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。

The clinical outcome of Narakas II obstetric brachial plexus palsy by neurolysis and never grafting

Objective To explore the efficacy of neurolysis or nerve grafting in the treatment of the conducting neuroma of Narakas II obstetric brachial plexus palsy (OBPP), and provide the reference basis for choosing an optimal method.Methods From January, 2009 to December, 2014, 32 patients undergoing surgical treatment due to Narakas II OBPP were included in this study. Neurolysis was performed in 15 patients, and the procedure of nerve grafting was performed in 17 patients. The general information included gender, age, birth weight, injury cause, etc. were recorded and compared to each other between 2 groups. A followed-up study had been conducting after surgery, the functional rating systems of Gilbert and Raimondi were used for quantitative comparison between preoperative function and postoperative function of shoulder joint, elbow joint and hand. In addition, the differences of the measurement data were compared with the single factor analysis of variance and paired t-test by using SPSS 22.0 statistical software. When P<0.05, it was considered statistically significant.Results There was no statistically significant difference in the baseline information between 2 groups (P>0.05). The average time of follow-up was 58.44 (48-96) months. And the fourth year' average score of shoulder joint, elbow joint, hand of the neurolysis group improved from preoperative (1.07±0.85) , (2.07±0.77) and (3.47±0.62) score to (3.00±0.73), (4.13±0.62) and (4.53±0.72) score (P<0.05), and the nerve grafting group rose from an average of (0.76±0.73), (1.71±0.46) and (3.71±0.67) score to (3.24±0.55), (4.29±0.46) and (4.65±0.48) score (P<0.05). But the different score between 2 groups was no statistically significant (P>0.05), respectively. In addition, the proportion of the patients who needed the secondary operation about functional reconstruction in the neurolysis group and the nerve grafting group was 73.33% and 35.29% respectively, besides the proportion of the shoulder joint and elbow joint in the surgical sites accounted for 82.35%, 17.65% respectively.Conclusion Nerve grafting is a better choice for the treatment of conducting neuroma of Narakas II OBPP at present.