本文選題：分娩　切入點(diǎn)：臂叢神經(jīng)損傷　出處：《吉林大學(xué)》2013年碩士論文

【摘要】：分娩性臂叢神經(jīng)損傷（OBPP: obstetric brachial plexuspalsy）又稱(chēng)產(chǎn)癱，是指在分娩過(guò)程中胎兒的一側(cè)或雙側(cè)臂叢神經(jīng)因受到頭肩分離暴力而發(fā)生的牽拉性損傷，臨床表現(xiàn)為患肢不同程度的癱瘓。由于臂叢損傷機(jī)制不同于成人[3]，且神經(jīng)恢復(fù)及患兒生長(zhǎng)發(fā)育過(guò)程中又可產(chǎn)生一系列繼發(fā)畸形，療效不可預(yù)見(jiàn)，因此很難制定出規(guī)范化的治療方案。如何根據(jù)患兒的具體情況制定個(gè)性化治療方案成為手外科的重要研究課題。目前對(duì)于分娩性臂叢神經(jīng)損傷的外科治療方法有早期顯微外科修復(fù)（臂叢神經(jīng)松解術(shù)，神經(jīng)移位、移植修復(fù)術(shù)等）和晚期功能重建。手術(shù)方法雖多，但仍缺乏規(guī)范化的序貫治療方案。 目的：總結(jié)本科28例有隨訪結(jié)果的分娩性臂叢神經(jīng)損傷患兒臨床治療資料，，探討治療方案及預(yù)后，探索手術(shù)時(shí)機(jī)及手術(shù)方法。 材料和方法：自2006年6月至2012年6月之間，我院共收治分娩性臂叢神經(jīng)損傷患者28例，除4例行保守治療外，余皆行外科手術(shù)治療，手術(shù)方法分別為：臂叢神經(jīng)松解術(shù),神經(jīng)移位術(shù)，腓腸神經(jīng)移植術(shù)，肌腱止點(diǎn)移位術(shù)。對(duì)術(shù)后患者進(jìn)行隨訪并進(jìn)行評(píng)估，以隨訪的綜合評(píng)分估計(jì)手術(shù)方法及手術(shù)時(shí)機(jī)選擇是否得當(dāng)。 結(jié)果：術(shù)后隨訪時(shí)間6個(gè)月～6年3個(gè)月，平均24個(gè)月。肩關(guān)節(jié)根據(jù)Mallet評(píng)分方法進(jìn)行評(píng)估，功能恢復(fù)優(yōu)12例；良11例；中4例；可0例；差1例。肘關(guān)節(jié)根據(jù)Gilbert評(píng)分方法進(jìn)行評(píng)估，功能恢復(fù)優(yōu)19例；良5例；中4例；可0例；差0例。手功能根據(jù)Raimeondi評(píng)分方法進(jìn)行評(píng)估，功能恢復(fù)優(yōu)15例；良8例；中4例；可0例；差1例。結(jié)論：（1）神經(jīng)移植與移位術(shù)預(yù)后差別不大，根據(jù)臨床情況，針對(duì)臂叢神經(jīng)節(jié)后損傷的患者可采用神經(jīng)松解術(shù)、神經(jīng)縫合或神經(jīng)移植術(shù)；針對(duì)臂叢神經(jīng)節(jié)前傷的患者則應(yīng)行神經(jīng)移位術(shù)；（2）肌腱止點(diǎn)移位術(shù)療效較肯定，對(duì)于適宜手術(shù)的患兒，應(yīng)重建主要功能而忽略次要功能，重建一個(gè)功能而不能喪失一個(gè)原有功能；（3）對(duì)明確臂叢神經(jīng)損傷的患者，生后3月內(nèi)屈肘功能無(wú)明顯恢復(fù)患者應(yīng)于早期積極進(jìn)行臂叢神經(jīng)探查修復(fù)術(shù)。
[Abstract]:Parturient brachial plexus nerve injury: obstetric brachial plexus palsy, also known as parturient paralysis, refers to the pulling injury of the brachial plexus nerve on one or both sides of the fetus due to head and shoulder separation violence during delivery. The clinical manifestation is paralysis of different degree of affected limb. Because the mechanism of brachial plexus injury is different from that of adults, and a series of secondary deformities can occur during nerve recovery and children's growth and development, the curative effect is unpredictable. Therefore, it is difficult to formulate a standardized treatment plan. How to make individualized treatment according to the specific conditions of children has become an important research topic in hand surgery. At present, the surgical treatment methods for childbirth brachial plexus injury are. Early microsurgical repair (brachial plexus neurolysis, Nerve transposition, graft repair, etc.) and late functional reconstruction. Although there are many surgical methods, there is still a lack of standardized sequential treatment. Objective: to summarize the clinical treatment data of 28 cases of puerperal brachial plexus injury, to explore the treatment plan and prognosis, and to explore the opportunity and method of operation. Materials and methods: from June 2006 to June 2012, 28 cases of puerperal brachial plexus injury were treated in our hospital. Nerve transposition, sural nerve transplantation and tendon insertion were followed up and evaluated. Results: the follow-up time was 6 months to 6 years and 3 months, with an average of 24 months. The shoulder joint was evaluated according to Mallet score in 12 cases, good in 11 cases, fair in 4 cases, fair in 0 cases, excellent in 12 cases, good in 11 cases, fair in 4 cases, fair in 0 cases. One case was poor. The elbow joint was evaluated according to Gilbert scoring method, 19 cases had excellent function recovery, 5 cases had good function, 4 cases had fair function, 0 case had poor hand function, 15 cases had excellent function recovery according to Raimeondi scoring method, 8 cases were good, 4 cases were fair; Conclusion there is no significant difference between nerve transplantation and transposition. According to the clinical situation, neurolysis, nerve suture or nerve transplantation can be used in patients with postganglionic injury of brachial plexus. For the patients with brachial plexus preganglionic injury, nerve transposition should be performed. The effect of tendon transfer should be confirmed. For the children with suitable operation, the main function should be reconstructed and the secondary function should be neglected. Reconstruction of a function without loss of an original function can not be lost) for the patients with definite brachial plexus injury, the patients with no obvious recovery of elbow flexion function within 3 months after birth should carry out early exploration and repair of brachial plexus nerve.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類(lèi)號(hào)】：R726.5

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