Chuang 法に準じた筋腱移行術により肩関節外転・外旋機能再建を行った分娩麻痺の 3 例

We reported muscle transfers for the reconstruction of shoulder abduction and external rotation in birth palsy. Case 1: A 5-year-old boy with left birth palsy presented co-contraction of shoulder abduction and elbow flexion. His preoperative active range of motion (a-ROM) was 80 degrees in abduction and —20 degrees in external rotation. The clavicular part of the pectoralis major was transfered to the infraspinatus for external rotation. Seventeen months after surgery, abduction improved to 130 degrees and external rotation improved to 60 degrees. Case 2: A 10-year-old girl with left birth palsy presented co-contraction of abduction and adduction, external rotation, and internal rotation. Her preoperative a-ROM was 130 degrees in abduction and —30 degrees in external rotation. Transferring the teres major to the infraspinatus for the reconstruction of external ratation, and lengthening of the sternal part of the pectoralis major for release of internal rotation contracture were performed. Twenty-six months after surgery, a-ROM improved 170 degrees in abduction and 90 degrees in external rotation. Case 3: A 5-year-old girl with bilateral birth palsy presented incomplete flaccid paralysis of the shoulder and elbow joint. We performed reconstruction of the elbow flexion by the Steindler procedure when she was four years of age. Her preoperative a-ROM was 0 degrees in abduction and —20 degrees in external rotation. Reconstruction of abduction and external rotation was performed like Case 1. Ten months after surgery, a-ROM improved to 145 degrees in abduction and 60 degrees in external rotation.Muscle transfers for the reconstruction of shoulder abduction and external rotation mentioned above are efficient surgical treatments in birth palsy.