Obstetrical brachial plexus palsy: Can excision of upper trunk neuroma and nerve grafting improve function in babies with adequate elbow flexion at nine months of age?

详细信息    查看全文

• 作者：Anne E. Argenta^a ; Jack Brooker^b ; Zoe MacIssac^a ; Megan Natali^a ; Stephanie Greene^c ; Meg Stanger^d ; Lorelei Grunwaldt^a ; ^{lorelei.grunwaldt@chp.edu" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Obstetrical brachial plexus palsy ; Active movement scale ; Cookie test ; Neuroma excision
• 刊名：Journal of Plastic, Reconstructive & Aesthetic Surgery
• 出版年：2016
• 出版时间：May 2016
• 年：2016
• 卷：69
• 期：5
• 页码：629-633
• 全文大小：184 K

文摘

Accepted indications for exploration in obstetrical brachial plexus palsy (OBPP) vary by center. Most agree that full elbow flexion against gravity at nine months of age implies high chance of spontaneous recovery and thus excludes a baby from surgical intervention. However, there are certain movements of the shoulder and forearm that may not be used frequently by the infant, but are extremely important functionally as they grow. These movements are difficult to assess in a baby and may lead to some clinicians to recommend conservative treatment, when this cohort of infants may in fact benefit substantially from surgery. A retrospective review was conducted on all infants managed surgically at the Brachial Plexus Center of a major children's hospital from 2009 to 2014. Further analysis identified five patients who had near-normal AMS scores for elbow flexion but who had weakness of shoulder abduction, flexion, external rotation, and/or forearm supination. In contrast to standard conservative management, this cohort underwent exploration, C5-6 neuroma excision, and sural nerve grafting. Data analysis was performed on this group to look for overall improvement in function. During an average follow-up period of 29 months, all patients made substantial gains in motor function of the shoulder and forearm, without loss of elbow flexion or extension, or worsening of overall outcome. In select infants with brachial plexus injuries but near-normal AMS scores for elbow flexion, surgical intervention may be indicated to achieve the best functional outcome.