F-3-03-01
THE STRATEGY OF NERVE SURGERY FOR BIRTH PALSY
Chwei-Chin David Chuang (Chang Gung Memorial Hospital, Taipei, Taiwan)
Fu-Chan Wei (Chang Gung Memorial Hospital, Taipei, Taiwan)
Hae-Shya Ma (Chang Gung Memorial Hospital, Taipei, Taiwan)
Purpose: Retrospectively to evaluate the functional recovery of the shoulder and elbow following the different techniques of nerve surgery.
Method: Twenty-five infants with obstetrical brachial plexus palsy underwent nerve surgery at an average of 5.5 months (range 2-11 months) between 1991 and 1993. Rupture of the upper trunk. or rupture of the upper and middle trunk were the most common lesions. Nerve grafting was the most frequently performed procedure, followed by nerve transfer. All patients had a minimum of 3 years follow-up. Five different coaptation techniques were involved. Postoperative evaluation and comparison was made based on the functional recovery and severity of co-contractions between shoulder and elbow.
Result & Conclusion: Interposition of nerve grafts in the ruptured brachial plexus did not prevent the development of cross innerration, no matter which distal recipient nerves were selected for reinnervation. Direction of the regenerated fibers and short nerve grafts seem the key points to achieve good results. Extraplexual neurotization such as intercostal nerve, spinal accessory nerve transfer had the least cross innerration and achieved good function of either elbow or shoulder.
F-3-03-02
A NEW STRATEGY OF MUSCLE TRANSPOSITION FOR TREATMENT OF SHOULDER DEFORMITY DUE TO BIRTH PALSY
Chwei-Chin David Chuang (Chang Gung Memorial Hospital, Taipei, Taiwan)
Fu-Chan Wei (Chang Gung Memorial Hospital, Taipei, Taiwan)
Hae-Shya Ma (Chang Gung Memorial Hospital, Taipei, Taiwan)
Purpose: Retrospectively to review the patients having undergone a new modified muscle transposition for the treatment of shoulder deformity due to birth palsy.
Method: Since 1993, twenty-nine patients having shoulder deformity due to birth palsy underwent reconstruction. If perioperative studies demonstrate the existence of muscle recovery by cross innerration, muscle transposition with release of muscles of pectoralis major and teres major, and transferring teres major to the infraspinatus muscle, reroute both ends of the clavicular part of the pectoralis major muscle laterally was performed. The timing for the reconstruction was at an average of 8.5 years (range 4 to 21 years). Objective evaluation of shoulder abduction and shoulder external rotation were utilized.
Result & Conclusion: The average shoulder abduction following the muscle transposition was 151°(i.e., an average 104%, 77°, gain) and that of external rotation was 720 (i.e., an average 200%, 48°, gain). The only complication is that shoulder abduction power decrease to one third of the normal limb. The results appear to be significantly impressive.
