Vinitpairot Chaiyos, Jianmongkol Surut
Department of Orthopedics, Hand and Reconstructive Unit, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
Arch Plast Surg. 2024 Jun 10;51(6):568-574. doi: 10.1055/a-2321-0468. eCollection 2024 Nov.
Spontaneous recovery of a birth brachial plexus disorder is difficult to predict. Although root avulsion and total plexus injury is indicated for surgical management, early nerve surgery is still doubtful. Hand motion is obviously an important indicator for predicting the function of an affected limb. However, the timing for diagnosing a transient or true total plexus injury from hand recovery is controversial. This study aimed to report the recovery time of total birth brachial plexus palsy in patients who did not undergo surgery due to various reasons. In this 15-year retrospective chart review, 45 patients of total birth brachial plexus injury with a mean follow-up time of 34.5 months, were included. Although patients met surgical indications, surgical management was abandoned for a variety of reasons. Imaging was not performed routinely and, nerve conduction study and Horner's syndrome were not consistently recorded in the past. All patients were evaluated for clinical improvement by motor power grading. The recovery time was reported as the median and interquartile range. Forty-five patients were diagnosed with total birth brachial plexus injury. Out of 45 patients, 36 showed clinical evidence of recovering their hand motion within a median of 3 months. The median time for the recovery of elbow flexion and shoulder abduction was 4 months. The median for achieving antigravity or full motion recovery of elbow flexion, shoulder abduction, and hand flexion were 10, 10.5, and 7 months, respectively. In this study, spontaneous recovery of shoulder, elbow and hand motion substantially occurred in the patient diagnosed with a total birth brachial plexus palsy. True total plexus palsy can be distinguished from transient palsy by the recovery of hand motion at 3 months. Most of the patients, who had spontaneous recovery, potentially achieved antigravity or full hand movement without surgery.
分娩性臂丛神经损伤的自然恢复情况难以预测。尽管根性撕脱和全丛损伤表明需要手术治疗，但早期神经手术仍存在疑问。手部活动显然是预测患肢功能的重要指标。然而，根据手部恢复情况诊断短暂性或真正的全丛损伤的时机仍存在争议。本研究旨在报告因各种原因未接受手术的分娩性全臂丛神经麻痹患者的恢复时间。
在这项为期15年的回顾性病历审查中，纳入了45例分娩性全臂丛神经损伤患者，平均随访时间为34.5个月。尽管患者符合手术指征，但由于各种原因放弃了手术治疗。过去未常规进行影像学检查，神经传导研究和霍纳综合征也未持续记录。所有患者均通过肌力分级评估临床改善情况。恢复时间报告为中位数和四分位间距。
45例患者被诊断为分娩性全臂丛神经损伤。在45例患者中，36例在中位数3个月内显示出手部活动恢复的临床证据。肘部屈曲和肩部外展恢复的中位数时间为4个月。实现肘部屈曲、肩部外展和手部屈曲抗重力或完全运动恢复的中位数分别为10个月、10.5个月和7个月。
在本研究中，诊断为分娩性全臂丛神经麻痹的患者肩部、肘部和手部活动基本出现自然恢复。真正的全丛麻痹可通过3个月时手部活动的恢复与短暂性麻痹相区分。大多数自然恢复的患者无需手术即可潜在地实现抗重力或全手运动。
