产瘫患儿Horner征的临床观察  

Clinical observation of concurrent Homer＇s sign in infants with obstetric brachial plexus palsy

作　　者：李清[1] 陈亮[1] 胡韶楠[1] 

机构地区：[1]复旦大学附属华山医院手外科,上海200040

出　　处：《中华手外科杂志》2012年第1期1-4,共4页Chinese Journal of Hand Surgery

基　　金：卫生部临床学科重点课题资助项目（2007-66-6）,上海市周围神经显微外科重点实验室课题资助项目（08DZ2270600）

摘　　要：目的 探讨Horner征在产瘫中的诊断意义,寻找单纯C7神经根撕脱导致Horner征的特异性临床体征.方法 对2009年1月至7月在我院接受手术治疗的39例Horner征阳性的产瘫患儿,术前记录患侧Horner征3项临床体征：瞳孔大小,睑裂大小及面部汗腺分泌功能.术中通过直视观察联合神经电生理检查明确患儿神经根损伤程度,并在患儿术后首次随访时再次记录Horner征的各项体征.结果 产瘫患儿平均首次评估Horner征时间为（3.58±0.87）个月.术后平均随访时间为（6.19±1.10）个月.术中证实单纯C7神经根撕脱患儿11例,C8、T1神经根中至少有1根撕脱患儿28例.2组患儿2次瞳孔缩小率和睑裂缩小率比较差异均无统计学意义（P＞0.05）.前组患儿在术后6个月时,面部出汗功能恢复优于后组（P＜0.05）.结论单纯C7神经根撕脱可导致产瘫患儿出现Horner征.但在3个月龄患儿中已不能辨别其可能存在的特异性临床体征表现.Objective To discuss the diagnostic value of concurrent Horner＇s sign in infants with obstetric brachial plexus palsy and discover the clinical characteristics of Horner＇s syndrome caused by C7 nerve root avulsion alone.Methods From January 2009 to July 2009,39 infants with OBPP were identified with concurrent Horner＇ s syndrome.Clinical signs of Homer＇s syndrome were recorded which include ipsilateral blepharoptosis,pupillary miosis and facial anhidrosis.Lesions of brachial plexus nerve roots were confirmed during the surgery by direct visualization and electrophysiology.After a period of 6-month follow-up,these signs were recorded again.Results The initial age of Horner＇s sign evaluation of these OBPP patients was（3.58 ±0.87）months.Average postoperative follow-up interval was（6.19 ± 1.10）months.C7 nerve root avulsion alone was confirmed in 11 patients（case group）,while the other 28 patients（control group）lind avulsion of at least one root of C8 and T1 nerve roots.There were not significant differences in anisocoria and blepharoptosis between the two groups（P 〉 0.05）.Facial gland secretary function was recovered more rapidly among patients in case group than their counterparts（P 〈 0.05）.Conclusion In newborns with OBPP,Horner＇ s syndrome can be correlated with C7 nerve root avulsion alone.No unique feature of Horner＇s syndrome which caused by C7 nerve root avulsion was found among patients of 3 months old.

关 键 词：臂丛 儿童 霍纳综合征 

分 类 号：R742.3[医药卫生—神经病学与精神病学]