Bade Stuart A, Lin Jenny C, Curtis Christine G, Clarke Howard M
Department of Plastic and Reconstructive Surgery, Hospital for Sick Children, Toronto, ON, Canada M5G 1X8 ; Royal Children's Hospital, Herston Road, Herston, Brisbane, QLD 4029, Australia.
Department of Plastic and Reconstructive Surgery, Hospital for Sick Children, Toronto, ON, Canada M5G 1X8 ; University of Montreal, Montreal, QC, Canada H3T 1C5.
Biomed Res Int. 2014;2014:627067. doi: 10.1155/2014/627067. Epub 2014 Jan 12.
This study identifies a small subset of patients with obstetrical brachial plexus palsy who, while they do not meet common surgical indications, may still benefit from primary nerve surgery.
Between April 2004 and April 2009, 17 patients were offered primary nerve surgery despite not meeting the standard surgical indications of the authors. The authors performed a retrospective analysis of these 17 patients using prospectively collected data.
This group of 17 patients were identified as having poor shoulder function at about 9 months of age despite passing the Cookie Test. Fourteen patients underwent surgical intervention and three families declined surgery. All patients in the operative group regained some active external rotation after surgery. Five patients in this group have required further interventions. Two of the three patients for whom surgery was declined have had no subsequent spontaneous improvement in active external rotation.
The commonly used indications for primary nerve surgery in obstetrical brachial plexus palsy may not adequately identify all patients who may benefit from surgical intervention. Patients who pass the Cookie Test but have poor spontaneous recovery of active shoulder movements, particularly external rotation, may still benefit from primary nerve surgery.
本研究旨在确定一小部分产科臂丛神经麻痹患者，这些患者虽不符合常见手术指征，但仍可能从一期神经手术中获益。
在2004年4月至2009年4月期间，17例患者尽管不符合作者的标准手术指征，但仍接受了一期神经手术。作者使用前瞻性收集的数据对这17例患者进行了回顾性分析。
这组17例患者在约9个月大时，尽管通过了曲奇测试，但仍被确定为肩部功能不佳。14例患者接受了手术干预，3个家庭拒绝手术。手术组的所有患者术后均恢复了一些主动外旋功能。该组中有5例患者需要进一步干预。拒绝手术的3例患者中有2例的主动外旋功能随后未出现自发改善。
产科臂丛神经麻痹一期神经手术常用的指征可能无法充分识别所有可能从手术干预中获益的患者。通过曲奇测试但主动肩部运动，尤其是外旋功能自发恢复不佳的患者，仍可能从一期神经手术中获益。
