Goubier Jean-Noël, Teboul Frédéric, Papadogeorgou Ellada
International Center of Hand Surgery, clinique du parc Monceau, 21 rue de Chazelles, 75017 Paris, France.
Microsurgery. 2008;28(2):117-20. doi: 10.1002/micr.20461.
Brachial plexus trauma is a rare condition in children except for obstetrical lesions, for which nerve grafting is generally proposed. Two children (9 and 12 years old) with C5 and C6 traumatic brachial plexus avulsion lesions are presented, where elbow flexion and shoulder abduction and external rotation were the functions to be restored. Nerve transfers have been performed. Shoulder abduction was restored by an accessory-to-suprascapular nerve transfer in one patient, while the triceps long head motor branch was transferred to the axillary nerve in both patients. Fascicles of the ulnar and median nerve were transferred respectively to the biceps muscle nerve and the brachialis motor branch. At 11 months follow-up, the elbow flexion scored M4 and the shoulder abduction recovered in both patients. No complications were observed. Nerve transfers currently used in adult patients may be applied in children with traumatic partial brachial plexus palsies.
除产科损伤外,臂丛神经损伤在儿童中较为罕见,对于此类损伤通常建议进行神经移植。本文介绍了两名患有C5和C6创伤性臂丛神经撕脱伤的儿童(分别为9岁和12岁),其需要恢复的功能为屈肘、肩外展和外旋。已进行了神经移位手术。一名患者通过副神经至肩胛上神经移位恢复了肩外展功能,而两名患者均将肱三头肌长头运动支移位至腋神经。尺神经和正中神经的束支分别移位至肱二头肌神经和肱肌运动支。随访11个月时,两名患者的屈肘功能均评分为M4,肩外展功能均已恢复。未观察到并发症。目前在成人患者中使用的神经移位方法可应用于创伤性部分臂丛神经麻痹的儿童患者。