Tse Raymond, Kozin Scott H, Malessy Martijn J, Clarke Howard M
Division of Plastic Surgery, Department of Surgery, Seattle Children's Hospital, University of Washington, Seattle, WA.
Department of Orthopaedic Surgery, Shriners Hospitals for Children, Temple University, Philadelphia, PA.
J Hand Surg Am. 2015 Jun;40(6):1246-59. doi: 10.1016/j.jhsa.2015.01.027. Epub 2015 May 1.
Nerve transfers have gained popularity in the treatment of adult brachial plexus palsy; however, their role in the treatment of neonatal brachial plexus palsy (NBPP) remains unclear. Brachial plexus palsies in infants differ greatly from those in adults in the patterns of injury, potential for recovery, and influences of growth and development. This International Federation of Societies for Surgery of the Hand committee report on NBPP is based upon review of the current literature. We found no direct comparisons of nerve grafting to nerve transfer for primary reconstruction of NBPP. Although the results contained in individual reports that use each strategy for treatment of Erb palsy are similar, comparison of nerve transfer to nerve grafting is limited by inconsistencies in outcomes reported, by multiple confounding factors, and by small numbers of patients. Although the role of nerve transfers for primary reconstruction remains to be defined, nerve transfers have been found to be effective and useful in specific clinical circumstances including late presentation, isolated deficits, failed primary reconstruction, and multiple nerve root avulsions. In the case of NBPP more severe than Erb palsy, nerve transfers alone are inadequate to address all of the deficits and should only be considered as adjuncts if maximal re-innervation is to be achieved. Surgeons who commit to care of infants with NBPP need to avoid an over-reliance on nerve transfers and should also have the capability and inclination for brachial plexus exploration and nerve graft reconstruction.
神经移位术在成人臂丛神经麻痹的治疗中越来越受欢迎；然而，其在新生儿臂丛神经麻痹（NBPP）治疗中的作用仍不明确。婴儿的臂丛神经麻痹在损伤模式、恢复潜力以及生长发育影响方面与成人有很大不同。这份国际手外科学会联合会关于NBPP的委员会报告基于对当前文献的综述。我们未发现关于NBPP一期重建中神经移植与神经移位术的直接比较。尽管个别报告中使用每种策略治疗Erb麻痹的结果相似，但神经移位术与神经移植术的比较受到报告结果不一致、多种混杂因素以及患者数量少的限制。尽管神经移位术在一期重建中的作用仍有待确定，但已发现神经移位术在特定临床情况下有效且有用，包括就诊较晚、孤立性缺损、一期重建失败以及多神经根撕脱。在NBPP比Erb麻痹更严重的情况下，仅靠神经移位术不足以解决所有缺损，若要实现最大程度的再支配，应仅将其视为辅助手段。致力于治疗NBPP婴儿的外科医生需要避免过度依赖神经移位术，还应具备进行臂丛神经探查和神经移植重建的能力和意愿。
