分娩麻痺に対する multiple muscle transfer の経験

概要

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Many reconstructive procedures of the shoulder with obstetrical palsy using muscle transfers have been reported. But all have both good and bad points, and determinative one has not yet existed.Multiple muscle transfers, containing transfers of the short head of the biceps and the long head of the triceps to the acromion, the latissimus dorsi with the teres major to the infraspinatus, and the posterior part of the deltoid to the clavicle, were performed in 3 cases.However in one of these, the biceps power was so weak to transfer that the pectoralis major was transferred to the great tuberosity instead, and the secondary reconstruction of the elbow flexion was planned. All had the significant improvement in the shoulder function. Active abduction has improved with the average gain of 57 degrees ranging from 40 to 70 degrees. In addition, the outline of the shoulder has been elevated making aesthetically better results.But, the mild abduction contracture without disability has remained in two cases. And in one case with shoulder joint laxity, the subluxation on motion has appeared and the corrective operation is needed.In conclusion, we could expect better results functionally and cosmetically with multiple muscle transfer, but should be cautious in case with joint laxity.
西日本整形・災害外科学会の論文