Bahm J, Gkotsi A, Bouslama S, El-Kazzi W, Schuind F
Euregio Reconstructive Microsurgery Unit, Franziskushospital Aachen, Aachen, Germany.
Department of Orthopaedics and Traumatology, Université Libre de Bruxelles, Erasme University Hospital, Brussels, Belgium.
J Brachial Plex Peripher Nerve Inj. 2017 Nov 9;12(1):e17-e20. doi: 10.1055/s-0037-1608624. eCollection 2017 Jan.
In rare, selected cases of severe (extended) upper obstetric brachial plexus palsy (OBPP), after supraclavicular exposure and distal mobilization of the traumatized trunks and careful neuroma excision, we decided to perform direct nerve coaptation with tolerable tension and immobilized the affected arm positioned in adduction and 90-degree elbow flexion for three weeks. We present our surgical technique and preliminary results in a prospective open patient series, including 22 patients (14 right and 8 left side affected) between 2009 and 2016, operated at a mean age of 8.4 months. Analysis of functional results after a minimum of 18 months was conducted using the British Medical Research Council (BMRC) scale. All children reached 60-90° of elbow flexion and 75° of shoulder abduction at already six months after surgery. For those patients having already passed one year post surgery, the mean active shoulder abduction reached 92°, and for those who past the 18 months 124°. We discuss the actual knowledge about nerve coaptation under "reasonable" tension including its advantages and drawbacks. This technique may be indicated in preoperatively selected cases of (extended) upper OBPP and may give good functional results.
在少数经挑选的严重（广泛性）上产科臂丛神经麻痹（OBPP）病例中，在锁骨上暴露并对受伤的神经干进行远端游离以及仔细切除神经瘤后，我们决定在可耐受的张力下进行直接神经吻合，并将患侧手臂固定在内收位且肘部屈曲90度，持续三周。我们在一个前瞻性开放性患者系列中展示了我们的手术技术和初步结果，该系列包括2009年至2016年间接受手术的22例患者（右侧14例，左侧8例），平均手术年龄为8.4个月。使用英国医学研究委员会（BMRC）量表对至少18个月后的功能结果进行分析。所有儿童在术后6个月时肘部屈曲均达到60 - 90°，肩部外展达到75°。对于术后已满1年的患者，平均主动肩部外展达到92°，对于术后已满18个月的患者，达到124°。我们讨论了在“合理”张力下神经吻合的实际知识，包括其优缺点。该技术可能适用于术前挑选的（广泛性）上OBPP病例，并可能产生良好的功能结果。
