Artikel
Management of obstetrical brachial plexus palsy (OBPP) – our own experience with 36 operated children
Management der geburtstraumatischen Plexusläsion – unsere Erfahrungen mit 36 operierten Kindern
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Autoren
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U. M. Bäzner
- Department of Neurosurgery, University of Ulm/Günzburg
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G. Antoniadis
- Department of Neurosurgery, University of Ulm/Günzburg
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C. P. Heinen
- Department of Neurosurgery, University of Ulm/Günzburg
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H. P. Richter
- Department of Neurosurgery, University of Ulm/Günzburg
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R. W. König
- Department of Neurosurgery, University of Ulm/Günzburg
| Veröffentlicht: | 30. Mai 2008 |
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Gliederung
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Objective: Nearly 90% of the OBPPs recover under physiotherapy within the first six months. In case of missing adequate functional recovery, surgical exploration should be performed. The management of OBPP changed in various aspects concerning time of intervention, treatment of neuroma-in-continuity and primary goals of reconstruction during the last decade.
Methods: A series of 36 children with OBPP underwent an operation in our department between 1993 and July 2007.
In 22/36 newborns nerve root avulsions were diagnosed by myelography preoperatively.
A paralysis of the upper roots (C5/C6) is noticed by 15 infants, of C5/C6/C7 by 5 infants and a complete paralysis is diagnosed by 16 infants.
We performed nerve grafting after neuroma excision in 21 cases, combined with neurotization in 5 cases and with plexo-plexal transfer in 3 cases. In 7 cases only neurolysis was performed.
The mean time of intervention was 9 months (5-21 months) after birth.
Results: The follow-up period ranged from 6 months to 10 years.
None of the neurolysis group – all patients presented with a conducting neuroma-in-continuity – had good functional results.
After resection, grafting and/or neurotization the shoulder abduction and external rotation got better in the early operated group (up to 9 mths) from Grade 0 to II and the elbow function from Grade I to IV; in the late operated group (>9 months) from Grade 0 to I (shoulder) and from II to III (elbow) in the Gilbert scale.
The hand function showed Grade III or better in 26% of the children.
Conclusions: The surgical procedure should be planed between the 4th and the 6th month after birth. In case of a neuroma-in-continuity, it should be resected even if intraoperative CNAPs are recorded. In the neonates the potential of regeneration is much more stronger than in older patients with a traumatic BPP, so the exploration and reconstruction of the lower roots/ the truncus inferior should be considered to optimize the hand function of the children. Also, except of intensive physical therapy, plastic surgery concerning muscle transfers and orthopaedic procedures have to be considered to ensure the best outcome for these infants.
