RESUMEN
Evaluate the results of a series of 28 cases of high obstetric paralysis treated with the Sever-L'Episcopo technique modified by Hoffer, between 2003 and 2016. Children (mean age, four years and seven months) with adduction contracture and internal rotation of the shoulder without secondary bone deformities (Mallet class II) underwent lengthening of the pectoralis major muscle and tenotomy of the subscapularis muscle associated with transfer of the latissimus dorsi and teres major muscle to the infraspinatus muscle, moving to the function of external rotators and elevators. The mean follow-up was three years and 10 months. At the end of the study, 24 patients achieved excellent functional assessment scores, mainly of the abduction and external rotation, passing from Mallet class II to class IV. Four patients still demonstrated some degree of global movement limitation, passing from class II to class III. Regardless of the final functional gain, all patients were able to perform tasks that were previously difficult. The data from this study suggest that Hoffer's surgery is an effective method in the treatment of the sequelae of high obstetric paralysis without secondary bone deformities.
RESUMEN
Abstract Evaluate the results of a series of 28 cases of high obstetric paralysis treated with the Sever-L'Episcopo technique modified by Hoffer, between 2003 and 2016. Children (mean age, four years and seven months) with adduction contracture and internal rotation of the shoulder without secondary bone deformities (Mallet class II) underwent lengthening of the pectoralis major muscle and tenotomy of the subscapularis muscle associated with transfer of the latissimus dorsi and teres major muscle to the infraspinatus muscle, moving to the function of external rotators and elevators. The mean follow-up was three years and 10 months. At the end of the study, 24 patients achieved excellent functional assessment scores, mainly of the abduction and external rotation, passing from Mallet class II to class IV. Four patients still demonstrated some degree of global movement limitation, passing from class II to class III. Regardless of the final functional gain, all patients were able to perform tasks that were previously difficult. The data from this study suggest that Hoffer's surgery is an effective method in the treatment of the sequelae of high obstetric paralysis without secondary bone deformities.
Resumo Avaliar os resultados de uma série de 28 casos de paralisia obstétrica alta tratadas com a técnica Sever-L'Episcopo modificada por Hoffer, entre 2003 e 2016. As crianças (idade média, quatro anos e sete meses) com contratura em adução e rotação interna do ombro sem deformidades ósseas secundárias (Mallet classe II) foram submetidas ao alongamento do músculo peitoral e tenotomia do músculo subescapular associada à transferência do latissimus dorsi e músculo redondo maior para o músculo infraespinhal, movendo-se para a função de rotadores externos e elevadores. O seguimento médio foi de 3 anos e 10 meses. Ao final do estudo, 24 pacientes obtiveram excelentes escores de avaliação funcional, principalmente de abdução e rotação externa, passando de Mallet classe II para classe IV. Quatro pacientes ainda demonstraram algum grau de limitação de movimento global, passando da classe II para a classe III. Independentemente do ganho funcional final, todos os pacientes foram capazes de realizar tarefas que antes eram difíceis. Os dados deste estudo sugerem que a cirurgia de Hoffer é um método eficaz no tratamento das sequelas de paralisia obstétrica alta sem deformidades ósseas secundárias.