全部 标题 作者
关键词 摘要

OALib Journal期刊
ISSN: 2333-9721
费用:99美元

查看量下载量

相关文章

更多...
-  2016 

分娩性臂丛损伤的神经重建诊治进展

DOI: doi:10.7507/1002-1892.20160266

Keywords: 分娩性臂丛损伤, 手术指征, 神经重建, 疗效评定

Full-Text   Cite this paper   Add to My Lib

Abstract:

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

References

[1]  23. Capek L, Clarke HM, Curtis CG. Neuroma-in-continuity resection:early outcome in obstetrical brachial plexus palsy. Plast Reconstr Surg, 1998, 102(5):1555-1564.
[2]  1. Tse R, Kozin SH, Malessy MJ, et al. International Federation of societies for surgery of the hand committee report:the role of nerve transfers in the treatment of neonatal brachial plexus palsy. J Hand Surg (Am), 2015, 40(6):1246-1259.
[3]  2. Chen L, Gu YD, Wang H. Microsurgical reconstruction of obstetric brachial plexus palsy. Microsurgery, 2008, 28(2):108-112.
[4]  3. Chauhan SP, Blackwell SB, Ananth CV. Neonatal brachial plexus palsy:incidence, prevalence, and temporal trends. Semin Perinatol, 2014, 38(4):210-218.
[5]  8. Nath RK, Avila MB, Melcher SE, et al. Birth weight and incidence of surgical obstetric brachial plexus injury. Eplasty, 2015, 15:e14.
[6]  4. Narakas AO. Obstetrical brachial plexus injuries//Lamb D. The paralysed hand. Edinburgh:Churchill Livingstone, 1987:16-35.
[7]  5. Birch R. Obstetric brachial plexus palsy//Gupta A. The growing hand:diagnosis management of the upper extremity in children. London:Mosby, 2000:461-474.
[8]  6. 高仕长, 陈亮, 孟炜, 等. 产瘫危险因素的病例对照研究. 中华流行病学杂志, 2005, 26(9):676-679.
[9]  7. 陈亮. 加强产瘫基础研究全面提高防治水平. 中华手外科杂志, 2005, 21(2):65-66.
[10]  10. Ecker JL, Greenberg JA, Norwitz ER, et al. Birth weight as a predictor of brachial plexus injury. Obstet Gynecol, 1997, 89(5 Pt 1):643-647.
[11]  11. Al-Qattan MM, El-Sayed AA, Al-Zahrani AY, et al. Narakas classification of obstetric brachial plexus palsy revisited. J Hand Surg (Eur Vol), 2009, 34(6):788-791.
[12]  12. El-Sayed AA. The prognostic value of concurrent Horner syndrome in extended Erb obstetric brachial plexus palsy. J Child Neurol, 2014, 29(10):1356-1359.
[13]  13. Huang YG, Chen L, Gu YD, et al. Sympathetic preganglionic neurons project to superior cervical ganglion via C7 spinal nerve in pup but not in adult rats. Auton Neurosci, 2010, 154(1-2):54-58.
[14]  14. Rolfe Birch, Thomas Carlstedt. Some controversies in the treatment of obstetrical brachial plexus palsy. 中华手外科杂志, 2000, 16(2):68-75.
[15]  15. Tse R, Nixon JN, Iyer RS, et al. The diagnostic value of CT myelography, MR myelography, and both in neonatal brachial plexus palsy. AJNR Am J Neuroradiol, 2014, 35(7):1425-1432.
[16]  16. Yang LJ. Neonatal brachial plexus palsy-management and prognostic factors. Semin Perinatol, 2014, 38(4):222-234.
[17]  9. Ouzounian JG, Korst LM, Phelan JP. Permanent Erb palsy:a traction-related injury? Obstet Gynecol, 1997, 89(1):139-141.
[18]  17. Heise CO, Siqueira MG, Martins RS, et al. Clinical-electromyography correlation in infants with obstetric brachial plexopathy. J Hand Surg (Am), 2007, 32(7):999-1004.
[19]  18. Chuang DC, Mardini S, Ma HS. Surgical strategy for infant obstetrical brachial plexus palsy:experiences at Chang Gung Memorial Hospital. Plast Reconstr Surg, 2005, 116(1):132-144.
[20]  20. Terzis JK, Papakonstantinou KC. Management of obstetric brachial plexus palsy. Hand Clin, 1999, 15(4):717-736.
[21]  21. 顾玉东. 手外科的现状与展望. 中华手外科杂志, 2002, 18(1):1-2.
[22]  22. Boome RS, Kaye JC. Obstetric traction injuries of the brachial plexus. Natural history, indications for surgical repair and results. J Bone Joint Surg (Br), 1988, 70(4):571-576.
[23]  24. 高仕长, 陈亮, 顾玉东, 等. 神经移植移位术治疗产瘫的早期疗效分析. 中华手外科杂志, 2005, 21(2):67-69.
[24]  25. Chen L, Gao SC, Gu YD, et al. Histopathologic study of the neuroma-in-continuity in obstetric brachial plexus palsy. Plast Reconstr Surg, 2008, 121(6):2046-2054.
[25]  26. Gilbert A, Pivato G, Kheiralla T. Long-term results of primary repair of brachial plexus lesions in children. Microsurgery, 2006, 26(4):334-342.
[26]  27. Malessy MJ, Pondaag W. Nerve surgery for neonatal brachial plexus palsy. J Pediatr Rehabil Med, 2011, 4(2):141-148.
[27]  28. Pan F, Wei HF, Chen L, et al. Different functional reorganization of motor cortex after transfer of the contralateral C7 to different recipient nerves in young rats with total brachial plexus root avulsion. Neurosci Lett, 2012, 531(2):188-192.
[28]  29. Zhang J, Chen L, Gu YD. Influence of contralateral homologous cortices on motor cortical reorganization after brachial plexus injuries in rats. Neurosci Lett, 2015, 606:18-23.
[29]  19. Gilbert A. Obstetrical brachial plexus palsy//Tubiana R. The hand. Philadelphia:WB Saunders, 1993:576-601.

Full-Text

Contact Us

service@oalib.com

QQ:3279437679

WhatsApp +8615387084133