- 期刊
Clinical Experience of the Woodward Procedure in Sprengel's Deformity
使用Woodward術式治療先天性肩胛骨高位症之臨床經驗
摘要
先天性肩胛骨高位症(Sprengel's deformity)是一種罕見的先天性肩胛骨異常疾病，目前確切的發生原因還不是很清楚。當病人的外觀變形或者功能受限情況嚴重的時候，常需要開刀來矯正外觀及功能上的缺陷。從1998至中2006年，共有9位先天性肩胛骨高位症的病人在我們醫院進行手術治療，其中包含6個男孩及3個女孩，年紀介於3到6歲間，平均是4.7±1.1歲時接受手術矯正。這類病人出生時多半合併有其他先天性異常，包含Klippel-Feil症候群（6例）、脊柱側彎（3例）、心血管疾病（1例）等。這9位病人我們均使用標準Woodward術式來進行手術矯正，術中沒有合併鎖骨切骨術或其他術式，術前術後肩關節的外展角度、功能恢復及外觀等均詳細加以測量並分級比較。經過臨床的統計分析，我們發現使用此術式的病人無論在外觀上或功能上均有明顯的進步：肩關節外展角度（術前／術後：82.22±7.12/160.56±11.84, p=0.006）；外觀分級(Cavendish grade，術前／術後：3.56±0.53/1.33±0.5, p=0.007）。所有病人在術後平均追蹤時間約8年（由3到10年不等），臨床上並沒有發現因手術所造成的併發症；總結來說，我們認爲使用Woodward術式矯正先天性肩胛骨高位症是一種有效且安全的手術。對小於6歲的病患，術中不合併鎖骨切骨手術並不會增加術後神經血管損傷的風險，且就長期追蹤來看其預後也令人滿意。
關鍵字
無資料並列摘要
Objectives: To determine the safety and outcome in the treatment of Sprengel's deformity by the standard Woodward procedure without clavicular osteotomy. Methods: This nine year retrospective study from 1998 to 2006 closely followed 9 patients, six boys and three girls, aged 3-6years (mean, 4.7±1.1 years), with Sprengel's deformity. The ages of patients at the time of diagnosis ranged from 0 (immediately after birth) to 5 years. Associated congenital diseases included Klippel-Feil syndrome (6 cases), congenital scoliosis (3 cases) and congenital heart disease (1 case). All patients underwent the standard Woodward surgical procedure. No clavicular osteotomy or other modified methods were performed during the operations. Changes in the shoulder abduction degrees and the appearance classified by the Cavendish grading system were recorded before and after the operations. Results: In this study using the Wilcoxon signed rank test, the results indicated significant improvements in the abduction degrees of the shoulder (before vs. after: 82.22±7.12 vs. 160.56±11.84, p=0.006) and the Cavendish grades (before vs. after: 3.56±0.53 vs. 1.33±0.5, p=0.007). No surgical complications were noted during the 4.5 year-follow-up period (mean: 8 years; ranging from 3 to 10 years). Conclusions: As a result of this clinical study, we conclude that the Woodward procedure is a safe and effective procedure in the treatment of Sprengel's deformity. Besides, for patients younger than six years of age, we consider that it is not necessary to combine the clavicular osteotomy with the Woodward procedure.