Department of Orthopedics and Traumatology, Reconstructive Microsurgery Unit, Assiut University School of Medicine, Assiut 71526, Egypt.
Microsurgery. 2010;30(3):169-78. doi: 10.1002/micr.20726.
From 2000 to 2006, 35 infants with total obstetric brachial plexus palsy underwent brachial plexus exploration and reconstruction. The mean age at surgery was 10.8 months (range 3-60 months), and the median age was 8 months. All infants were followed for at least 2.5 years (range 2.5-7.3 years) with an average follow-up of 4.2 years. Assessment was performed using the Toronto Active Movement scale. Surgical procedures included neurolysis, neuroma excision and interposition nerve grafting and neurotization, using spinal accessory nerve, intercostals and contralateral C7 root. Satisfactory recovery was obtained in 37.1% of cases for shoulder abduction; 54.3% for shoulder external rotation; 75.1% for elbow flexion; 77.1% for elbow extension; 61.1% for finger flexion, 31.4% for wrist extension and 45.8% for fingers extension. Using the Raimondi score, 18 cases (53%) achieved a score of three or more (functional hand). The mean Raimondi score significantly improved postoperatively as compared to the preoperative mean: 2.73 versus 1, and showed negative significant correlation with age at surgery. In total, obstetrical brachial plexus palsy, early intervention is recommended. Intercostal neurotization is preferred for restoration of elbow flexion. Tendon transfer may be required to improve external rotation in selected cases. Apparently, intact C8 and T1 roots should be left alone if the patient has partial hand recovery, no Horner syndrome, and was operated early (3- or 4-months old). Apparently, intact nonfunctioning lower roots with no response to electrical stimulation, especially in the presence of Horner syndrome, should be neurotized with the best available intraplexal donor.
从 2000 年到 2006 年，35 名完全性产科臂丛神经损伤婴儿接受了臂丛神经探查和重建手术。手术时的平均年龄为 10.8 个月（3-60 个月），中位数为 8 个月。所有婴儿至少随访 2.5 年（2.5-7.3 年），平均随访 4.2 年。使用多伦多主动运动量表进行评估。手术程序包括神经松解、神经瘤切除和神经移植，使用副神经、肋间神经和对侧 C7 神经根。肩关节外展恢复满意的占 37.1%；肩关节外旋 54.3%；肘关节屈曲 75.1%；肘关节伸展 77.1%；手指屈曲 61.1%；腕关节伸展 31.4%；手指伸展 45.8%。根据 Raimondi 评分，18 例（53%）达到 3 分或以上（功能手）。术后 Raimondi 评分明显高于术前平均评分：2.73 比 1，与手术年龄呈负相关。总的来说，建议对产科臂丛神经损伤进行早期干预。肋间神经化是恢复肘关节屈曲的首选方法。在选定的病例中，可能需要肌腱转移来改善外旋。如果患者手部部分恢复、无霍纳综合征且手术早期（3-4 个月龄），则应保留明显完整的 C8 和 T1 根，而不进行神经化。如果存在霍纳综合征且电刺激无反应的情况下，明显完整的无功能下根，应使用最佳的丛内供体进行神经化。
