分娩性臂丛损伤的神经重建诊治进展  

ADVANCES IN NERVE RECONSTRUCTION OF OBSTETRIC BRACHIAL PLEXUS PALSY

作　　者：孙嘉宇[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：《中国修复重建外科杂志》2016年第10期1311-1314,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的 综述分娩性臂丛损伤（又称产瘫）的诊治进展。方法 广泛查阅近年与产瘫有关的文献,并对其发病率、危险因素、临床分型、辅助检查以及神经重建手术的适应证、方式和疗效进行总结分析。结果 近年来产瘫发病率未见明显下降。体质量≥4 kg、产钳助产和孕妇体质量指数≥21是产瘫的主要危险因素,而剖宫产是保护因素。神经电生理检查可用于产瘫的定性诊断,但不可用作定量指标。脊髓CT及MRI造影的敏感度和特异性分别约为0.7和0.97。一般采用Narakas分型,即Ⅰ型为C5、6损伤,Ⅱ型为C5~7损伤,Ⅲ型为全臂丛损伤,Ⅳ型为Ⅲ型伴Horner征。通常认为3个月无屈肘动作是臂丛探查指征。10%~30%产瘫需要手术治疗,对于上干创伤性神经瘤,绝大多数作者主张行神经瘤切除神经重建。上中干手术疗效的最终评价应在术后4年、全臂丛应在术后8年;功能评价主要采用肩关节Mallet评分、肘关节Gilbert评分和手功能Raimondi分级。结论 出生后3个月无屈肘时应行手术探查;对于创伤性神经瘤（即使术中有电传导）应行切除并臂丛重建。Objective To review the advances in the diagnosis and treatment of obstetric brachial plexus palsy （OBPP）. Methods The incidence, risk factors, classification, and imaging tests of OBPP and indication, technique, and results of surgery were reviewed and summarized. Results The incidence of OBPP is not declining in recent years. Birth weight of I〉 4 kg, forceps delivery, and prepregnancy body mass index of ≥ 21 are considered to be major risk factors, and caesarean section delivery seems to be a protective factor. Neurophysiological investigations can be applied to qualitative diagnosis of OBPP, but can not to quantitative one. Sensitivity and specificity of both CT and MRI myelography are about 0.7 and 0.97, respectively. Narakas classification is widely used： C5-6 injury as type I, C5-7 injury as type 1I, C5-T1 injury as type Ⅲ, C5-T1 injury with Homer＇s syndrome as type IV. It is generally considered that the brachial plexus exploration should be undertaken for infants without spontaneous recovery of elbow flexion by a maximum of 3 months old; and 10% to 30% of patients may need nerve reconstruction surgery. It is advocated that traumatic neuroma of the upper trunk should be resected with nerve reconstruction. The final evaluation for surgical results should be at minimal 4 years for upper roots and 8 years for total roots. Scales of Mallet, Gilbert, and Raimondi are mostly used for assessing shoulder function, elbow function, and hand function. Conclusion Brachial plexus exploration should be undertaken for infants without flexion of elbow at the age of 3 months. Traumatic neuroma （even neuroma-in-continuity） resection followed by microsurgical reconstruction of the brachial plexus is favored.

关 键 词：分娩性臂丛损伤 手术指征 神经重建 疗效评定 

分 类 号：R714.2[医药卫生—妇产科学]