Buljina A, Zubcević S, Catibusić F
Pedijatrijska klinika, Klinicki centar Univerziteta u Sarajevu.
Med Arh. 2000;54(5-6):283-4.
Although birth-related brachial plexus injury (BPI) was first described more than two centuries ago, it still represents therapeutic dillemma. Incidence is 0.37-2.0 per 1000 live births. The most frequent etiologic cause is extreme lateral traction and excessive fundal pressure in a case of shoulder dystocia. However, in last decade there are reports that cite of BPIs occurring prior to delivery in up to 46% cases--intrauterine maladaptation. In 1998. and 1999. at the Rehabilitation Department of Pediatric Hospital, Clinical University Center in Sarajevo 32 children with BPI were treated. The incidence is 2.67 per 1000 live births. There were 21 cases of Erb's palsy (65.63%), 2 cases of Klumpke's palsy (6.25%). Total plexus palsy was present in 9 children (28.63%), and Horner's Syndrome in 1 case. In 25.77% of cases (8 children) there was-no evidence of shoulder dystocia at delivery. Treatment of the brachial plexus injuries in newborn is still controversial. Proper immobilization in first 7-15 days is of great importance. In this study 25 children (78.13%), in average age of 4.6 days, were brought for examination with improper immobilization. The role of widely applied electrotherapy is controversial. Complete recovery is expected in about one half, and in this study it was achieved in 75% of cases (24 children). Consensus about timing od surgical approach does not exist still. However, there is strong agreement that decision about eventual surgical treatment should be based on clinical motor testing and that MRI should precede the surgery. Although the electrodiagnostic studies have proven to be of limited prognostic value in the evaluation of children with acute obstetrical brachial plexus injuries, electromyography should be performed prior the surgery in the aim of later comparison of the results. According to our data, at this particular moment in BiH surgical treatment in this age is not available, as well as use of MRI in diagnostics of BPIs.
尽管与分娩相关的臂丛神经损伤(BPI)早在两个多世纪前就被首次描述,但它仍然是一个治疗难题。发病率为每1000例活产中有0.37 - 2.0例。最常见的病因是肩难产时的极端侧向牵引和过度的宫底压力。然而,在过去十年中,有报告称高达46%的病例在分娩前就发生了BPI——宫内适应不良。1998年和1999年,在萨拉热窝临床大学中心儿童医院康复科,治疗了32例臂丛神经损伤患儿。发病率为每1000例活产中有2.67例。有21例埃尔布氏麻痹(65.63%),2例克伦佩克氏麻痹(6.25%)。9名儿童(28.63%)出现全丛性麻痹,1例出现霍纳综合征。25.77%的病例(8名儿童)在分娩时没有肩难产的证据。新生儿臂丛神经损伤的治疗仍然存在争议。在最初7 - 15天进行适当的固定非常重要。在本研究中,25名儿童(78.13%)平均年龄为4.6天,因固定不当前来检查。广泛应用的电疗法的作用存在争议。预计约一半的患儿能完全康复,在本研究中,75%的病例(24名儿童)实现了完全康复。关于手术时机的共识仍然不存在。然而,人们强烈一致认为,最终手术治疗的决定应基于临床运动测试,并且在手术前应进行磁共振成像(MRI)检查。尽管电诊断研究已被证明在评估急性产科臂丛神经损伤患儿时预后价值有限,但为了便于后期结果比较,在手术前应进行肌电图检查。根据我们的数据,在波斯尼亚和黑塞哥维那(BiH)这个特定时刻,这个年龄段无法进行手术治疗,也无法使用MRI诊断BPI。