DOĞUMSAL BRAKİYAL PLEKSUS PARALİZİSİNDE SUPİNASYON DEFORMİTESİNİ DÜZELTMEK İÇİN RADİUS ROTASYON OSTEOTOMİSİ UYGULAMASI

Yıl 2021, Cilt: 84 Sayı: 4, 508 - 513, 01.10.2021

Ömer Berköz , Bora Akalın , Erol Kozanoğlu , Safiye Özkan , Atakan Aydın

https://doi.org/10.26650/IUITFD.2021.942881

Öz

Amaç: Doğumsal brakiyal pleksus paralizisi (DBPP) şiddetli supinasyon deformitesi ile seyredebilir. Bu çalışmanın amacı, bu deformitenin tedavisinde radius pronasyon osteotomisinin etkinliğini saptamaktır. Gereç ve Yöntemler: Şiddetli supinasyon deformiteleri olan DBPP hastaları bu çalışmaya eklenmiştir ve bu hastalar Kasım 2003 ila Aralık 2015 tarihleri arasında, aynı ekip tarafından ameliyat edilmiştir. Radius pronasyon osteotomisi yapılmıştır ve kemiksel sabitleme Kirschner telleri veya semitübüler plaklar ile sağlanmıştır. Bazı hastalarda, omuz ve başparmak abdüksiyonu ve el bileği ekstansiyonunun sağlanması için aynı ameliyatta tendon transferleri de yapılmıştır. Bulgular: Kırk bir hastada DBPP’ye bağlı supinasyon deformiteleri saptanmıştır. Hastaların ortalama yaşı 9,2 yıldır (4-22 yıl). Hastaların ortalama takip süresi 5 yıldır (1-7 yıl). Ortalama ameliyat öncesi etkin pronasyon -60° iken pasif değer -10°’dir. Ortalama ameliyat sonrası etkin pronasyon 9° iken pasif değer 45°’dir. Ortalama ameliyat öncesi etkin supinasyon 75° iken pasif değer 85°’dir. Ortalama ameliyat sonrası etkin supinasyon 45° iken pasif değer 65°’dir. Bir hastada ameliyat sonrası ikinci yılda malünyon saptanmıştır (1/41). Üç hastada ameliyat sonrası dönemde yetersiz pronasyon elde edilmiştir (3/41). Sonuç: Şiddetli supinasyon kontraktürü olan hastalarda, radius pronasyon osteotomisi ile tatmin edici bir görünüm ve işlevsel düzelme elde edilebilir.

Anahtar Kelimeler

Doğumsal brakiyal pleksus paralizisi, kontraktür, radius pronasyon osteotomisi, supinasyon deformitesi, tendon transferi

THE PRONATING RADIUS OSTEOTOMY FOR CORRECTING THE SUPINATION DEFORMITY IN BRACHIAL PLEXUS BIRTH PALSY

Öz

Objective: Severe supination deformity may be seen in brachial plexus birth palsy (BPBP). The aim of this study was to determine the efficacy of pronating radius osteotomy in the management of this deformity. Material and Methods: BPBP patients with severe supination deformity were included in this study and they were operated between November 2003 and December 2015, by the same operative team. Pronating radius osteotomy was performed and internal fixation was maintained either by Kirschner wires or semitubular plates. In some patients, tendon transfers were performed during the same operation for the restoration of shoulder and thumb abduction and wrist extension. Results: Forty one patients had supination deformities caused by BPBP. The mean age was 9.2 years (4-22). The mean follow-up was 5 years (1-7). The mean active pronation was -60° before the operation, and the passive one was -10°. The mean active pronation of the patients was 9° after the operation, and the passive one was 45°. The mean active supination of the patients was 75° before the operation, and the passive one was 85°. The mean active supination of the patients was 45° after the operation, and the passive one was 65°. One malunion was detected at the second year after the operation (1/41). Three patients had low pronation degrees during the follow-up (3/41). Conclusion: Satisfactory postural and functional improvement can be achieved with the use of pronating radius osteotomy for patients with severe supination contractures.

Anahtar Kelimeler

Brachial plexus birth palsy, contracture, pronating radius osteotomy, supination deformity, tendon transfer

Kaynakça

• 1. Aitken J. Deformity of the elbow joint as a sequel to Erb’s obstetrical paralysis. J Bone Joint Surg Br 1952;34(3):352- 65.
• 2. Zancolli EA. Paralytic supination contracture of the forearm. J Bone Joint Surg Am 1967;49(7):1275-84.
• 3. Ozkan T, Aydin A, Ozer K, Ozturk K, Durmaz H, Ozkan S. A surgical technique for pediatric forearm pronation: brachioradialis rerouting with interosseous membrane release. J Hand Surg Am 2004;29(1):22-7.
• 4. Zancolli EA. Palliative surgery: pronosupination in obstetrical palsy. In: Brachial plexus injuries. Martin Dunitz, London; 2001. p. 275-91.
• 5. Blount W. Osteoclasis for supination deformities in children. J Bone Joint Surg Am 1940;22(2):300-14.
• 6. Burman M. Paralytic supination contracture of the forearm. J Bone Joint Surg Am 1956;38(2):303-12.
• 7. Zaoussis A. Osteotomy of the proximal end of the radius for paralytic supination deformity in children. J Bone Joint Surg Br 1963;45(3):523-7.
• 8. Goddard N, Fixsen J. Rotation osteotomy of the humerus for birth injuries of the brachial plexus. J Bone Joint Surg Br 1984;66(2):257-9.
• 9. Metsaars W, Nagels J, Pijls B, Langenhoff J, Nelissen R. Treatment of supination deformity for obstetric brachial plexus injury: a systematic review and meta-analysis. J Hand Surg Am 2014;39(10):1948-58. e2.
• 10. Bahm J, Gilbert A. Surgical correction of supination deformity in children with obstetric brachial plexus palsy. J Hand Surg Am 2002;27(1):20-3. 11. Allende CA, Gilbert A. Forearm supination deformity after obstetric paralysis. Clin Orthop Relat Res 2004;426:206-11.