产瘫臂丛神经断伤及撕脱伤的术前评估及治疗

Preoperative evaluation and treatment for nerve rupture or avulsion of obstetric brachiai plexus palsy

目的 回顾 2 1例产瘫的术前术后情况 ,探讨产瘫术前评估及治疗中的有关问题。方法 游离神经移植及多种神经移位术。结果 肩肘功能Mallet评分优良率为 76 % ;全臂丛损伤由于放弃了下干的修复 ,手功能恢复较差 ,肢体发育短小 ;膈神经移位后肺功能代偿良好。结论 术前对患肢功能 ,伴随损伤、自然恢复进程、Itorner氏征 ,SNAP及SEP等进行综合评估 ,决定保守或手术治疗 ,手术时机及方法 ;手术时机及方法影响术后效果 ;康复训练可以预防或减轻骨关节后遗症。

Objective: A retrospective analysis was in 21 patients of obstetric brachial plexus palsy (OBPP).The rupture and avulsion of brachial plexus were proved by operations. Methods:Nerve grafting was performed in 11 patients, nerve transfer in 10 cases.Results:The functions of shoulder and elbow after operation showed that the excellent and good rates were 76%, and the hands were bad for giving up the lower roots repaired. After phrenic nerves were transferred, the compensations of lung function were good.Conclusions: The timing of surgical intervention is based on evaluation for limb function, accompanying injuries, spontaneous recovery, Homer's sign, and electrodiagnosis.The outcome shows a correlation with extensive root lesion, the timing of surgical intervention and approach. Rehabilitation is encouraged to minimize sequels of OBPP.