Restoration of active elbow flexion by pectoralis major transfer in children with amyoplasia
Introduction Amyoplasia is the most common type of arthrogryposis multiplex congenita. Some patients may lack active elbow flexion due to aplasia of the forearm flexor muscles. The objective was to identify the optimal age for pectoralis major muscle transfer to improve elbow flexion in children w...
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| Format: | Article |
| Language: | English |
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Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics
2022-08-01
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| Series: | Гений oртопедии |
| Subjects: |
| _version_ | 1811340802401501184 |
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| author | Olga E. Agranovich Ekaterina V. Petrova Sergey F. Batkin Igor A. Komolkin Evgeny D. Blagovechtchenski |
| author_facet | Olga E. Agranovich Ekaterina V. Petrova Sergey F. Batkin Igor A. Komolkin Evgeny D. Blagovechtchenski |
| author_sort | Olga E. Agranovich |
| collection | DOAJ |
| description | Introduction Amyoplasia is the most common type of arthrogryposis multiplex congenita. Some patients may lack active elbow flexion due to aplasia
of the forearm flexor muscles. The objective was to identify the optimal age for pectoralis major muscle transfer to improve elbow flexion in children
with amyoplasia and estimate outcomes of the procedure depending on the level of spinal cord injury. Material and methods Restoration of active
elbow flexion was performed for 34 children with amyoplasia (39 upper limbs) between 2011 and 2020 using partial monopolar pectoralis major
muscle transfer. The age of patients ranged between 1.5 and 15.5 years (6.24 ± 4.24 years). The patients were divided into 3 groups depending on the
level of spinal cord injury: C6–C7 (n = 4; 11.8 %), C5–C7 (n = 24; 70.6 %), C5–Th1 (n = 6; 17.6 %). The outcomes were estimated at 6 to 99 months
(44.53 ± 31.72 months). The patients underwent preoperative and postoperative clinical and neurological examination. The results were statistically
analyzed. Results Active elbow flexion improved by 56.8 degrees (p < 0.0001), forearm flexor muscles strengthened by 2.0 points (p < 0.0001) and
extension deficit improved by 14.5 degrees (p < 0.0001) were postoperatively statistically significant. Results were rated as good in 15 (38.5 %); as fair,
in 8 (20.5 %) and poor in 16 (41 %) cases. Greater differences were found between the group of patients with the level of C6-C7 spinal cord injury in
relation to the group of patients with the level of C5-Th1 (p < 0.05). There were no statistically significant differences between patients with C6–C7
and C5–C7 lesion levels (p > 0.05). Children of different age groups showed no differences in the results of treatment (p > 0.05). Conclusion Pectoralis
major muscle could be used for active elbow flexion restoration in patients with amyoplasia. The best results were observed in patients with C6–C7,
C5–C7 segmental lesions of the spinal cord. There was no correlation between age of patient at the time of surgery and the effectiveness of operation. |
| first_indexed | 2024-04-13T18:47:22Z |
| format | Article |
| id | doaj.art-8c0674df251a4587939b33df87e808f2 |
| institution | Directory Open Access Journal |
| issn | 1028-4427 2542-131X |
| language | English |
| last_indexed | 2024-04-13T18:47:22Z |
| publishDate | 2022-08-01 |
| publisher | Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics |
| record_format | Article |
| series | Гений oртопедии |
| spelling | doaj.art-8c0674df251a4587939b33df87e808f22022-12-22T02:34:32ZengRussian Ilizarov Scientific Center for Restorative Traumatology and OrthopaedicsГений oртопедии1028-44272542-131X2022-08-0128454655310.18019/1028-4427-2022-28-4-546-553Restoration of active elbow flexion by pectoralis major transfer in children with amyoplasiaOlga E. Agranovich0https://orcid.org/0000-0002-6655-4108Ekaterina V. Petrova1https://orcid.org/0000-0002-1596-3358Sergey F. Batkin2https://orcid.org/0000-0001-9992-8906Igor A. Komolkin3https://orcid.org/0000-0002-0021-9008Evgeny D. Blagovechtchenski4https://orcid.org/0000-0002-0955-6633H. Turner National Medical Research Center for Сhildren's Orthopedics and Trauma Surgery, Saint Petersburg, Russian FederationH. Turner National Medical Research Center for Сhildren's Orthopedics and Trauma Surgery, Saint Petersburg, Russian FederationH. Turner National Medical Research Center for Сhildren's Orthopedics and Trauma Surgery, Saint Petersburg, Russian FederationH. Turner National Medical Research Center for Сhildren's Orthopedics and Trauma Surgery, Saint Petersburg, Russian FederationH. Turner National Medical Research Center for Сhildren's Orthopedics and Trauma Surgery, Saint Petersburg, Russian Federation; National Research University “Higher School of Economics”, Moscow, Russian FederationIntroduction Amyoplasia is the most common type of arthrogryposis multiplex congenita. Some patients may lack active elbow flexion due to aplasia of the forearm flexor muscles. The objective was to identify the optimal age for pectoralis major muscle transfer to improve elbow flexion in children with amyoplasia and estimate outcomes of the procedure depending on the level of spinal cord injury. Material and methods Restoration of active elbow flexion was performed for 34 children with amyoplasia (39 upper limbs) between 2011 and 2020 using partial monopolar pectoralis major muscle transfer. The age of patients ranged between 1.5 and 15.5 years (6.24 ± 4.24 years). The patients were divided into 3 groups depending on the level of spinal cord injury: C6–C7 (n = 4; 11.8 %), C5–C7 (n = 24; 70.6 %), C5–Th1 (n = 6; 17.6 %). The outcomes were estimated at 6 to 99 months (44.53 ± 31.72 months). The patients underwent preoperative and postoperative clinical and neurological examination. The results were statistically analyzed. Results Active elbow flexion improved by 56.8 degrees (p < 0.0001), forearm flexor muscles strengthened by 2.0 points (p < 0.0001) and extension deficit improved by 14.5 degrees (p < 0.0001) were postoperatively statistically significant. Results were rated as good in 15 (38.5 %); as fair, in 8 (20.5 %) and poor in 16 (41 %) cases. Greater differences were found between the group of patients with the level of C6-C7 spinal cord injury in relation to the group of patients with the level of C5-Th1 (p < 0.05). There were no statistically significant differences between patients with C6–C7 and C5–C7 lesion levels (p > 0.05). Children of different age groups showed no differences in the results of treatment (p > 0.05). Conclusion Pectoralis major muscle could be used for active elbow flexion restoration in patients with amyoplasia. The best results were observed in patients with C6–C7, C5–C7 segmental lesions of the spinal cord. There was no correlation between age of patient at the time of surgery and the effectiveness of operation.amyoplasiaarthrogryposiselbowmuscle flapsspinal cord |
| spellingShingle | Olga E. Agranovich Ekaterina V. Petrova Sergey F. Batkin Igor A. Komolkin Evgeny D. Blagovechtchenski Restoration of active elbow flexion by pectoralis major transfer in children with amyoplasia Гений oртопедии amyoplasia arthrogryposis elbow muscle flaps spinal cord |
| title | Restoration of active elbow flexion by pectoralis major transfer in children with amyoplasia |
| title_full | Restoration of active elbow flexion by pectoralis major transfer in children with amyoplasia |
| title_fullStr | Restoration of active elbow flexion by pectoralis major transfer in children with amyoplasia |
| title_full_unstemmed | Restoration of active elbow flexion by pectoralis major transfer in children with amyoplasia |
| title_short | Restoration of active elbow flexion by pectoralis major transfer in children with amyoplasia |
| title_sort | restoration of active elbow flexion by pectoralis major transfer in children with amyoplasia |
| topic | amyoplasia arthrogryposis elbow muscle flaps spinal cord |
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