Peripheral Nerve & Brachial Plexus Surgery Program, Department of Neurosurgery, Hospital de Clínicas, University of Buenos Aires School of Medicine, La Pampa 1175 Torre 2 5A, 1428, Buenos Aires, Argentina.
Peripheral Nerve & Brachial Plexus Surgery Unit, Division of Neurosurgery, Hospital de Clínicas, University of Buenos Aires School of Medicine, Torre 2 5A, Buenos Aires, Argentina.
Childs Nerv Syst. 2024 Feb;40(2):479-486. doi: 10.1007/s00381-023-06072-2. Epub 2023 Jul 12.
To compare two populations of brachial plexus palsies, one neonatal (NBPP) and the other traumatic (NNBPP) who underwent different nerve transfers, using the plasticity grading scale (PGS) for detecting differences in brain plasticity between both groups.
To be included, all patients had to have undergone a nerve transfer as the unique procedure to recover one lost function. The primary outcome was the PGS score. We also assessed patient compliance to rehabilitation using the rehabilitation quality scale (RQS). Statistical analysis of all variables was performed. A p ≤ 0.050 set as criterion for statistical significance.
A total of 153 NNBPP patients and 35 NBPP babies (with 38 nerve transfers) met the inclusion criteria. The mean age at surgery of the NBPP group was 9 months (SD 5.42, range 4 to 23 months). The mean age of NNBPP patients was 22 years (SD 12 years, range 3 to 69). They were operated around sixth months after the trauma. All transfers performed in NBPP patients had a maximum PGS score of 4. This was not the case for the NNBPP population that reached a PGS score of 4 in approximately 20% of the cases. This difference was statistically significant (p < 0.001). The RQS was not significantly different between groups.
We found that babies with NBPP have a significantly greater capacity for plastic rewiring than adults with NNBPP. The brain in the very young patient can process the changes induced by the peripheral nerve transfer better than in adults.
使用可塑性分级量表（PGS）比较接受不同神经转移术的两种臂丛神经麻痹人群，即新生儿（NBPP）和创伤性（NNBPP），以检测两组大脑可塑性的差异。
所有患者均须行神经转移术作为恢复丧失功能的唯一术式。主要结局指标为 PGS 评分。我们还使用康复质量量表（RQS）评估患者对康复的依从性。对所有变量进行统计学分析。p 值≤0.050 为统计学显著性标准。
共有 153 例 NNBPP 患者和 35 例 NBPP 婴儿（38 例神经转移术）符合纳入标准。NBPP 组的平均手术年龄为 9 个月（SD 5.42，范围 4 至 23 个月）。NNBPP 患者的平均年龄为 22 岁（SD 12 岁，范围 3 至 69 岁）。他们在创伤后大约 6 个月接受手术。NBPP 患者所有转移术均达到最大 PGS 评分 4 分。而 NNBPP 人群则并非如此，其中约 20%的病例达到 PGS 评分 4 分。这一差异具有统计学意义（p<0.001）。两组之间的 RQS 无显著差异。
我们发现，NBPP 婴儿的神经可塑性重布线能力明显大于 NNBPP 成人。与成人相比，非常年轻的患者大脑能够更好地处理外周神经转移术引起的变化。
