分娩性臂丛神经损伤手术方法及预后

发布时间：2018-03-25 17:28

本文选题：分娩　切入点：臂丛神经损伤　出处：《吉林大学》2013年硕士论文

【摘要】：分娩性臂丛神经损伤（OBPP: obstetric brachial plexuspalsy）又称产瘫，是指在分娩过程中胎儿的一侧或双侧臂丛神经因受到头肩分离暴力而发生的牵拉性损伤，临床表现为患肢不同程度的瘫痪。由于臂丛损伤机制不同于成人[3]，且神经恢复及患儿生长发育过程中又可产生一系列继发畸形，疗效不可预见，因此很难制定出规范化的治疗方案。如何根据患儿的具体情况制定个性化治疗方案成为手外科的重要研究课题。目前对于分娩性臂丛神经损伤的外科治疗方法有早期显微外科修复（臂丛神经松解术，神经移位、移植修复术等）和晚期功能重建。手术方法虽多，但仍缺乏规范化的序贯治疗方案。目的：总结本科28例有随访结果的分娩性臂丛神经损伤患儿临床治疗资料，，探讨治疗方案及预后，探索手术时机及手术方法。材料和方法：自2006年6月至2012年6月之间，我院共收治分娩性臂丛神经损伤患者28例，除4例行保守治疗外，余皆行外科手术治疗，手术方法分别为：臂丛神经松解术,神经移位术，腓肠神经移植术，肌腱止点移位术。对术后患者进行随访并进行评估，以随访的综合评分估计手术方法及手术时机选择是否得当。结果：术后随访时间6个月～6年3个月，平均24个月。肩关节根据Mallet评分方法进行评估，功能恢复优12例；良11例；中4例；可0例；差1例。肘关节根据Gilbert评分方法进行评估，功能恢复优19例；良5例；中4例；可0例；差0例。手功能根据Raimeondi评分方法进行评估，功能恢复优15例；良8例；中4例；可0例；差1例。结论：（1）神经移植与移位术预后差别不大，根据临床情况，针对臂丛神经节后损伤的患者可采用神经松解术、神经缝合或神经移植术；针对臂丛神经节前伤的患者则应行神经移位术；（2）肌腱止点移位术疗效较肯定，对于适宜手术的患儿，应重建主要功能而忽略次要功能，重建一个功能而不能丧失一个原有功能；（3）对明确臂丛神经损伤的患者，生后3月内屈肘功能无明显恢复患者应于早期积极进行臂丛神经探查修复术。
[Abstract]:Parturient brachial plexus nerve injury: obstetric brachial plexus palsy, also known as parturient paralysis, refers to the pulling injury of the brachial plexus nerve on one or both sides of the fetus due to head and shoulder separation violence during delivery. The clinical manifestation is paralysis of different degree of affected limb. Because the mechanism of brachial plexus injury is different from that of adults, and a series of secondary deformities can occur during nerve recovery and children's growth and development, the curative effect is unpredictable. Therefore, it is difficult to formulate a standardized treatment plan. How to make individualized treatment according to the specific conditions of children has become an important research topic in hand surgery. At present, the surgical treatment methods for childbirth brachial plexus injury are. Early microsurgical repair (brachial plexus neurolysis, Nerve transposition, graft repair, etc.) and late functional reconstruction. Although there are many surgical methods, there is still a lack of standardized sequential treatment. Objective: to summarize the clinical treatment data of 28 cases of puerperal brachial plexus injury, to explore the treatment plan and prognosis, and to explore the opportunity and method of operation. Materials and methods: from June 2006 to June 2012, 28 cases of puerperal brachial plexus injury were treated in our hospital. Nerve transposition, sural nerve transplantation and tendon insertion were followed up and evaluated. Results: the follow-up time was 6 months to 6 years and 3 months, with an average of 24 months. The shoulder joint was evaluated according to Mallet score in 12 cases, good in 11 cases, fair in 4 cases, fair in 0 cases, excellent in 12 cases, good in 11 cases, fair in 4 cases, fair in 0 cases. One case was poor. The elbow joint was evaluated according to Gilbert scoring method, 19 cases had excellent function recovery, 5 cases had good function, 4 cases had fair function, 0 case had poor hand function, 15 cases had excellent function recovery according to Raimeondi scoring method, 8 cases were good, 4 cases were fair; Conclusion there is no significant difference between nerve transplantation and transposition. According to the clinical situation, neurolysis, nerve suture or nerve transplantation can be used in patients with postganglionic injury of brachial plexus. For the patients with brachial plexus preganglionic injury, nerve transposition should be performed. The effect of tendon transfer should be confirmed. For the children with suitable operation, the main function should be reconstructed and the secondary function should be neglected. Reconstruction of a function without loss of an original function can not be lost) for the patients with definite brachial plexus injury, the patients with no obvious recovery of elbow flexion function within 3 months after birth should carry out early exploration and repair of brachial plexus nerve.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R726.5

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