分娩性臂丛神经麻痹的诊治

分娩性臂丛神经麻痹(obstetric brachial plexus palsy，OBPP)简称产瘫，主要是指在分娩过程中胎儿的一侧或双侧臂丛神经因受到头肩分离暴力作用而发生的牵拉性损伤。临床上曾长期盛行保守治疗的观点。近20年来广泛开展的显微神经修复技术使产瘫的预后得到了很大的改善，从而确立了早期手术在产瘫治疗中的价值。目前产瘫的临床及相关基础研究已成为国际手外科学界关注的热点之一。     

婴幼儿童分娩性臂丛神经损伤及其进展

婴幼儿童分娩性臂丛神经损伤通常称为产瘫。根据Evans—Jonest于20世纪90年代末期进行的包括英国及爱尔兰的全国性流行病学调查,新生儿产瘫的发生率为0.42／1000。尽管这是一种少见的损伤,却是导致儿童上肢残疾的主要原因之一,一直受到相关专业医师的重视。然而,由于分娩引起的臂丛神经损伤,在损伤范围、部位和性质等方面有所不同,其自然病史或者自然恢复的几率存在很大的差别,据文献报告,其自然恢复率在3％-72．6％,因此,对婴幼儿童分娩性臂丛神经损伤是否需要早期外科治疗、早期外科治疗的指征及时机。不同学者之间尚有分歧。     

小儿臂丛神经阻滞麻醉中神经损伤的防治

1993年10月—2002年7月，我院施行小儿臂丛神经阻滞麻醉106例，其麻醉径路包括肌间沟、腋路、锁骨上三种。在这些不同臂丛神经麻醉径路中均有发生不同神经损伤。待麻醉药物作用消失后表现为活动不利、酸胀、握力减弱，个别患者在麻醉后的近几年内遇寒冷时仍有前述症状。其损伤原     

肌电生物反馈疗法对新生儿分娩性臂丛神经损伤的疗效分析

目的初步评价肌电生物反馈疗法对新生儿分娩性臂丛神经损伤的临床疗效。方法对湖南省儿童医院162例新生儿分娩性臂丛神经损伤患儿的临床资料进行回顾性分析,按照患儿家长是否接受并全程配合肌电生物反馈治疗将受试者分为观察组及对照组;对照组采用运动疗法、早期手功能训练及针刺等进行综合康复治疗,观察组在对照组基础上添加肌电生物反馈治疗,一个疗程(3个月)结束后针对两组患儿各项临床症状评分(评分越高代表相应临床表现越明显)及神经肌电图CMAP变化情况进行对比。结果两组接受治疗后临床症状评分均较治疗前显著降低(P 0. 05);从治疗后评分来看,观察组临床症状评分显著低于对照组(P 0. 05),观察组中上干型及下干型临床症状评分明显低于对照组(P 0. 05),而两组全干型临床症状评分无明显差异(P0. 05)。观察组临床疗效总有效率及肌电图CMAP变化率高于对照组(P 0. 05),观察组全干型临床有效率及肌电图CMAP恢复有效率均高于对照组(P 0. 05),两组上干型及下干型则无明显差异(P0. 05)。结论肌电生物反馈疗法治疗新生儿分娩性臂丛神经损伤效果总体满意,值得临床积极推广。     

肌电图联合磁共振诊断新生儿臂丛神经损伤的应用

目的 探讨神经肌电图及MRI在诊断新生儿臂丛神经损伤中的特点及应用.方法对30例临床诊断臂丛神经损伤的新生儿进行肌电图检查,测定臂丛神经的五大分支神经传导及其所主要支配肌肉的肌电活动,同时完善臂丛神经MRI检查,对比分析两种检查结果.结果 肌电图提示上(中)干型损害25例(83.3%),全干型4例(13.3%),下干型1例(3.3%),节前受累6例(20%),完全性损伤7例(23.3%),不完全损伤23例(76.7%).MRI提示节前损伤7例(23.3%),其中上(中)臂丛型损害5例(16.7%),全臂丛型1例(3.3%),下臂丛型损伤1例(3.3%).结论 神经肌电图与MRI在臂丛神经损伤定位上均有良好的提示作用,但对于轻度不完全损伤,肌电图检测结果更佳,二者联合能更好地进行诊断.     

儿童癫痫的手术治疗

目的 总结分析儿童期顽固性癫痫手术治疗效果和经验。方法 回顾性分析2001年7月～2002年11月在我科接受手术治疗的25例14岁以下的顽固性癫痫病例，统计患儿的发病、检查及手术治疗情况，手术方式的选择应依据患儿术前脑电图与术中脑电图的定位情况而进行。结果 本组25例患儿，年龄3～14岁，病程平均5．3年，影像学异常9例，占36．0％(9／25)，智商明确缺陷12例，占48．0％(12／25)，以强直一痉挛性发作为主16例，占64．0％(16／25)。病灶位于额叶10例，占40．0％(10／25)，颞叶6例，占24．0％(6／25)，额颞叶5例，占20．0％(5／25)，顶叶和枕叶各2例，占8.0％(2／25)。手术行病灶切除及前颢叶切除11例，占44．0％(11／25)，选择性海马一杏仁核切除4例，占16．0％(4／25)，胼胝体切开15例，占60.0％(15／25)，单纯多处软膜下横切2例，占8，0％(2／25)。术后出现一过性对侧轻瘫4例，一过性语言不利2例。术后疗效满意23例占92.0％(23／25)，显著改善1例占4.0％(1／25)，良好1例占4．0％(1／25)。结论 合理的选择手术方式，对儿童期顽固性癫痫手术治疗，手术效果良好，非常安全。     

小剂量氯胺酮、咪唑安定辅助臂丛用于小儿上肢手术体会

小儿上肢手术中，臂丛阻滞常因不易取得小儿配合被迫改为全麻。在临床实践中，我们将小剂量氯胺酮、咪唑安定辅助臂丛用于小儿上肢手术，效果满意，现总结资料报告如下。     

分娩性臂丛损伤后的肩外展及外旋功能重建

目的评价斜方肌和(或)背阔肌移位术重建分娩性臂丛神经损伤(产瘫)后肩外展及外旋功能的疗效及临床应用前景.方法对34例产瘫后肩外展及外旋功能障碍的患儿行斜方肌和(或)背阔肌移位术并经术后1年以上的随访.34例中25例行单纯背阔肌移位术以重建肩袖功能,另9例行背阔肌及斜方肌的组合式移位以同时重建三角肌功能.采用Gilbert肩关节功能5级评定法作术后评价.结果25例行单纯背阔肌移位者,肩外旋功能均有较明显的改善,但外展功能仅13例有明显改善,另12例改善不显著(Gilbert分级无进步);9例行斜方肌背阔肌组合式移位者,8例肩外展及外旋功能均有明显的改善,仅1例无效.结论对于产瘫的肩外展及外旋功能障碍者,若术前外展达到90°以上,则可仅行背阔肌移位术,否则应行背阔肌与斜方肌的组合移位重建其肩外展及外旋功能.     

Using Contingent Reinforcement to Augment Muscle Activation After Perinatal Brachial Plexus Injury: A Pilot Study

Aim: Examine the feasibility of increasing muscle activation with electromyographically (EMG)-triggered musical-video as reinforcement for children with perinatal brachial plexus injury (PBPI). Methods: Six children with PBPI (9.3 ± 6.3 months; 5 female, 1 male) and 13 typically developing (TD) controls (7.8 ± 3.5 months; 4 female, 9 males) participated. The left arm was affected in 5/6 children with PBPI. We recorded the integral (Vs) of biceps activation with surface EMG during two conditions per arm in one session: (1) 100 second (s) baseline without reinforcement and (2) 300 s reinforcement (musical-video triggered to play with biceps activation above threshold [V]). We examined the relation between the mean integral with reinforcement and hand preference. Results: Mean biceps activation significantly increased from baseline in the affected arm of the group with PBPI by the 2nd (p < .008) and 3rd (p < .0004) 100 s intervals of reinforcement. Six of 6 children with PBPI and 12/13 TD controls increased activation in at least one arm. A lower integral was linked with hand preference for the unaffected right side in the PBPI group. Conclusion: This study supports contingent reinforcement as a feasible method to increase muscle activation. Future work will examine training dose and intensity to increase arm function.     

Cause and Effect of Obstetric (Neonatal) Brachial Plexus Palsy

ABSTRACT. We have studied the causes and outcome of obstetric brachial plexus palsy in all children born in Malmö during the 10-year period 1973–1982. Forty-eight of 25736 live-bom children (0.19%) were neonatally diagnosed as having a brachial plexus paresis. Twenty-five percent of these, i.e., one child in 2000 liveborn, had a persistent palsy. The obstetric history was characterized by high birthweight, vertex presentation with shoulder dystocia and multiparity; and in two cases the mother had two children with brachial palsy. The children who recovered totally did so during the first few months. The prognosis for the more common upper brachial plexus, or Erb's, was more favorable than that for entire brachial plexus palsy. All the children with persistent palsy were afflicted with considerable reduction in arm function, resulting in varying degrees of handicap, such as not being able to use the palsied arm at all or not being able to perform certain tasks—writing properly, playing a musical instrument, doing the hair, wearing clothing with shoulder straps, etc. We wish to point out that, in several cases, obstetric brachial plexus palsy results in a lifelong handicap and that prevention and therapy are essential both in obstetric and in pediatric management.     

A Rare Case of Congenital Choroid Plexus Carcinoma

We report a 1-year-old child with the prenatal (week 29 + 5) diagnosis of a brain tumor. The parents were informed about all aspects of prognosis and options concerning termination of pregnancy. The parents opted for an aggressive therapeutic approach after extensive and informative case conferences and counseling. The histopathological diagnosis after partial tumor resection was choroid plexus carcinoma, two weeks thereafter tumor size was progressive. The parents opted for palliative treatment at this stage. The patient died at the age of one year. Ethical aspects have to be actively considered and addressed when caring for children with choroid plexus carcinoma.     

Diagnostic performance of MRI and MR myelography in infants with a brachial plexus birth injury

Background Detailed evaluation of a brachial plexus birth injury is important for treatment planning. Objective To determine the diagnostic performance of MRI and MR myelography in infants with a brachial plexus birth injury. Materials and methods Included in the study were 31 children with perinatal brachial plexus injury who underwent surgical intervention. All patients had cervical and brachial plexus MRI. The standard of reference was the combination of intraoperative (1) surgical evaluation and (2) electrophysiological studies (motor evoked potentials, MEP, and somatosensory evoked potentials, SSEP), and (3) the evaluation of histopathological neuronal loss. MRI findings of cord lesion, pseudomeningocele, and post-traumatic neuroma were correlated with the standard of reference. Diagnostic performance characteristics including sensitivity and specificity were determined. Results From June 2001 to March 2004, 31 children (mean age 7.3 months, standard deviation 1.6 months, range 4.8–12.1 months; 19 male, 12 female) with a brachial plexus birth injury who underwent surgical intervention were enrolled. Sensitivity and specificity of an MRI finding of post-traumatic neuroma were 97% (30/31) and 100% (31/31), respectively, using the contralateral normal brachial plexus as the control. However, MRI could not determine the exact anatomic area (i.e. trunk or division) of the post-traumatic brachial plexus neuroma injury. Sensitivity and specificity for an MRI finding of pseudomeningocele in determining exiting nerve injury were 50% and 100%, respectively, using MEP, and 44% and 80%, respectively, using SSEP as the standard of reference. MRI in infants could not image well the exiting nerve roots to determine consistently the presence or absence of definite avulsion. Conclusion In children younger than 18 months with brachial plexus injury, the MRI finding of pseudomeningocele has a low sensitivity and a high specificity for nerve root avulsion. MRI and MR myelography cannot image well the exiting nerve roots to determine consistently the presence or absence of avulsion of nerve roots. The MRI finding of post-traumatic neuroma has a high sensitivity and specificity in determining the side of the brachial plexus injury but cannot reveal the exact anatomic area (i.e. trunk or division) involved. The information obtained is, however, useful to the surgeon during intraoperative evaluation of spinal nerve integrity for reconstruction.     

Aspects of activities and participation in daily life related to body structure and function in adolescents with obstetrical brachial plexus palsy: a descriptive follow-up study

AIM: To analyse whether activities and participation in daily life differed between adolescents with obstetrical brachial plexus palsy (OBPP) and their able-bodied peers. METHOD: Fifty-one teenagers born in 1985-1987 with OBPP and a comparison group consisting of 116 age-matched adolescents in a socioeconomically and socioculturally representative area answered a self-report questionnaire concerning their daily life, school performance and friendships. The OBPP group was divided into three functional groups according to the degree of severity of the OBPP. RESULTS: Subjects with OBPP had interests, activities and a social life very similar to those of the teenagers in the comparison group. Differences were, however, found in self-esteem for sport/motor activities, with self-esteem being significantly lower in teenagers with the most severe type of OBPP. The OBPP groups were concerned about the risks for their affected and unaffected limb. CONCLUSION: In our society, adolescents with OBPP report a typical teenage life today. However, the indications for distress and worry related to the disability have to be considered.     

儿童肱动脉假性动脉瘤一例并文献复习

目的:报道1例儿童肱动脉假性动脉瘤的诊疗,并回顾相关文献总结此类疾病的病因、诊治及预后。方法:回顾性分析了2019年6月1例16天新生儿的左上肢肱动脉假性动脉瘤的临床资料。本例患儿出生后6d发现逐渐增大的左肘部包块。B型超声、左上肢MRI及CTA提示左肱动脉假性动脉瘤。经局部加压包扎治疗,包块持续增大并出现表面皮肤坏死...     

Function in unaffected arms of children with obstetric brachial plexus palsy

Objective

The objective is to compare the fine and gross motor function of unaffected arms of children with obstetric brachial plexus palsy (OBBP) with typically developing children's dominant upper extremities.