Piatt J H, Hudson A R, Hoffman H J
Division of Neurological Surgery, University of Toronto, Ontario.
Neurosurgery. 1988 Apr;22(4):715-23. doi: 10.1227/00006123-198804000-00016.
The application of microsurgical techniques to the peripheral nervous system has made possible the reconstruction of the brachial plexus after vehicular and penetrating injuries. We now report our preliminary experiences utilizing these same techniques in the microsurgical management of brachial plexus birth injury. In contrast to other authors and in distinction from our own experiences with vehicular trauma in children, we did not find lesions requiring reconstruction by grafting or neurotization in any of seven plexus explorations for birth injury. The history of the surgical management of brachial plexus birth injury is reviewed, and the rationale for exploration is developed in the context of the natural history of the condition. Differences between our experiences and the existing literature are analyzed, with particular regard for timing of operation and technique of intraoperative assessment of nerve injury. All children with birth injuries of the brachial plexus require careful, repeated neurological evaluation during the first few months of life. Although the great majority make a rapid and satisfactory spontaneous recovery, the minority who do not recover are destined to suffer significant, life-long disability. Microsurgical brachial plexus exploration may benefit this select group of patients.
显微外科技术应用于周围神经系统，使得在车辆撞击伤和穿透伤后臂丛神经的重建成为可能。我们现报告在臂丛神经产伤的显微外科治疗中运用同样技术的初步经验。与其他作者不同，也与我们自己在儿童车辆创伤方面的经验不同，在七例臂丛神经产伤探查中，我们未发现任何需要通过移植或神经植入重建的损伤。本文回顾了臂丛神经产伤的外科治疗史，并根据该病的自然病程阐述了进行探查的理论依据。分析了我们的经验与现有文献之间的差异，特别关注手术时机和术中神经损伤评估技术。所有臂丛神经产伤的儿童在出生后的头几个月都需要仔细、反复的神经学评估。尽管绝大多数患儿能迅速且令人满意地自发恢复，但少数未能恢复的患儿注定会遭受严重的终身残疾。显微外科臂丛神经探查可能会使这一特定群体的患者受益。
