The Results of Neurolysis In Perinatal Brachial Plexus Lesions Treatment

• Authors: Jerzy Gosk , Roman Rutowski , Roman Wiâcek , Maciej Urban , Witold Wnukiewicz , Pawel Reichert
• Languages of publication: EN

Abstracts

EN

The aim of the study was to evaluate of the results of neurolysis in perinatal brachial plexus lesions treatment.Material and methods. Clinical material comprised 31 children, both sex, in age between 3 and 29 months, who had neurolysis of brachial plexus in period from 1998 to 2005. Treatment results have been evaluated in group of 26 children by commonly accepted scales. The shortest postoperative observation period lasted 4 years.Results. Good and very good function of shoulder after surgical treatment has been noted in 14 cases, good function of elbow has been noted in 21 cases. Advantageous position of forearm has been observed in 19 cases. Useful function of wrist in group of upper-middle and total lesions has been found in 18 examined children. Useful motor and sensory hand function has been observed in 7 from 11 examined children with total lesions.Conclusions. Significant compression of brachial plexus neural elements is an indication for their release (neurolysis) also in lesions which have been classified as a I and II degree in Sunderland's scale. In brachial plexus lesions with preserved macroscopic continuity of neural elements (after exclusion of avulsion lesions), intrafascicular fibrosis may be one of reasons of poor neural function improvement.

Keywords

EN

neurolysis; obstetrical brachial plexus palsy; traction; compression

• Publisher: Index Copernicus International
• Journal: Polish Journal of Surgery
• Year: 2010
• Volume: 82
• Issue: 10
• Pages: 543-546

Dates

published

1 - 10 - 2010

online

6 - 12 - 2010

Contributors

author

Jerzy Gosk

• Department of Traumatology, Clinic of Traumatology and Hand Surgery, Medical University in Wrocław

author

Roman Rutowski

author

Roman Wiâcek

• Department of Traumatology, Clinic of Traumatology and Hand Surgery, Medical University in Wrocław

author

Maciej Urban

• Department of Traumatology, Clinic of Traumatology and Hand Surgery, Medical University in Wrocław

author

Witold Wnukiewicz

• Department of Traumatology, Clinic of Traumatology and Hand Surgery, Medical University in Wrocław

author

Pawel Reichert

• Department of Traumatology, Clinic of Traumatology and Hand Surgery, Medical University in Wrocław

References

• Abbott R, Abbott M, Alzate J et al.: Magnetic resonance imaging of obstetrical brachial plexus injuries. Childs Nerv Syst 2004; 20: 720-25.
• Bae DC, Waters, PM, Zurakowski D: Reliability of three classification systems measuring active motion in brachial plexus birth palsy. J Bone Joint Surg 2003; 85A: 1733-38.
• Birch R: Obstetric brachial plexus palsy. J Hand Surg 2002; 27B: 3-8.
• Haftek J: Urazy i uszkodzenia nerwów obwodowych. W: Tylman D, Dziak A (red.) Traumatologia narzαdu ruchu. PZWL, Warszawa 1996; T1: s. 251-301.
• Kiwerski J: Patomechanika urazów splotu ramiennego. Chir Narz Ruchu Ortop Pol 1977; XLII: 241-45.
• Slooff ACJ: Obstetric brachial plexus lesions and their neurosurgical treatment. Microsurg 1995; 16: 30-34.[Crossref]
• Sunderland S: Nerves and nerve injuries. Edinburgh London: Churchill Livingstone 1978.
• Giele H: Management of obstetrical brachial plexus palsy. Curr Paediatr 1999; 9: 182-97.[Crossref]
• Millesi H: Brachial plexus injury in adults: operative repair. W: Gelberman RHJB (red.) Operative nerve repair and reconstruction. New York: Lippincott Company 1991; s. 1285-1301.
• Bisinella GL, Birch R: Obstetric brachial plexus lesions: a study of 74 children registered with the British Paediatric Surveillance Unit (March 1998 - March 1999). J Hand Surg 2003; 28B: 40-45.
• O'Brien DF, Park TS, Noetzel MJ et al.: Management of birth brachial plexus palsy. Childs Nerv Syst 2006; 22: 103-12.
• Rutowski R: Neurotyzacja nerwami splotu szyjnego w urazowych uszkodzeniach splotu ramiennego połączonych z wyrwaniem korzeni nerwów rdzeniowych. Rozprawa habilitacyjna Wrocław 1992.
• Eng GD, Binder H, Getson P et al.: Obstetrical brachial plexus palsy outcome with conservative management. Muscle & Nerve 1996, 19: 884-91.
• Grossman JA: Early operative intervention for birth injuries to the brachial plexus. Sem Pediatr Neurol 2000; 7: 36-43.
• Malessy MJ, de Ruiter GCW, de Boer KS et al. Evaluation of suprascapular nerve neurotization after nerve graft or transfer in the treatment of brachial plexus traction lesions. J Neurosurg 2004; 101: 377-89.[Crossref]
• Haerle M, Gilbert A: Management of complete obstetric brachial plexus lesions. J Pediatr Orthop 2004: 24: 194-200.
• Al-Qattan MM: Assessment of the motor power in older children with obstetric brachial plexus palsy. J Hand Surg 2003; 28B: 46-49.
• Dellon AL: The moving two-point discrimination test: clinical evaluation of the quickly-adapting fiber-receptor system. J Hand Surg 1978; 3: 478-81.
• Omer GE: Report of the Committee for evaluation of the clinical result in peripheral nerve injury. J Hand Surg 1983; 8: 754-58.
• Gosk J, Rutowski R, Rabczyński J: The analysis of the intrasurgical view of the obstetric brachial plexus palsy. Folia Neuropathol 2005; 43: 143-47.
• Gosk J, Rutowski R: Pierwotne zabiegi naprawcze w okołoporodowych uszkodzeniach splotu ramiennego - własne doświadczenia. Pol Przegl Chir 2006; 78: 1361-67.
• Benjamin K: Injuries to the brachial plexus: mechanisms of injury and identification of risk factors. Distinguishing physical characteristics and management of brachial plexus injuries. Adv Neonat Care 2005; 5: 181-189, 240-51.
• Rutowski R: Chirurgia nerwów obwodowych. W: Mackiewicz Z i Szymczyński GA (red.) Wybrane zagadnienia z mikrochirurgii. Bydgoszcz: Andromed ltd 1998; s. 125-37.

Identifiers

DOI

10.2478/v10035-010-0080-3