elbow. J Hand Surg Am. 1998;23(6):1063−1070. doi: 10.1016/S0363-5023(98)80017-8
  4. 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. Shoulder Elbow Surg. 2017;26(11):2004−2009. doi: 10.1016/j.jse.2017.04.002
  5. Oishi S, Agranovich O, Zlotolow D, et al. Treatment and outcomes of arthrogryposis in the upper extremity. Am J Med Genet C Semin Med Genet. 2019;181(3):363−371. doi: 10.1002/ajmg.c.31722
  6. Takagi T, Seki A, Kobayashi Y, et al. Isolated muscle transfer to restore elbow flexion in children with arthrogryposis. J Hand Surg Asian Pac Vol. 2016;21(1):44−48. doi: 10.1142/S2424835516500053
  7. Chomiak J, Dungl P. Reconstruction of elbow flexion in arthrogryposis multiplex congenita type I. Part I: surgical anatomy and vascular and nerve supply of the pectoralis major muscle as a basis for muscle transfer. J Child Orthop. 2008;2(5):357−364. doi: 10.1007/s11832-008-0130-0
  8. Sochol KM, Edwards G 3rd, Stevanovic M. Restoration of elbow flexion with a free functional gracilis muscle transfer in an ar-throgrypotic patient using a motor nerve to pectoralis major. Hand (NY). 2020;15(5):739−743. doi: 10.1177/1558944720923412
  9. Chomiak J, Dungl P, Včelák J. Reconstruction of elbow flexion in arthrogryposis multiplex congenita type I: results of transfer of pectoralis major muscle with follow-up at skeletal maturity. J Pediatr Orthop. 2014;34(8):799–807. doi: 10.1097/BPO.0000000000000204
  10. Clark JMP. Reconstruction of biceps brachii by pectoral muscle transplantation. Br J Surg. 1946;34(134):180−181.
  11. Ezaki M. Treatment of the upper limb in the child with arthrogryposis. Hand Clin. 2000;16(4):703−711.
  12. Atkins RM, Bell MJ, Sharrard WJ. Pectoralis major transfer for paralysis of elbow flexion in children. J Bone Joint Surg Br. 1985;67(4):640−644. doi: 10.1302/0301-620X.67B4.4030867
  13. Carroll RE, Kleinman WB. Pectoralis major transplantation to restore elbow flexion to the paralytic limb. J Hand Surg Am. 1979;4(6):501−507. doi: 10.1016/s0363-5023(79)80001-5
  14. Lahoti O, Bell MJ. Transfer of pectoralis major in arthrogryposis to restore elbow flexion: deteriorating results in the long term. J Bone Joint Surg Br. 2005;87(6):858−860. doi: 10.1302/0301-620X.87B6.15506
  15. Doyle JR, James PM, Larsen LJ, Ashley RK. Restoration of elbow flexion in arthrogryposis multiplex congenita. J Hand Surg Am. 1980;5(2):149−152. doi: 10.1016/s0363-5023(80)80146-8
  16. Tsai TM, Kalisman M, Burns J, Kleinert HE. Restoration of elbow flexion by pectoralis major and pectoralis minor transfer. J Hand Surg Am. 1983;8(2):186−190. doi: 10.1016/s0363-5023(83)80013-6
  17. Cambon-Binder A, Walch A, Marcheix PS, Belkheyar Z. Bipolar transfer of the pectoralis major muscle for restoration of elbow flexion in 29 cases. J Shoulder Elbow Surg. 2018;27(11):e330−e336. doi: 10.1016/j.jse.2018.06.027
  18. Morrey BF, Askew LJ, Chao EY. A biomechanical study of normal functional elbow motion. J Bone Joint Surg Am. 1981;63(6):872−877.
  19. Tobin GR. Segmentally split pectoral girdle muscle flaps for chest-wall and intrathoracic reconstruction. Clin Plast Surg. 1990;17(4):683−696.

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1. JATS XML
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2. 图 6 右侧胸大肌部分单极移植术后6年乳腺图

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3. 图 1 手术前后《主动屈伸，度》指标的跨度图表

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4. 图 2 《前臂屈肌力量》指标在手术前后跨度示意图

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5. 图 3 手术前后《伸展障碍，度》指标范围示意图

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6. 图 4 1岁患者N.将胸大肌部分单极移植至右前臂屈肌位置，效果良好：a—患儿术前外观（右肘关节伸展障碍为20°）； b—右肘关节被动屈曲；c,d—手术阶段；e,f—术后6年的治疗结果

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7. 图 5 《伸展障碍》指标的动态：a—度；b—百分率

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版权所有 © Agranovich O., Petrova E., Batkin S., Ermolovich E., Komolkin I., Kenis V., Sapogovskiy A., Blagoveschenskiy E., 2021

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