Clinical Study Of The Treatment Of Teres Major And Latissimus Dorsi Transfer To Teres Minor For Shoulder Adduction And Internal Rotation In Obstetric Brachial Plexus Palsy

Objective:To investigate etiology and pathogenesis of shoulder adduction andinternal rotation in obstetric brachial plexus palsy,and introduction the surgerymethod of latissimus dorsi and teres major tendon transfer with anteriorrelease,and summarize its efficacy, improve the quality of life of patients.Methods:Retrospectively analyze the clinical data of6cases has treated withlatissimus dorsi and teres major tendon transfer and anterior released forabduction and lateral rotation limitation of the shoulder in obstetric brachialplexus palsy since February2006to August2013. All patients had3malesand3females, Their age is16months to16years old. There are five cases onthe left, on the right there is one case. All patients from the clinic were not bornto this line of brachial plexus exploration and nerve reconstruction, but onecase in nine years before this surgery only point line subscapularis musclelengthening, due to external rotation weakness treatment.Surgery to testify: children6months or more, a clear diagnosis of obstetricbrachial plexus injury; within progressive shoulder adduction, internal rotation contractures, no external rotation function; deltoid muscle, the latissimusdorsi muscle strength4-5,there is an obvious shoulder abduction, externalrotation barriers.Passive shoulder abduction, external rotation angle preoperative records.Shoulder abduction angle measurement angle between the inner sidewall of theupper arm and chest; shoulder external rotation angle measuring the anglebetween the horizontal plane of the ulnar forearm. Shoulder function using theMallet score.Results:Patients were followed up for6months to22months. Preoperativeabduction average56.67±36.70°, postoperative shoulder abduction143.33±10.33°, improving86.67±35.59°(range50°-140°). Preoperative shoulderexternal rotation0°, external rotation after shoulder raise75.83±19.08°75.83±19.08°(range45°-90°). Groups were compared using the Wilcoxon ranksum test, P=0.02. Postoperative Mallet score (not measured in this group,"hand-to-back"), normal Mallet score total score of20points, Mallet Thepreoperative mean score8.33points, after an average of16.5points. Two caseswere "hand-to-root of the neck" was still difficult, but easier to complete theremaining four cases this action.Conclusion:This study confirmed through clinical observation and score Mallet, in thepassive shoulder abduction, external rotation90°position, the latissimus dorsi muscle-joint tendon teres muscle fiber without tension along the smallround braided suture can reach to extend the latissimus dorsi-the actual effectof the large circle abdominal muscle; Meanwhile, the teres minor arrivedbeyond the humeral greater tuberosity, can give full play to the effect ofexternal rotation muscle power. Moreover, due to the shift of power passivemuscle stretch without their muscle fibers were normal resting state, avoidingthe latissimus dorsi-closing the teres major direct effect on the greatertuberosity suture generated. This study confirms that the proper choice of thecases, the latissimus dorsi-teres major shift in the teres minor tendon joint,combined with extra-articular soft tissue release can significantly improveobstetric brachial plexus injury due to shoulder adduction, internal rotationdeformity.