产伤性臂丛神经上干神经瘤的早期治疗

Early management of obstetrical brachial plexus upper trunk neuroma

目的：探讨产伤性臂丛神经上干神经瘤的手术方式及时机。方法：２６例中１０例为出生后３个月，上干支配肌无肌力恢复的产瘫，行神经移位或移植术。另１６例年龄１．１～１．８岁，其上干支配肌肌力均为２级，行神经松解术。两组术中均行电生理检测，并对其治疗效果进行分析。结果：术中电刺激上干处神经瘤两组均有传导性。出生后３个月组平均随访１６．３个月，疗效优良者７例，占７０％。晚期神经松解组平均随访１９．８个月，肌力均无明显恢复。结论：出生后３个月肱二头肌肌力未恢复者应立即手术，不管术中电刺激神经有无传导性。

Objective: To investigate the proper surgical method and timing for the treatment of obstetrical palsy in which upper trunk neuroma was found to be conductive by intraoperative EMG study. Methods: Two operative fashions were used in 26 patients of upper trunk type OBPP. Neurolization or nerve grafting were operation of choise in 10 patients whose upper trunk innervating muscles didn't show any sign of recovery at 3 months of age. Another 16 patients underwent neurolysis when they were 1.1～1.8 year's old. The muscle power in this group was MRC grade two. Results: 7 cases of the 3 months' old group had a good to excellent result at a 16.3 months follow up period, amounting to 70%. The result of the later neurolysis group was not satisfying after 19.8 months of follow up. There was no obvious increment of the muscle power. Conclusions: Neurolysis can not improve the shoulder and elbow function while the better results were found after nerve transfer or grafting in the early stage. When there is no recovery of the biceps at 3 months after birth, surgical intervention is indicated. The neuroma of the upper trunk should be resected, and nerve transfer or nerve grafting be done even if the intraoperative EMG suggests conductibility of the neuroma.