Al-Qattan M M
Department of Surgery, King Khalid University Hospital, King Saud University, PO Box 18097, Riyadh 11415, Saudi Arabia.
Ann Plast Surg. 2003 Sep;51(3):257-64; discussion 265. doi: 10.1097/01.SAP.0000063750.16982.E4.
A review of the English literature revealed that only two birth palsy centers have specifically reviewed their experience with obstetrical palsy associated with breech delivery. The aim of this paper is to review the author's center's experience with birth palsy associated with breech delivery, compare their epidemiological and surgical findings with previous studies, and describe their management approach to this unique injury. A total of 34 limbs were studied. Erb's palsy was seen in 32 limbs and total palsy was seen in the remaining 2 limbs. The mean birth weight was low (2.3 kg). Six patients had bilateral lesions and 3 patients had phrenic nerve palsy. In their center, the indication for primary brachial plexus exploration is the lack of active elbow flexion against gravity at 4 months of age. A study of the natural history showed that 58% of limbs had full spontaneous recovery, 21% had good but partial recovery, and the prognosis was considered to be poor in the remaining 21% of limbs because active elbow flexion was not evident by 4 months of age. Intraoperatively, the usual lesion was C5/C6 avulsion or avulsion in situ, which seemed to be specific for breech deliveries. Their approach for management is described, including the role of Oberlin's ulnar nerve to biceps nerve transfer in these cases. Finally, the lack of contractures at the shoulder and elbow in these patients are explained.
对英文文献的回顾显示，仅有两家产瘫治疗中心专门回顾了其与臀位分娩相关的产瘫治疗经验。本文旨在回顾作者所在中心与臀位分娩相关的产瘫治疗经验，将其流行病学和手术结果与既往研究进行比较，并描述针对这种独特损伤的治疗方法。共研究了34条肢体。32条肢体为臂丛上干型麻痹，其余2条肢体为全臂丛麻痹。平均出生体重较低（2.3千克）。6例患者为双侧病变，3例患者伴有膈神经麻痹。在他们的中心，4个月大时不能主动对抗重力屈曲肘部是一期臂丛探查的指征。一项关于自然病程的研究表明，58%的肢体完全自发恢复，21%的肢体恢复良好但不完全，其余21%的肢体预后较差，因为4个月大时仍未出现明显的主动肘部屈曲。术中，常见病变为C5/C6撕脱或原位撕脱，这似乎是臀位分娩所特有的。文中描述了他们的治疗方法，包括在这些病例中使用奥伯林尺神经转位至肱二头肌的作用。最后，解释了这些患者肩部和肘部未出现挛缩的原因。
