Carlson Strother Courtney, Joslyn-Eastman Nichole, Loosbrok Michelle F, Pulos Nicholas, Bishop Allen T, Spinner Robert J, Shin Alexander Y
Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.
World Neurosurg. 2022 May;161:e244-e251. doi: 10.1016/j.wneu.2022.01.113. Epub 2022 Feb 3.
To evaluate demographics, treatment options, and outcomes of traumatic brachial plexus injuries in pediatric patients.
Traumatic brachial plexus reconstructions in patients ≤17 years old were reviewed. Patients were stratified into pan-plexus and incomplete plexus injuries. Functional outcomes (modified British Medical Research Council grade) were reviewed after a minimum follow-up of 9 months.
Brachial plexus reconstruction was performed in 71 patients at a mean age of 13.9 years (range, 2-17 years). Approximately half of the patients had a pan-brachial plexus injury (n = 33, 46.5%) with 59.2% having at least 1 preganglionic avulsion injury. Among the 25 patients with pan-brachial plexus injuries who had >9 months of follow-up, 12 (48%), 24 (96%), and 17 (68%) had reconstruction surgery for shoulder, elbow, and grasp function, respectively. At last follow-up, 50%, 83%, and 29% of these patients had a modified British Medical Research Council grade ≥3 in shoulder abduction, elbow flexion, and grasp, respectively. Of the 31 patients with incomplete brachial plexus injuries, 28 (90%) underwent reconstruction for shoulder function, and 13 (42%) underwent surgery for elbow flexion. At last follow-up, 71% and 100% of patients had modified British Medical Research Council grade 3 in shoulder abduction and elbow flexion, respectively.
Pediatric traumatic brachial plexus injuries are often high-energy injuries resulting in nerve root avulsions. Most patients were able to regain antigravity elbow flexion or stronger after brachial plexus reconstruction, and more than half had similar improvement in shoulder function. Treatment should be directed with goals of elbow flexion, shoulder stability/external rotation, and rudimentary grasp.
评估小儿创伤性臂丛神经损伤的人口统计学特征、治疗选择及治疗结果。
回顾了年龄≤17岁患者的创伤性臂丛神经重建情况。将患者分为全臂丛神经损伤和不全臂丛神经损伤。在至少随访9个月后评估功能结果（改良英国医学研究委员会分级）。
71例患者接受了臂丛神经重建，平均年龄13.9岁（范围2 - 17岁）。约半数患者为全臂丛神经损伤（n = 33，46.5%），其中59.2%至少有1处节前撕脱伤。在25例接受了9个月以上随访的全臂丛神经损伤患者中，分别有12例（48%）、24例（96%）和17例（68%）因肩、肘和抓握功能进行了重建手术。在末次随访时，这些患者中分别有50%、83%和29%的改良英国医学研究委员会分级在肩外展、肘屈曲和抓握方面≥3级。在31例不全臂丛神经损伤患者中，28例（90%）因肩功能进行了重建，13例（42%）因肘屈曲进行了手术。在末次随访时，分别有71%和100%的患者在肩外展和肘屈曲方面改良英国医学研究委员会分级为3级。
小儿创伤性臂丛神经损伤常为高能损伤，导致神经根撕脱。大多数患者在臂丛神经重建后能够恢复抗重力肘屈曲或更强的功能，超过半数患者在肩功能方面有类似改善。治疗应以肘屈曲、肩稳定性/外旋和基本抓握功能为目标。
