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目的综述分娩性臂丛损伤(又称产瘫)的诊治进展。方法广泛查阅近年与产瘫有关的文献,并对其发病率、危险因素、临床分型、辅助检查以及神经重建手术的适应证、方式和疗效进行总结分析。结果近年来产瘫发病率未见明显下降。体质量≥4 kg、产钳助产和孕妇体质量指数≥21是产瘫的主要危险因素,而剖宫产是保护因素。神经电生理检查可用于产瘫的定性诊断,但不可用作定量指标。脊髓CT及MRI造影的敏感度和特异性分别约为0.7和0.97。一般采用Narakas分型,即Ⅰ型为C5、6损伤,Ⅱ型为C5~7损伤,Ⅲ型为全臂丛损伤,Ⅳ型为Ⅲ型伴Horner征。通常认为3个月无屈肘动作是臂丛探查指征。10%~30%产瘫需要手术治疗,对于上干创伤性神经瘤,绝大多数作者主张行神经瘤切除神经重建。上中干手术疗效的最终评价应在术后4年、全臂丛应在术后8年;功能评价主要采用肩关节Mallet评分、肘关节Gilbert评分和手功能Raimondi分级。结论出生后3个月无屈肘时应行手术探查;对于创伤性神经瘤(即使术中有电传导)应行切除并臂丛重建。
Objective To summarize the diagnosis and treatment of labor brachial plexus injury (also known as paraplegia). Methods The literatures related to paralysis in recent years were consulted extensively. The incidence, risk factors, clinical classification, auxiliary examination and indications, methods and curative effects of neurological reconstruction were analyzed. Results The incidence of paralysis in recent years, no significant decline. Body mass ≥ 4 kg, forceps midwifery and pregnant women body mass index ≥ 21 is the main risk factors for paraplegia, and cesarean section is a protective factor. Neurophysiological examination can be used for the qualitative diagnosis of paraplegia, but not as a quantitative indicator. Sensitivity and specificity of spinal CT and MRI were about 0.7 and 0.97, respectively. General Narakas classification, that type Ⅰ C5,6 injury, type Ⅱ for the C5 ~ 7 injury, type Ⅲ for the whole brachial plexus injury, type Ⅳ Ⅲ with Horner syndrome. Brachial plexus probing is usually considered as a three-month elbow-free maneuver. 10% to 30% of patients with paraplegia require surgical treatment, for the upper traumatic neuroma, the vast majority of authors advocate the nerve excision of nerve reconstruction. The final evaluation of the efficacy of upper and middle stem surgery should be 4 years after operation and the whole brachial plexus should be 8 years after operation. The functional evaluation mainly includes the Mallet score of the shoulder joint, the Gilbert score of the elbow joint and the Raimondi classification of the hand function. Conclusions Surgical exploration should be performed without elbow flexion 3 months after birth. For traumatic neuroma (even if there is electrical conduction during operation), resection and brachial plexus reconstruction should be performed.