膈神经移位治疗产瘫节前损伤

目的 总结临床膈神经移位治疗产瘫节前损伤的疗效及其对肺功能的影响。方法 本组16例，皆在全麻下行膈神经移位修复撕脱的臂丛神经，术后观察膈神经移位后患儿上肢功能恢复及呼吸功能情况。结果 随访2～6年，按照Mallet评分标准评定膈神经移位功能恢复情况，优5例，良7例，可3例，差1例，优良率75％，3个月以内优良率80％。11例呼吸平稳；4例呼吸急促，术后1周平稳；1例发生肺炎，经治疗10余天后呼吸平稳。结论 早期膈神经移位治疗产瘫节前损伤疗效满意，肥胖及体弱新生儿膈神经移位时需慎重，切取一侧嗝神经对患儿呼吸功能无明显影响。

Phrenic nerve transfer for preganglionic injuries of brachial plexus in obstetrical palsy

Objective To summarize the results of phrenic nerve transfer in treatment of preganglionic injuries of brachial plexus in obstetrical palsy and its effect on respiratory function in babies. Methods 16 child cases underwent phrenic nerve transfer for avulsion of brachial plexus under general anaesthesia. The systematic conditions of the babies after operation were observed. Results After follow ups of 2 to 6 years,Mallet scoring system was used to evaluate the results. 5 cases were rated as excellent, 7 good, 3 fair and 1 poor. The total excellent and good function rate was 75%, while the excellent and good rate for the 10 cases who underwent operation 3 months old reached 80%. The respiratory function was steady in 11 cases. 4 cases experienced tachypnoea but recovered to normal after one week therapy. 1 case was afflicted with pneumonia but the breathing turned to normal after 10 days therapy. Conclusions Satisfactory outcomes can be achieved if phrenic nerve transfer is performed at an early stage for preganglionic injuries in obstetrical palsy, but it must be done with caution for fat or feeble babies. The respiratory function of the baby will not be affected if one side of phrenic nerve is cut off.