Hale Holly B, Bae Donald S, Waters Peter M
Department of Orthopaedic Surgery, Children's Hospital Boston, Boston, MA 02115, USA.
J Hand Surg Am. 2010 Feb;35(2):322-31. doi: 10.1016/j.jhsa.2009.11.026.
Brachial plexus birth palsy, although rare, may result in substantial and chronic impairment. Physiotherapy, microsurgical nerve reconstruction, secondary joint corrections, and muscle transpositions are employed to help the child maximize function in the affected upper extremity. Many present controversies regarding natural history, microsurgical treatment, and secondary shoulder reconstructive surgery remain unresolved in infants with brachial plexus birth palsies. Recent literature has enhanced our understanding of the pathoanatomy and natural history of the injury as well as the surgical indications, expected outcomes, and complications; this literature has led to improved care of these patients. Based on the present evidence, recommendations for both microsurgery and shoulder reconstruction with tendon transfer and arthroscopic and open reductions are presented.
臂丛神经产瘫虽然罕见，但可能导致严重的慢性功能障碍。物理治疗、显微外科神经重建、二期关节矫正和肌肉转位术被用于帮助患儿最大限度地恢复患侧上肢的功能。关于臂丛神经产瘫患儿的自然病程、显微外科治疗及二期肩部重建手术，目前仍存在诸多争议，尚无定论。近期的文献增进了我们对该损伤的病理解剖、自然病程以及手术指征、预期疗效和并发症的认识；这些文献推动了对这些患者的治疗改进。基于现有证据，本文提出了关于显微外科手术以及采用肌腱转位、关节镜下复位和切开复位进行肩部重建的建议。
