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Preganglionic injuries in perinatal brachial plexus palsies – results of surgical treatment
Affiliations- Department of Traumatology, Anaesthesiology and Military Surgery of the Kharkiv Medical Academy of Postgraduate Education, Kharkiv, Ukraine
- Wrocław University of Environmental and Life Sciences; Faculty of Veterinary Medicine; Department of Biostructure and Animal Physiology, Kożuchowska 1/3, 51-631 Wrocław, Poland
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Abstract
The authors report their experience in surgical treatment of preganglionic injuries in perinatal brachial plexus palsies.
Material and methodsClinical material consisted of 16 children, of both sexes, aged from 2.5 to 33 months (mean 6.2 months), treated surgically between 1994 and 2006. The clinical view of the injury and location of preganglionic lesions was analysed and the description of the performed microsurgical techniques is provided. Control clinical examinations included a group of 14 children. The shortest postoperative observation period was 3 years. The currently accepted scales of evaluation of function of particular joints of the upper limb were used.
ResultsThe following outcome was noted after surgical treatment of perinatal brachial plexus palsies with signs of pre- and postganglionic injuries: good shoulder function in 6 cases, and average in 2 others; good elbow function in 4 cases, and average in 7 patients; functional position of the forearm in 9 cases, and good range of pronation and supination in 1 patient; useful function of wrist (flexion/extension) in 4 cases; good motor hand function in 3 cases, and fair in 6 patients.
ConclusionsIn preganglionic perinatal brachial plexus injuries located in the upper-middle part, spinal nerve C7 roots avulsion is the most frequently observed, and in the lower part of the brachial plexus, spinal nerve C8 roots avulsion is the most frequently observed. In preganglionic injuries of the brachial plexus, the number of avulsed spinal nerves has an influence on technical possibilities of performing reconstruction procedures, and then the results of the surgical treatment.
Abstract
The authors report their experience in surgical treatment of preganglionic injuries in perinatal brachial plexus palsies.
Material and methodsClinical material consisted of 16 children, of both sexes, aged from 2.5 to 33 months (mean 6.2 months), treated surgically between 1994 and 2006. The clinical view of the injury and location of preganglionic lesions was analysed and the description of the performed microsurgical techniques is provided. Control clinical examinations included a group of 14 children. The shortest postoperative observation period was 3 years. The currently accepted scales of evaluation of function of particular joints of the upper limb were used.
ResultsThe following outcome was noted after surgical treatment of perinatal brachial plexus palsies with signs of pre- and postganglionic injuries: good shoulder function in 6 cases, and average in 2 others; good elbow function in 4 cases, and average in 7 patients; functional position of the forearm in 9 cases, and good range of pronation and supination in 1 patient; useful function of wrist (flexion/extension) in 4 cases; good motor hand function in 3 cases, and fair in 6 patients.
ConclusionsIn preganglionic perinatal brachial plexus injuries located in the upper-middle part, spinal nerve C7 roots avulsion is the most frequently observed, and in the lower part of the brachial plexus, spinal nerve C8 roots avulsion is the most frequently observed. In preganglionic injuries of the brachial plexus, the number of avulsed spinal nerves has an influence on technical possibilities of performing reconstruction procedures, and then the results of the surgical treatment.
Keywords
preganglionic injuries, spinal nerve roots avulsion, perinatal brachial plexus palsy, extra-anatomical extraplexus reconstructions, extra-anatomical intraplexus reconstructions
About this articleTitle
Preganglionic injuries in perinatal brachial plexus palsies – results of surgical treatment
Journal
Neurologia i Neurochirurgia Polska
Issue
Pages
140-147
Page views
225
Article views/downloads
391
DOI
10.1016/S0028-3843(14)60025-6
Bibliographic record
Neurol Neurochir Pol 2011;45(2):140-147.
Keywords
preganglionic injuries
spinal nerve roots avulsion
perinatal brachial plexus palsy
extra-anatomical extraplexus reconstructions
extra-anatomical intraplexus reconstructions
Authors
Jerzy Gosk
Roman Rutowski
Roman Wiącek
Maciej Urban
Piotr Mazurek
