Siqueira Mario G, Heise Carlos Otto, Alencar Gustavo C, Martins Roberto S, Foroni Luciano
Peripheral Nerve Surgery Unit, Department of Neurosurgery, University of São Paulo Medical School, São Paulo, SP, Brazil.
Clinical Neurophysiology, Department of Neurology, University of São Paulo Medical School, São Paulo, SP, Brazil.
Childs Nerv Syst. 2019 Feb;35(2):349-354. doi: 10.1007/s00381-018-04036-5. Epub 2019 Jan 4.
The outcome from microsurgical reconstruction of neonatal brachial plexus palsy (NBPP) varies, and comparison between different series is difficult, given the differences in preoperative evaluation, surgical strategies, and outcome analysis. To evaluate our results, we reviewed a series of children who underwent surgical treatment in a period of 14 years.
We made a retrospective review of 104 cases in which microsurgical repair of the brachial plexus was performed. Strength was graded using the Active Movement Scale. Whenever possible, upper palsies underwent surgery 4 to 6 months after birth and total lesions around 3 months. The lesions were repaired, according to the type of injury: neurolysis, nerve grafting, nerve transfer, or a combination of techniques. The children were followed for at least 24 months.
The majority of cases were complete lesions (56/53.8%). Erb's palsy was present in 10 cases (9.6%), and 39 infants (37.5%) presented an extended Erb's palsy. The surgical techniques applied were neurolysis (10.5%), nerve grafts (25.9%), nerve transfers (34.6%), and a combination of grafts and transfers (30.7%). The final outcome was considered poor in 41.3% of the cases, good in 34.3%, and excellent in 24%. A functional result (good plus excellent) was achieved in 58.3% of the cases.
There is no consensus regarding strategies for treatment of NBPP. Our surgical outcomes indicated a good general result comparing with the literature. However, our results were lower than the best results reported. Maybe the explanation is our much higher number of total palsy cases (53.8% vs. 25% in the literature).
新生儿臂丛神经麻痹（NBPP）显微外科重建的结果各不相同，鉴于术前评估、手术策略和结果分析存在差异，不同系列之间难以进行比较。为评估我们的结果，我们回顾了14年间接受手术治疗的一系列儿童病例。
我们对104例行臂丛神经显微修复术的病例进行了回顾性研究。使用主动运动量表对肌力进行分级。只要有可能，上肢麻痹患儿在出生后4至6个月接受手术，全瘫患儿在出生后约3个月接受手术。根据损伤类型进行修复：神经松解术、神经移植术、神经移位术或多种技术联合应用。对患儿进行了至少24个月的随访。
大多数病例为全瘫（56/53.8%）。10例（9.6%）为Erb麻痹，39例婴儿（37.5%）为扩展性Erb麻痹。应用的手术技术包括神经松解术（10.5%）、神经移植术（25.9%）、神经移位术（34.6%）以及移植术与移位术联合应用（30.7%）。41.3%的病例最终结果被认为较差，34.3%为良好，24%为优秀。58.3%的病例获得了功能结果（良好及以上）。
关于NBPP的治疗策略尚无共识。与文献相比，我们的手术结果显示总体效果良好。然而，我们的结果低于所报道的最佳结果。也许原因是我们的全瘫病例数要高得多（53.8%，而文献报道为25%）。
