Bahm Jörg, Ocampo-Pavez Claudia, Disselhorst-Klug Catherine, Sellhaus Bernd, Weis Joachim
Arbeitsbereich Plastische und Handchirurgie, Franziskushospital Aachen, Aachen, Germany.
Dtsch Arztebl Int. 2009 Feb;106(6):83-90. doi: 10.3238/arztebl.2009.0083. Epub 2009 Feb 6.
Obstetric brachial plexus palsy is rare, but the limb impairments are manifold and often long-lasting. Physiotherapy, microsurgical nerve reconstruction, secondary joint corrections, and muscle transpositions are employed with success. The role of conservative and operative treatment options should be regularly reviewed.
Selective literature review (evidence levels 3 and 4) and analysis of personal clinical operative and scientific experience over the past 15 years.
Children with upper and total plexus palsy displaying nerve root avulsions and/or -ruptures are treated today by early primary nerve reconstruction in the first few months of life followed by secondary corrections, with good functional results. The late complications, with muscle weakness, impaired motion patterns, and joint dysplasia, are often underrated.
The potential for scientific analysis is limited, due to the rarity and interindividual variability of the lesions and the varying effects on function and growth. Expectations and compliance are different in every patient. Surgical techniques are not yet standardized. Knowledge of the consequences for joint growth and congruence is inadequate. Today, functional improvement can be achieved by surgery in most clinical manifestations of obstetric brachial plexus palsy, within the framework of an interdisciplinary treatment concept.
产科臂丛神经麻痹较为罕见，但肢体损伤多种多样且往往持续时间较长。物理治疗、显微外科神经重建、二期关节矫正和肌肉转位等方法取得了成功。应定期评估保守治疗和手术治疗方案的作用。
进行选择性文献综述（证据等级为3和4），并分析过去15年个人的临床手术和科研经验。
如今，患有上丛和全丛麻痹且伴有神经根撕脱和/或断裂的儿童，在出生后的头几个月接受早期一期神经重建，随后进行二期矫正，功能恢复良好。肌肉无力、运动模式受损和关节发育异常等晚期并发症常常被低估。
由于病变的罕见性、个体差异以及对功能和生长的不同影响，科学分析的潜力有限。每个患者的期望和依从性各不相同。手术技术尚未标准化。对关节生长和一致性的后果了解不足。如今，在跨学科治疗理念的框架内，通过手术可在大多数产科臂丛神经麻痹的临床表现中实现功能改善。
