Socolovsky Mariano, Costales Javier Robla, Paez Miguel Domínguez, Nizzo Gustavo, Valbuena Sebastian, Varone Ernesto
Department of Neurosurgery, Peripheral Nerve & Brachial Plexus Unit, University of Buenos Aires School of Medicine, La Pampa 1175 5 A, 1428, Buenos Aires, Argentina.
Department of Neurosurgery, Hospital de León, León, Spain.
Childs Nerv Syst. 2016 Mar;32(3):415-25. doi: 10.1007/s00381-015-2971-4. Epub 2015 Nov 28.
Obstetric brachial plexus injuries (OBPP) are a relatively common stretch injury of the brachial plexus that occurs during delivery. Roughly 30 % of patients will not recover completely and will need a surgical repair. Two main treatment strategies have been used: primary surgery, consisting in exploring and reconstructing the affected portions of the brachial plexus within the first few months of the patient's life, and secondary procedures that include tendon or muscle transfers, osteotomies, and other orthopedic techniques. Secondary procedures can be done as the only surgical treatment of OBPP or after primary surgery, in order to minimize any residual deficits. Two things are crucial to achieving a good outcome: (1) the appropriate selection of patients, to separate those who will spontaneously recover from those who will recover only partially or not at all; and (2) a good surgical technique. The objective of the present review is to assess the published literature concerning certain controversial issues in OBPP, especially in terms of the true current state of primary and secondary procedures, their results, and the respective roles each plays in modern-day treatment of this complex pathology. Considerable published evidence compiled over decades of surgical experience favors primary nerve surgery as the initial therapeutic step in patients who do not recover spontaneously, followed by secondary surgeries for further functional improvement. As described in this review, the results of such treatment can greatly ameliorate function in affected limbs. For best results, multi-disciplinary teams should treat these patients.
产科臂丛神经损伤（OBPP）是分娩期间发生的一种相对常见的臂丛神经牵拉伤。约30%的患者无法完全恢复，需要进行手术修复。主要采用了两种治疗策略：一期手术，即在患者出生后的头几个月内探查并重建臂丛神经的受损部分；二期手术，包括肌腱或肌肉转移、截骨术及其他矫形技术。二期手术可作为OBPP的唯一手术治疗方式，也可在一期手术后进行，以尽量减少任何残留缺陷。要取得良好疗效，有两点至关重要：（1）正确选择患者，区分哪些患者会自发恢复，哪些患者只能部分恢复或根本无法恢复；（2）掌握良好的手术技术。本综述的目的是评估已发表的关于OBPP中某些争议问题的文献，特别是一期和二期手术的真实现状、其结果以及它们在这种复杂病症的现代治疗中各自所起的作用。数十年来积累的大量已发表证据支持将一期神经手术作为不能自发恢复的患者的初始治疗步骤，随后进行二期手术以进一步改善功能。如本综述所述，这种治疗的结果可极大地改善患肢功能。为获得最佳效果，应由多学科团队治疗这些患者。
