Nath Rahul K, Avila Meera B, Melcher Sonya E, Nath Devin K, Eichhorn Mitchell G, Somasundaram Chandra
Texas Nerve and Paralysis Institute, Houston, TX.
Eplasty. 2015 Apr 28;15:e14. eCollection 2015.
(1) To analyze the birth weight of obstetric brachial plexus injury (OBPI) patients requiring one or more reconstructive surgeries and (2) to analyze whether there is any difference in the severity of the injury, and the outcome of the surgery between the macrosomic and nonmacrosomic OBPI patients.
An observational cohort study was performed on 100 consecutive patients treated with surgery at the Texas Nerve and Paralysis Institute. Ninety of the 100 patients underwent the modified Quad surgery, which improves the shoulder abduction and overall shoulder function. All OBPI patients in our study were assessed preoperatively and postoperatively by evaluating video recordings of active shoulder abduction.
Using a 4000 g definition of macrosomia, 52% of patients would be considered macrosomic, and using a 4500 g definition of macrosomia, 18% of patients are considered macrosomic in our study. Permanent injury occurs also in average-birth-weight children.
A significant percentage (48%-82% depending on definition of macrosomia) of OBPI patients requiring major reconstructive surgery had birth weights which would put them in the "normal" birth weight category. In addition, we found that there was no significant difference in the severity of the injury, and the outcome of the modified Quad surgical procedure between macrosomic and nonmacrosomic OBPI patients. However, there was a significant improvement in shoulder movement in both macrosomic and nonmacrosomic patients after modified Quad surgery.
（1）分析需要进行一次或多次重建手术的产科臂丛神经损伤（OBPI）患者的出生体重；（2）分析巨大儿和非巨大儿OBPI患者在损伤严重程度及手术结果方面是否存在差异。
对在德克萨斯神经与麻痹研究所接受手术治疗的100例连续患者进行了一项观察性队列研究。100例患者中有90例接受了改良四头肌手术，该手术可改善肩部外展和整体肩部功能。我们研究中的所有OBPI患者在术前和术后均通过评估主动肩部外展的视频记录进行评估。
以4000克作为巨大儿的定义，在我们的研究中，52%的患者将被视为巨大儿；以4500克作为巨大儿的定义，18%的患者被视为巨大儿。平均出生体重的儿童也会发生永久性损伤。
需要进行重大重建手术的OBPI患者中，相当大比例（根据巨大儿的定义为48%-82%）的出生体重处于“正常”出生体重类别。此外，我们发现巨大儿和非巨大儿OBPI患者在损伤严重程度及改良四头肌手术结果方面没有显著差异。然而，改良四头肌手术后，巨大儿和非巨大儿患者的肩部活动均有显著改善。
