Zuo Kevin J, Ho Emily S, Hopyan Sevan, Clarke Howard M, Davidge Kristen M
From the Divisions of Plastic, Reconstructive, and Aesthetic Surgery.
Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children.
Plast Reconstr Surg. 2023 May 1;151(5):857e-874e. doi: 10.1097/PRS.0000000000010047. Epub 2023 Apr 26.
After studying this article, the participant should be able to: 1. Describe methods of clinical evaluation for neurologic recovery in brachial plexus birth injury. 2. Understand the role of different diagnostic imaging modalities to evaluate the upper limb. 3. List nonsurgical strategies and surgical procedures to manage shoulder abnormality. 4. Explain the advantages and disadvantages of microsurgical nerve reconstruction and distal nerve transfers in brachial plexus birth injury. 5. Recognize the prevalence of pain in this population and the need for greater sensory outcomes evaluation.
Brachial plexus birth injury (BPBI) results from closed traction injury to the brachial plexus in the neck during an infant's vertex passage through the birth canal. Although spontaneous upper limb recovery occurs in most instances of BPBI, some infants do not demonstrate adequate motor recovery within an acceptable timeline and require surgical intervention to restore upper limb function. This article reviews major advances in the management of BPBI in the past decade that include improved understanding of shoulder pathology and its impact on observed motor recovery, novel surgical techniques, new insights in sensory function and pain, and global efforts to develop standardized outcomes assessment scales.
在学习本文后，参与者应能够：1. 描述臂丛神经产伤中神经恢复的临床评估方法。2. 理解不同诊断成像方式在评估上肢方面的作用。3. 列出处理肩部异常的非手术策略和手术方法。4. 解释显微外科神经重建和臂丛神经产伤中远端神经移位的优缺点。5. 认识到该人群中疼痛的患病率以及更全面的感觉功能评估的必要性。
臂丛神经产伤（BPBI）是婴儿头先露通过产道时颈部臂丛神经受到闭合性牵拉伤所致。尽管大多数臂丛神经产伤病例上肢能自发恢复，但一些婴儿在可接受的时间内未表现出足够的运动恢复，需要手术干预来恢复上肢功能。本文回顾了过去十年臂丛神经产伤治疗的主要进展，包括对肩部病理及其对观察到的运动恢复的影响有了更深入的理解、新的手术技术、感觉功能和疼痛方面的新见解，以及为制定标准化结局评估量表所做的全球努力。
