产瘫的分型分度

目的 提出新的产瘫分类方法。方法 通过对358例产瘫的诊治，研究，按照损伤的解剖部位进行分型；按照损伤的程度进行分度。结果 本组358例产瘫均可用新的分型分度法进行,共分5型4度。结论 分型分度法是一种切实可行的新的产瘫分类方法，可以更好地指导产瘫的医，教，研工作。     

产瘫4型4度的分类

目的 修正产瘫分型分度后,使产瘫的新分类方法 更完善.方法 通过对389例产瘫的诊治、科研,按照损伤的解剖部位进行分型,按照损伤的程度进行分度.在原5型4度的分类基础上修正产瘫的分型分度为4型4度.结果 本组389例产瘫均可用新修正后的分型分度法进行分类,共4型4度.结论 分型分度法是一种切实可行的新的产瘫分类方法,可以更好地指导产瘫的医疗、教学及科研工作.修正后的分类使产瘫的分型分度方法 更加科学完善,更加全面实用.     

带蒂大圆肌双极移位重建产瘫肩外展功能

目的评价带蒂大圆肌双板移位重建分娩性臂丛神经损伤（产瘫）后肩外展功能的疗效及临床应用前景。方法对9例产瘫后肩外展功能障碍的患儿行带血管神经蒂大圆肌双极移位术重建肩外展功能,并经术后1年以上的随访,观察其临床应用效果。结果9例患儿术前肩外展平均11．2°（0°-30°）,术后肩外展平均75．4°（45°～95°）。按照顾玉东的评定标准评价：优3例,良4例,可2例,优良率为77．8％。结论对于产瘫后肩外展功能障碍者,用带血管神经蒂大圆肌双极移位术重建其肩外展功能是有效而值得临床推广的治疗方法。     

Bone discrepancy as a powerful indicator for early surgery in obstetric brachial plexus palsy

Objectives  

One of the unfortunate sequelae in obstetric brachial plexus palsy (OBPP) is upper limb length discrepancy. However, the influence of primary nerve reconstruction remains undetermined. In this study, the resultant discrepancy in children with OBPP who underwent primary reconstruction was analyzed in relation to the severity of the lesion, the timing of surgery, and the functional outcome following surgery.     

产瘫的早期显微外科治疗

目的报道产瘫早期显微外科治疗的经验及分型.方法总结临床发现产瘫类型,应用显微外科技术对产瘫早期进行神经松解、移植及移位手术治疗309例.结果随访二年以上168例,优良率82.35%.结论探讨产瘫临床分型及术式选择;早期诊断治疗很重要.     

Improvements after mod Quad and triangle tilt revision surgical procedures in obstetric brachial plexus palsy

AIM To compare outcomes of our revision surgical operations in obstetric brachial plexus palsy(OBPP) patients to results of conventional operative procedures at other institutions. METHODS We analyzed our OBPP data and identified 10 female and 10 male children aged 2.0 to 11.8 years(average age 6.5 years), who had prior conventional surgical therapies at other clinics. Of the 20 patients, 18 undergone triangle tilt, 2 had only mod Quad. Among 18 patients, 8 had only triangle tilt and 10 had also mod Quad as revision surgeries with us. We analyzed the anatomical improvements and functional modified Mallet statistically before and after a year post-revision operations.RESULTS Pre-revision surgery average modified Mallet score was 12.0 ± 1.5. This functional score was greatly improved to 18 ± 2.3(P 0.0001) at least one-year after revision surgical procedures. Radiological scores(PHHA and glenoid version) were also improved significantly to 31.9 ± 13.6(P 0.001),-16.3 ± 11(P 0.0002), at least one-year after triangle tilt procedure. Their mean pretriangle tilt(yet after other surgeon's surgeries) PHHA, glenoid version and SHEAR were 14.6 ± 21.7,-31.6 ± 19.3 and 16.1 ± 14.7 respectively.CONCLUSION We demonstrate here, mod Quad and triangle tilt assuccessful revision surgical procedures in 20 OBPP patients, who had other surgical treatments at other clinics before presenting to us for further treatment.     

神经松解与神经移植治疗Narakas II型产瘫的随访研究

目的探讨对比神经松解术与神经移植术对Narakas II型产瘫(OBPP)传导性神经瘤的治疗价值。方法纳入2009年1月至2014年12月行外科治疗的32例Narakas II型OBPP患儿。根据不同手术方法,分为神经松解组(15例)和神经移植组(17例),记录并比较患者的一般资料:性别、年龄、出生体重及病因等。术后通过门诊随访,采用Gilbert肩、肘关节和Raimondi手功能评定系统进行功能评价。应用方差分析和配对t检验进行数据分析,P<0.05为差异有统计学意义。结果两组患儿的一般情况相近(P>0.05);平均随访58.44个月,术后第4年神经松解组肩关节、肘关节和手部评分分别由术前(1.07±0.85)分、(2.07±0.77)分、(3.47±0.62)分提升到(3.00±0.73)分、(4.13±0.62)分、(4.53±0.72)分,手术前、后各评分差异有统计学意义(P<0.05),神经移植组分别由术前(0.76±0.73)分、(1.71±0.46)分、(3.71±0.67)分升高至(3.24±0.55)分、(4.29±0.46)分、(4.65±0.48)分,手术前、后各评分差异有统计学意义(P<0.05),两组间手术前、后的差异无统计学意义(P>0.05);神经移植和神经松解术组II期行功能重建手术的比例分别为73.33%、35.29%,手术部位中肩、肘关节分别占82.35%、17.65%。结论神经移植术对Narakas II型产瘫传导性神经瘤的疗效更显著。     

患侧颈7神经根移位治疗产瘫根性撕脱伤

目的 报道患侧C7神经根移位治疗根性撕脱伤性产瘫的临床效果。方法 将患侧C7在中干前后股处切断并移位与上干或下干远端缝合，治疗单纯上干或下干根性撕脱伤的产瘫患儿11例，其中上干损伤9例，下干损伤2例。结果 单纯上干损伤优5例，良3例，中2例，差1例。单纯下干损伤差2例。结论 患侧C7神经根移位是治疗单纯上干根性撕脱伤产瘫的较好方法，值得应用推广，但对单纯下干损伤的产瘫效果较差。     

Pediatric Evaluation of Disability Inventory: its application to children with obstetric brachial plexus palsy

PURPOSE: A standardized method of measurement of self-care ability in children with obstetric brachial plexus palsy (OBPP) has not been universally adopted. A study was conducted to determine if the Pediatric Evaluation of Disability Inventory (PEDI) was able to discriminate between the self-care ability of children with OBPP and their peers and distinguish between those with differing severities of OBPP. METHODS: The PEDI self-care domain results for 45 children with OBPP (30 without hand impairment, 15 with hand impairment) were reviewed retrospectively. RESULTS: The group performance of children without hand impairment was within 1 SD above the mean. The group performance of children with hand impairment was more than 2 SDs below the mean. The difference between the 2 groups was statistically significant. CONCLUSIONS: In this study children without hand impairment did not have a self-care activity limitation as measured by the PEDI. A deficit in self-care ability was found in those with hand impairment. The PEDI was able to differentiate between the performances of reported self-care activities of children with differing severities of OBPP; however, it was unable to discriminate between those without hand impairment and their peers. TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic, Level II.     

Prognosis following neonatal brachial plexus palsy: an evidence-based review

Purpose  

The spontaneous recovery rate of neonatal brachial plexus palsy (NBPP) is often cited as 75–95%. However, recent reports have found the recovery rate to be much lower. The purpose of this study was to perform an evidence-based review aimed at summarizing the available English language information regarding prognosis following NBPP based on the Narakas classification.     

Morphometric analysis of the association of primary shoulder reconstruction procedures with scapular growth in obstetric brachial plexus paralysis patients

Background

Obstetric brachial plexus paralysis (OBPP) has been associated with shoulder deformities, scapular growth, and shoulder function impairment. The absence of balanced muscular forces acting on the scapula has been considered responsible for scapula dysplasia and impaired growth as compared with the normal side. Scapula growth impairment may also lead to shoulder and upper extremity dysfunction. This study aims at showing the association of primary nerve reconstruction with the restoration of scapular bone growth potential.

Methods

This is a retrospective review of 73 patients with OBPP who underwent primary shoulder reconstruction. Patients were categorized for assessment and analysis into group A, global paralysis; group B, Erb’s palsy; and group C, Erb’s palsy with C7 root involvement. Scapular posteroanterior and lateral X-rays were obtained in which four scapula dimensions were manually measured. The growth discrepancy depending on the applied treatment was investigated.

Results

The highest improvement was noted in scapular height in the Erb’s palsy group who underwent simultaneous neurotization of the suprascapular and axillary nerves. The oblique axis was more improved in the Erb’s palsy group while both big and small widths were more improved in the Erb’s palsy with C7 root involvement group in patients who underwent concomitant neurotization of the suprascapular and the axillary nerves. Functional improvement correlated positively with growth improvement in all groups and scapular dimensions.

Conclusion

Scapula growth and shoulder function improvement were higher in patients with Erb’s palsy. Simultaneous axillary and suprascapular nerve neurotization provided the best outcome in both functional and growth restoration.     

Microsurgical repair and secondary surgery in obstetrical brachial plexus palsy

We present a personal experience with 750 children suffering from obstetrical brachial plexus palsy. The related surgery is described, including early microsurgical nerve reconstruction and secondary procedures including tendon and muscle transfers. The clinical examination, indications and timing for surgery, technical details of primary and secondary operations and the possible outcome are discussed. Both clinical and research work need an interdisciplinary team approach, and diagnostic, therapeutic and prognostic improvement is based on the refinements of microsurgical skills and the continuous exchange of information between specialized centers.     

Morphometric analysis of the effect of scapula stabilization on obstetric brachial plexus paralysis patients

Background

Scapular position and size deficiency is evident in obstetric brachial plexus paralysis (OBPP) patients due to the absence of balanced muscular forces acting on the scapula. Scapula stabilization (SS) procedures aim to restore a balanced musculature and anatomic position and to augment shoulder function and enhance developmental potential.

Methods

Retrospective chart review of 106 patients with OBPP between March 1979 and March 2007 was performed. Forty-one female and 27 male were included in the study. In 38 patients, the paralysis was global, 13 had Erb’s paralysis with C7 root involvement; in 18 patients, the lesion was limited to C5 and C6. X-rays were evaluated, and scapula dimensions were manually measured at several stages. Shoulder abduction (SA) and external rotation (SER) outcomes were also recorded.

Results

Mean improvement was 85.68° in shoulder abduction and 36.74° in shoulder external rotation. SA and SER improvement was significantly better in those who underwent SS procedures compared to those who did not (mean improvement was increased by 9.15° and 8.54°, respectively). Improvement was noted in all scapular dimensions, in all groups, postoperatively. However, the mean improvement in scapular height, big width, small width, and oblique axis discrepancies was 4.92, 14.04, 12.66, and 13.89 %, respectively, higher in patients who underwent SS procedures compared to those who did not.

Conclusion

Dimensional discrepancies and functional outcomes are improved by SS procedures. Maximal results are attained in patients who have undergone both primary and secondary shoulder reconstruction before age 2.     

Modified constraint-induced movement therapy during hospitalization in children with perinatal brachial plexus palsy: A randomized controlled trial

Study DesignProspective single-blind, randomized controlled study.IntroductionChildren with perinatal brachial plexus palsy (PBPP) have motion limitations in the affected upper extremity. Modified constraint-induced movement therapy (mCIMT) is one of the treatment options used for the improvement of the function of the affected limb.Purpose of the StudyThe purpose of this study was to compare the effect of mCIMT and conventional therapy in improving active range of motion (ROM) and functional use of the affected upper extremity in children with PBPP with injuries to upper and middle trunks in the hospital environment.Materials26 patients received conventional rehabilitation program (control group) and 13 patients participated in a mCIMT program (study group). Children had a mean age 56.3 months (range 4-10 years). The mCIMT included 1 hour therapy sessions emphasizing the affected arm use for 14 consecutive days during hospitalization. Their normal arm was also constrained for 6 hour per day. All the patients were assessed at the baseline, one day, one month, and three months after completion of therapy using active ROM, active movement scale, hand dynamometer, box and blocks test.ResultsThe mCIMT group improved more than the control group in shoulder internal rotation, forearm supination, elbow flexion active ROMs, hand grip strength, and in upper extremity function.ConclusionmCIMT has a potential to promote functional gains for children with PBPP; this approach should be widely applied within routine clinical practice.     

产瘫节前损伤体感诱发电位的改变及治疗

目的：报道产瘫节前损伤早期诊断及早期手术的疗效。方法：16例患儿在术前应用体感诱发电位（SEP）测定，节前损伤的诊断一旦明确，尽早行神经移位术。结果：随访2-5年，优31.25％，良43.75％，中12.5％，差12.5％。结论：SEP是诊断产瘫节前损伤的可靠方法，早期显微外科手术治疗产瘫节前损伤非常必要。