Children's Orthopaedic Center, Children's Hospital Los Angeles, 4650 Sunset Boulevard, Mailstop 69, Los Angeles, CA 90027.
J Bone Joint Surg Am. 2013 Nov 6;95(21):e161. doi: 10.2106/JBJS.M.00222.
Brachial plexus injuries have been reported in association with distraction-based instrumentation for early-onset scoliosis. The purpose of this study was to describe brachial plexus injuries associated with distraction-based spine instrumentation with rib anchors and the mechanisms and risk factors responsible.
We performed a retrospective single-center review of a consecutive series of forty-one patients with early-onset scoliosis who underwent distraction-based instrumentation with rib anchors from 2000 to 2011.
Four (10%) of the forty-one patients experienced an intraoperative brachial plexus injury. Three mechanisms of brachial plexus injuries were identified: (1) injury of the brachial plexus by the first rib being pushed superiorly by rib-anchored growing instrumentation, (2) direct injury to the brachial plexus by the superior pole of the retracted scapula, and (3) injury of the brachial plexus when the scapula was moved inferiorly during Sprengel deformity reconstruction. The last two mechanisms are independent of spinal instrumentation. Two patients had neurological symptoms or neuromonitoring signal changes when the arm was in the adducted position but not when the arm was abducted. All patients had complete neurological recovery.
Patients with Sprengel deformity appear to be at increased risk for brachial plexus injury when undergoing distraction-based spine instrumentation with rib anchors. Injury to the brachial plexus can occur with scapular elevation alone, presumably by direct compression of the superior end of the scapula on the brachial plexus. Brachial plexus injuries may be "hidden" during monitoring of an arm in shoulder abduction but symptomatic with shoulder adduction, as the brachial plexus is draped over the elevated first rib.
Therapeutic level IV. See Instructions for Authors for a complete description of levels of evidence.
据报道，在使用基于牵张的器械治疗早发性脊柱侧凸时，会出现臂丛神经损伤。本研究旨在描述与肋骨锚定的基于牵张的脊柱器械相关的臂丛神经损伤，以及导致这种损伤的机制和危险因素。
我们对 2000 年至 2011 年间接受肋骨锚定的基于牵张的器械治疗的 41 例早发性脊柱侧凸患者进行了回顾性单中心研究。
41 例患者中有 4 例（10%）发生术中臂丛神经损伤。发现了 3 种臂丛神经损伤机制：（1）第一肋骨被肋骨锚定的生长器械向上推，导致臂丛神经损伤；（2）肩胛骨回缩时，臂丛神经直接受到肩胛骨上极的损伤；（3）肩胛骨在进行 Sprengel 畸形重建时向下移位时，臂丛神经受损。后两种机制与脊柱器械无关。当手臂内收时，2 例患者出现神经症状或神经监测信号改变，但当手臂外展时则没有。所有患者均完全恢复神经功能。
在接受肋骨锚定的基于牵张的脊柱器械治疗时，患有 Sprengel 畸形的患者似乎更容易发生臂丛神经损伤。臂丛神经损伤可能仅在肩胛骨抬高时发生，推测是由于肩胛骨的上极直接压迫臂丛神经所致。当手臂内收时，臂丛神经可能会被抬高的第一肋骨覆盖，因此在监测手臂外展时可能会“隐藏”臂丛神经损伤，但当手臂内收时，臂丛神经损伤可能会出现症状。
治疗性 IV 级。有关证据水平的完整描述，请参见作者说明。
