Operation Method And Proginosis In Obstetric Brachial Plexus Palsy

Objective:Obstetric brachial plexus palsy(OBPP) are usually caused by tractionduring delivery.The result may vary from neurapraxia or axonatmesis toneurotmesis and avulsion of rootlets from the spinal cord.Brachial plexuspalsy leads to paresis of shoulder and elbow flexion.Wrist or handproblem is rare for the reason that upper part of the brachial plexus ismost commonly affected. Physiotherapy, microsurgical nerve reconstr-uction, seconddary joint corrections,and muscle transpositions areemployed to help the child maximize function in the upper extremity.Yetnormative surgical process can’t be unified because the pathogenisis ofobstetric brachial plexus palsy differs from adults’ as well as secondarydysplasia ensuing. This paper aim to explore when and how to takemeasures to treat obstetric brachial plexus palsy.Meterlals and Methods:Children diagnosed with obstetric brachial plexus palsy from June2006to June2012in our department,with or without surgicaltreatment,are followed up.Some take conservative treatment and otherstake operations.Operation meathods include neurolysis,neuroma excision,interposition nerve grafting and neurotization，latissimus dorsi and teres major tendon transfer,and musculotendinous lengthening of thesubscapularis.Evaluated the results to assess operation time and operationmethods proper or not.Results:Using Mallet score to assess shoulder functions, Gilbert score toassess elbow functions and Raimondi score to assess handfunctions.Scores are separated into five degrees: excellent, good, ordinary,acceptable and bad.All patients who have been followed-up haveexcellent or good results.Some have shoulder or elbow deformaties takesecondary tendon transfer achieving higher score than before.Concluslons:(1) There is no statistical difference between neurotization andinterposition nerve grafting.According to clinical setting to choseoperation methords.(2) Tendon transfer achieve effectve results.We take operations torebuild major functions.The functions have been rebuilt last timeshouldn’t be lost in the secondary progress.(3)Patients diagnosed with obstetric brachial plexus palsy shouldtake microsurgery whose elbow flexion function recovery isunconspicuous in3month.