Curative Effect Analysis Of Early Stage And Stage Operation Of Obstetric Brachial Plexus Injury

Objective: To evaluate the outcomes of treating obstetric brachial plexus palsy with an early and staging surgery strategy.Obstetric brachial plexus injury refers to the infant brachial plexus injury during delivery,which easily leads to disability,performing as obstacle of feeling and movement,especially when diagnosis and treatment is not in time and standard.It`s not rare in clinical,which is not only a sorrow to patient but also a burden to society and family.At present,treatment to it contains of recovery practice,nerve release,nerve transposition and function reconstruction.Though it has a fair outcome,there is not a standard yet,such as the treatment of neuroma,choice of time and operation method.By summarizing the patients` data who underwent an early and staging surgery strategy,our research aims to purpose a standard of the treatment of OBBP in surgery method and time,with the purpose of promotion of surgery outcomes and probability of disability.Methods: Retrospectively analyzed the clinical date of 36 cases of brachial plexus palsy who underwent surgical treatment in the Third hospital of Hebei Medical university during 2009 to 2013.The group of patients is with male 23 cases,female 13 cases,aged from 2 months to 8 years old,with the median age 7 months,5 cases ages above 2 years old.Right side suffered in 21 cases,left side in 15 cases and no case suffered both sides.The birth weights were 3.0-4.8Kg,with an average weight of 3.8Kg.35 cases were natural birth and 1 case was cesarean delivery.The cases classified by the Tassin classification standard: 6 cases were Tassin type,accounting for 16.7%;17 Ⅰcases were Tassin Ⅱ,accounting for 47.2%;12 cases were Tassin Ⅲtype,accounting for 33.3%;1 case were Tassin Ⅳtype,accounting for 2.8%.We treated them using a early and staging surgical tragedy: in first stage we performed an accessory nerve end-to-side transposition to recover the upper trunk or its frontier division,in second stage we performed nerve release determined by follow-up outcomes,and finally we performed a function reconstruction if the child didn’t recover an acceptable shoulder abduction function after 2 years old.We followed up the children every 3 months to evaluate their functions until there were no improvement.We evaluate the shoulder function by Mallett standard,elbow function by Gilbert standard and hand function by Raimondi function.Results: All the cases acquired follow-up from 18 months to 42 months.Shoulder function evaluated by Mallett standard: excellent in 18 cases,good in 15 cases,ordinary in 2 cases,acceptable in 1 case and no bad case.Elbow function evaluated by Gilbert standard: excellent in 25 cases,good in 10 cases,ordinary in 1 cases and no acceptable and bad case.Hand function evaluated by Raimondi function: excellent in 30 cases,good in 5 cases,no ordinary case,acceptable in 1 case and no bad case.Conclusion:1 Operation of neuroma release with restoring the continuity of neuroma early can maintain the function of the original nerve.2 A tragedy of early using an accessory nerve end-to-side transposition to recover the upper thunk,nerve releasing in the recovery period is beneficial to nerve regeneration and recover the limb function as soon as possible.3 After suspend of nerve regeneration using a limb function reconstruction operation can recover the function as much as possible.