PDF(Pubmed)
Abstract：
OBJECTIVE: Brachial plexus birth injury (BPBI) is a common injury with the spectrum of disease prognosis ranging from spontaneous recovery to lifelong debilitating disability. A common sequela of BPBI is glenohumeral dysplasia (GHD) which, if not addressed early on, can lead to shoulder dysfunction as the child matures. However, there are no clear criteria for when to employ various surgical procedures for the correction of GHD.
METHODS: We describe our approach to correcting GDH in infants with BPBIs using a reverse end-to-side (ETS) transfer from the spinal accessory to the suprascapular nerve. This technique is employed in infants that present with GHD with poor external rotation (ER) function who would not necessitate a complete end-to-end transfer and are still too young for a tendon transfer. In this study, we present our outcomes in seven patients.
RESULTS: At presentation, all patients had persistent weakness of the upper trunk and functional limitations of the shoulder. Point-of-care ultrasounds confirmed GHD in each case. Five patients were male, and two patients were female, with a mean age of 3.3 months age (4 days-7 months) at presentation. Surgery was performed on average at 5.8 months of age (3-8.6 months). All seven patients treated with a reverse ETS approach had full recovery of ER according to active movement scores at the latest follow-up. Additionally, ultrasounds at the latest follow-up showed a complete resolution of GHD.
CONCLUSIONS: In infants with BPBI and evidence of GHD with poor ER, end-to-end nerve transfers, which initially downgrade function, or tendon transfers, that are not age-appropriate for the patient, are not recommended. Instead, we report seven successful cases of infants who underwent ETS spinal accessory to suprascapular nerve transfer for the treatment of GHD following BPBI.
METHODS: We describe our approach to correcting GDH in infants with BPBIs using a reverse end-to-side (ETS) transfer from the spinal accessory to the suprascapular nerve. This technique is employed in infants that present with GHD with poor external rotation (ER) function who would not necessitate a complete end-to-end transfer and are still too young for a tendon transfer. In this study, we present our outcomes in seven patients.
RESULTS: At presentation, all patients had persistent weakness of the upper trunk and functional limitations of the shoulder. Point-of-care ultrasounds confirmed GHD in each case. Five patients were male, and two patients were female, with a mean age of 3.3 months age (4 days-7 months) at presentation. Surgery was performed on average at 5.8 months of age (3-8.6 months). All seven patients treated with a reverse ETS approach had full recovery of ER according to active movement scores at the latest follow-up. Additionally, ultrasounds at the latest follow-up showed a complete resolution of GHD.
CONCLUSIONS: In infants with BPBI and evidence of GHD with poor ER, end-to-end nerve transfers, which initially downgrade function, or tendon transfers, that are not age-appropriate for the patient, are not recommended. Instead, we report seven successful cases of infants who underwent ETS spinal accessory to suprascapular nerve transfer for the treatment of GHD following BPBI.
摘要：
目的：臂丛神经出生损伤（BPBI）是一种常见的损伤，其疾病预后范围从自发恢复到终身衰弱。BPBI的常见后遗症是肱骨发育不良（GHD），如果没有尽早解决，随着孩子的成熟，会导致肩部功能障碍。然而,对于何时采用各种外科手术来矫正GHD,目前尚无明确的标准.
方法：我们描述了我们使用从脊柱附件到肩胛骨上神经的反向端对侧（ETS）转移来纠正患有BPBIs的婴儿GDH的方法。该技术用于患有GHD且外部旋转（ER）功能较差的婴儿，这些婴儿不需要完全的端到端转移，并且对于肌腱转移来说还太年轻。在这项研究中,我们介绍了7例患者的结局.
结果：在演讲中，所有患者均存在上躯干持续无力和肩关节功能受限.护理点超声在每种情况下都证实了GHD。五名患者是男性，两个病人是女性,演示时平均年龄为3.3个月（4天至7个月）。手术平均在5.8个月（3-8.6个月）进行。根据最新随访的活动运动评分，采用反向ETS方法治疗的所有7例患者的ER均已完全恢复。此外,最新随访的超声显示GHD完全消退。
结论：在患有BPBI且有GHD证据且ER较差的婴儿中，端到端的神经转移，最初降级功能，或者肌腱转移，不适合患者的年龄，不推荐。相反，我们报告了7例成功的婴儿在BPBI后接受了肩胛骨上神经转移的ETS脊髓附件治疗GHD的病例.
方法：我们描述了我们使用从脊柱附件到肩胛骨上神经的反向端对侧（ETS）转移来纠正患有BPBIs的婴儿GDH的方法。该技术用于患有GHD且外部旋转（ER）功能较差的婴儿，这些婴儿不需要完全的端到端转移，并且对于肌腱转移来说还太年轻。在这项研究中,我们介绍了7例患者的结局.
结果：在演讲中，所有患者均存在上躯干持续无力和肩关节功能受限.护理点超声在每种情况下都证实了GHD。五名患者是男性，两个病人是女性,演示时平均年龄为3.3个月（4天至7个月）。手术平均在5.8个月（3-8.6个月）进行。根据最新随访的活动运动评分，采用反向ETS方法治疗的所有7例患者的ER均已完全恢复。此外,最新随访的超声显示GHD完全消退。
结论：在患有BPBI且有GHD证据且ER较差的婴儿中，端到端的神经转移，最初降级功能，或者肌腱转移，不适合患者的年龄，不推荐。相反，我们报告了7例成功的婴儿在BPBI后接受了肩胛骨上神经转移的ETS脊髓附件治疗GHD的病例.
