分娩性臂丛神经损伤的长期随访和疗效分析  

Long term follow-up and efficacy analysis of obstetric brachial plexus injury

作　　者：赵利华 陈胤贤 王士奇 胡韶楠 焦勤 Zhao Lihua;Chen Yinxian;Wang Shiqi;Hu Shaonan;Jiao Qin(Department of Orthopedics,Shanghai Children's Hospital,Children's Hospital Afiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200060,China;Department of Hand Surgery,Huashan Hospital Affiliated to Fudan University,Key Laboratory of Hand Function Reconstruction,Ministry of Health,Shanghai Key Laboratory of Peripheral Neurosurgery,Shanghai 200040,China)

机构地区：[1]上海市儿童医院,上海交通大学医学院附属儿童医院骨科,上海200060 [2]复旦大学附属华山医院手外科,手功能重建卫生部重点实验室,上海市周围神经显微外科重点实验室,上海200040

出　　处：《中华手外科杂志》2024年第5期413-419,共7页Chinese Journal of Hand Surgery

基　　金：上海市儿童医院临床研究培育专项(2022YLYM03);上海交通大学医工交叉基金青年项目(YG2021QN115)。

摘　　要：目的分娩性臂丛神经损伤(obstetric brachial plexus injury, OBPI)病情的发展过程和治疗的有效性仍存在很多不确定性, 本研究拟探讨早期神经移植和/或移位手术治疗OBPI患儿的长期疗效。方法我科自2014年7月至2015年7月, 对15例OBPI患儿于出生后3~6个月行臂丛神经移植和/或移位修复术。术后门诊定期随访8年以上, 所有患儿术后均未再接受第二次肌腱转位等功能重建术, 评估手术前后肩、肘和手功能, 肩关节功能评价采用Mallet评分, 肘关节采用Gilbert评分, 手功能采用Raimondi分级。P<0.05为差异有统计学意义。结果 15例患儿术后平均随访110.6个月(96~115个月), 初次神经探查和神经重建术后未再接受第二次功能重建术, 上中干型臂丛神经损伤(TassinⅡ型)患儿8例、全臂丛型神经损伤患儿7例(TassinⅢ型4例, TassinⅣ3例)。所有TassinⅡ型损伤患儿术后的肩关节功能Mallet评分≥4分、达正常5分者占50%(4/8), 肘关节Gilbert评分达到屈肘3分和伸肘2分的正常范围, 术前和术后的肩关节和肘关节功能差异有统计学意义(P<0.001)。TassinⅢ型和TassinⅣ型损伤患儿术前术后肩、肘和手功能差异有统计学意义(P<0.01), 肩关节Mallet评分、肘关节Gilbert评分和手功能Raimondi分级分别从术前的1~2分、屈1分伸0分和0级增加到术后的3~4分、屈2分伸1分和1~2级。结论早期行神经移植及移位修复术治疗OBPI患儿的术后长期疗效显著, 特别是TassinⅡ型损伤患儿的肢体功能恢复能满足正常生活所需, TassinⅢ型和TassinⅣ型损伤患儿手功能恢复不如肩和肘关节功能恢复好, Horner征提示更严重的损伤和较差的预后, 术前肩前屈活动反映了较好的动力神经根质量, 可能提示良好的预后。Objective To explore the long-term efficacy of early nerve transplantation and/or transfer surgery for the treatment of obstetric brachial plexus injury(OBPI)in children because of the uncertainties in the development process and effectiveness of treatment for OBPI.Methods From July 2014 to July 2015,15 children with OBPI were performed on brachial plexus nerve transplantation and/or transfer repair surgery at 3 to 6 months after birth.The regular follow-up visits were conducted in the postoperative outpatient department for more than 8 years.All patients did not undergo a second tendon transposition or other functional reconstruction surgery after surgery.The shoulder,elbow,and hand functions were evaluated before and after surgery.Mallet score was used for shoulder joint function evaluation,Gilbert score was used for elbow joint evaluation,and Raimondi score was used for hand function evaluation.P<0.05 indicated a statistically significant difference.Results Fifteen patients were follow-up for 96 to 115 months with an average of 110.6 months after surgery.After the initial nerve exploration and nerve reconstruction surgery,no second functional reconstruction surgery was performed.There were 8 patients with upper middle trunk type brachial plexus injury(Tassin type Ⅱ)and 7 patients with total brachial plexus injury(4 patients with Tassin type Ⅲ and 3 patients with Tassin type Ⅳ).50%(4/8)of all children with Tassin type Ⅱ injury had a Mallet score of ≥ 4 and a normal score of 5 for shoulder joint function after surgery.The Gilbert score for elbow joint reached the normal range of 3 points for elbow flexion and 2 points for elbow extension.There was a statistically significant difference in shoulder and elbow joint function before and after surgery(P<0.001).There was a statistically significant difference in shoulder,elbow,and hand function between children with Tassin type Ⅲ and Tassin type Ⅳ injuries before and after surgery(P<0.01).The Mallet score for shoulder joint,Gilbert score for elbow joint,

关 键 词：臂丛 治疗结果 分娩性臂丛神经损伤 早期治疗 长期随访 

分 类 号：R726.5[医药卫生—儿科]