Department of Traumatology, Clinic of Traumatology and Hand Surgery, Wroclaw Medical University, Poland.
Folia Neuropathol. 2011;49(3):197-203.
The aim of the study was to evaluate the surgical treatment results of cases of perinatal brachial plexus palsy with presence of neuroma-in-continuity. Clinical material included 21 children, aged from 3.5 to 36 months, treated surgically between 1996 and 2005. The control examination included 19 children. The shortest postoperative observation period was 4 years. After surgical treatment during clinical evaluation of function dependent on localization of neuroma-in-continuity we observed the following: in upper injury in 1 child good shoulder and elbow function; in upper-middle injuries with neuroma-in-continuity in upper trunk good elbow function in 66.6%, good shoulder function in 83.3% of cases; in upper-middle injuries with neuroma-in-continuity in upper and middle trunk in 1 examined child good function of elbow, shoulder, and wrist; in total injuries with neuroma-in-continuity in upper trunk good elbow function in 75%, and good shoulder function in 50% of cases; in total injuries with neuroma-in-continuity in upper and middle trunk good elbow function in 66.6%, good shoulder function in 33.3%, good wrist function in 66.6% of cases; in total injuries with neuroma-in-continuity in lower trunk grade 2 of motor hand function and return of sensibility to a level of S3+.
The choice of microsurgical technique during surgical treatment of perinatal brachial plexus palsies with neuroma-in-continuity should be based on the whole clinical and intraoperative view. The best results after neurolysis should be expected when neuroma-in-continuity is localized in the upper trunk, the injury corresponds to third degree on Sunderland's scale, and during electric stimulation a normal motor response can be obtained.
研究旨在评估存在神经瘤连续性的围产期臂丛神经麻痹病例的手术治疗效果。
纳入 1996 年至 2005 年间手术治疗的 21 例年龄 3.5 至 36 个月的儿童。对照组包括 19 例儿童。最短的术后观察期为 4 年。术后，根据神经瘤连续性的定位对功能进行临床评估，我们观察到：在上部损伤中，1 例患儿肩部和肘部功能良好；在上部和中部损伤中，若神经瘤连续性位于上干，66.6%的患儿肘部功能良好，83.3%的患儿肩部功能良好；在上部和中部损伤中，若神经瘤连续性位于上干和中干，1 例患儿肘部、肩部和腕部功能良好；在完全性上干神经瘤连续性损伤中，75%的患儿肘部功能良好，50%的患儿肩部功能良好；在上部和中部干完全性神经瘤连续性损伤中，66.6%的患儿肘部功能良好，33.3%的患儿肩部功能良好，66.6%的患儿腕部功能良好；在完全性下干神经瘤连续性损伤中，手部运动功能 2 级，感觉恢复至 S3+水平。
在存在神经瘤连续性的围产期臂丛神经麻痹的手术治疗中，应根据整体临床和术中情况选择显微外科技术。当神经瘤连续性位于上干，损伤程度符合桑德兰德 3 度，且电刺激可获得正常的运动反应时，神经松解术的效果最佳。
