Utility of delayed surgical repair of neonatal brachial plexus palsy

被引:14
作者
Ali, Zarina S. [1 ]
Bakar, Dara [1 ]
Li, Yun R. [1 ]
Judd, Alex [1 ]
Patel, Hiren [1 ]
Zager, Eric L. [1 ]
Heuer, Gregory G. [1 ,2 ]
Stein, Sherman C. [1 ]
机构
[1] Univ Penn, Dept Neurosurg, Philadelphia, PA 19104 USA
[2] Childrens Hosp Philadelphia, Div Neurosurg, Philadelphia, PA 19104 USA
关键词
neonatal brachial plexus palsy; peripheral nerve; obstetric brachial plexus palsy; pediatric brachial plexus palsy; POOR FUNCTIONAL RECOVERY; NATURAL-HISTORY; MUSCULOCUTANEOUS NERVE; CONTRIBUTING FACTORS; DECISION-MAKING; BIRTH INJURIES; RISK-FACTORS; UPPER-LIMB; LESIONS; MANAGEMENT;
D O I
10.3171/2013.12.PEDS13382
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Object. Neonatal brachial plexus palsy (NBPP) represents a significant health problem with potentially devastating consequences. The most common form of NBPP involves the upper trunk roots. Currently, primary surgical repair is performed if clinical improvement is lacking. There has been increasing interest in "early" surgical repair of NBPPs, occurring within 3-6 months of life. However, early treatment recommendations ignore spontaneous recovery in cases of Erb's palsy. This study was undertaken to evaluate the optimal timing of surgical repair in this group with respect to quality of life. Methods. The authors formulated a decision analytical model to compare 4 treatment strategies (no repair or repair at 3, 6, or 12 months of life) for infants with persistent NBPPs. The model derives data from a critical review of published studies and projects health-related quality of life and quality-adjusted life years over a lifetime. Results. When evaluating the quality of life of infants with NBPP, improved outcomes are seen with delayed surgical repair at 12 months, compared with no repair or repair at early and intermediate time points, at 3 and 6 months, respectively. ANOVA showed that the differences among the 4 groups are highly significant (F = 8369; p < 0.0001). Pairwise post hoc comparisons revealed that there are highly significant differences between each pair of strategies (p < 0.0001). Meta-regression showed no evidence of improved outcomes with more recent treatment dates, compared with older ones, for either nonsurgical or for surgical treatment (p = 0.767 and p = 0.865, respectively). Conclusions. These data support a delayed approach of primary surgical reconstruction to optimize quality of life. Early surgery for NBPPs may be an overly aggressive strategy for infants who would otherwise demonstrate spontaneous recovery of function by 12 months. A randomized, controlled trial would be necessary to fully elucidate the natural history of NBPP and determine the optimal time point for surgical intervention.
引用
收藏
页码:462 / 470
页数:9
相关论文
共 86 条
[1]   NARAKAS CLASSIFICATION OF OBSTETRIC BRACHIAL PLEXUS PALSY REVISITED [J].
Al-Qattan, M. M. ;
El-Sayed, A. A. F. ;
Al-Zahrani, A. Y. ;
Al-Mutairi, S. A. ;
Al-Harbi, M. S. ;
Al-Mutairi, A. M. ;
Al-Kahtani, F. S. .
JOURNAL OF HAND SURGERY-EUROPEAN VOLUME, 2009, 34E (06) :788-791
[2]   Obstetric brachial plexus palsy associated with breech delivery [J].
Al-Qattan, MM .
ANNALS OF PLASTIC SURGERY, 2003, 51 (03) :257-264
[3]   The outcome of Erb's palsy when the decision to operate is made at 4 months of age [J].
Al-Qattan, MM .
PLASTIC AND RECONSTRUCTIVE SURGERY, 2000, 106 (07) :1461-1465
[4]   CONGENITAL BRACHIAL PALSY IN THE EASTERN PROVINCE OF SAUDI-ARABIA [J].
ALRAJEH, S ;
COREA, JR ;
ALSIBAI, MH ;
ALUMRAN, K ;
SANKARANKUTTY, M .
JOURNAL OF CHILD NEUROLOGY, 1990, 5 (01) :35-39
[5]   Long-term motor outcome analysis using a motor score composite following surgical brachial plexus repair [J].
Ashley, William W., Jr. ;
Baty, Jack D. ;
Hollander, Trisha ;
Noetzel, Michael J. ;
Park, Tae Sung .
JOURNAL OF NEUROSURGERY, 2007, 106 (04) :276-281
[6]   Correlation of Pediatric Outcomes Data Collection Instrument With Measures of Active Movement in Children With Brachial Plexus Birth Palsy [J].
Bae, Donald S. ;
Waters, Peter M. ;
Zurakowski, David .
JOURNAL OF PEDIATRIC ORTHOPAEDICS, 2008, 28 (05) :584-592
[7]   Perinatally acquired brachial plexus palsy - a persisting challenge [J].
Bager, B .
ACTA PAEDIATRICA, 1997, 86 (11) :1214-1219
[8]   Navigating the gray zone: a guideline for surgical decision making in obstetrical brachial plexus injuries Clinical article [J].
Bain, James R. ;
DeMatteo, Carol ;
Gjertsen, Deborah ;
Hollenberg, Robert D. .
JOURNAL OF NEUROSURGERY-PEDIATRICS, 2009, 3 (03) :173-180
[9]   Functional scoring system for obstetric brachial plexus palsy [J].
Basheer, H ;
Zelic, V ;
Rabia, F .
JOURNAL OF HAND SURGERY-BRITISH AND EUROPEAN VOLUME, 2000, 25B (01) :41-45
[10]   PROGNOSIS AND EARLY MANAGEMENT OF BIRTH INJURIES TO BRACHIAL-PLEXUS [J].
BENNET, GC ;
HARROLD, AJ .
BRITISH MEDICAL JOURNAL, 1976, 1 (6024) :1520-1521