Al-Qattan Mohammad M, El-Sayed Amel A F
Department of Surgery, King Saud University, Riyadh, Saudi Arabia.
Department of Obstetrics and Gynecology, King Saud University, Riyadh, Saudi Arabia.
Eur J Plast Surg. 2017;40(4):329-332. doi: 10.1007/s00238-016-1267-6. Epub 2017 Jan 6.
The outcome of primary brachial plexus reconstruction in extended Erb's obstetric palsy with single root avulsion has not been specifically documented in the literature.
A series of 46 consecutive cases of extended Erb's obstetric palsy with single root avulsion was retrospectively reviewed. The upper and middle trunks were reconstructed with nerve grafts from the available two roots. No nerve transfers were used. The percentage of a satisfactory motor recovery was documented.
The postoperative motor recovery was excellent (over 97%) satisfactory outcome for elbow flexion, elbow extension, and digital extension. A satisfactory wrist extension was noted in 84.8% of children. The lowest rates of satisfactory outcomes were for shoulder external rotation (65.2%) and shoulder abduction (56.5%).
In extended Erb's obstetric palsy with single root avulsion, two ruptured roots are available for intraplexus neurotization of the upper and middle trunks. The surgeon gives a priority to elbow flexion and this is translated in an excellent outcome for elbow flexion. The triceps and digital extensors get a major contribution form the unaffected C8 root, and this is also translated in an excellent outcome for these two functions. Fewer cable grafts are available for reconstruction of the posterior division of upper trunk and the middle trunk, resulting in a lower rate of satisfactory outcomes at the shoulder for wrist extension. Level of Evidence: Level IV, therapeutic study.
文献中尚未专门记录单根撕脱性产瘫性臂丛神经损伤的初次重建结果。
回顾性分析46例连续性单根撕脱性产瘫性臂丛神经损伤病例。用上臂和中臂的可用两根神经进行神经移植重建。未使用神经移位术。记录运动恢复满意的百分比。
术后运动恢复良好（超过97%），屈肘、伸肘和指背伸功能恢复满意。84.8%的患儿腕背伸功能恢复满意。恢复满意率最低的是肩外旋（65.2%）和肩外展（56.5%）。
在单根撕脱性产瘫性臂丛神经损伤中，有两根断裂的神经可用于臂丛神经内上干和中干的神经化。外科医生优先考虑屈肘功能，这也体现在屈肘功能恢复良好。肱三头肌和指背伸肌主要由未受影响的C8神经支配，这也体现在这两项功能恢复良好。用于重建上干和中干后支的电缆移植物较少，导致肩部腕背伸功能恢复满意率较低。证据级别：IV级，治疗性研究。
