Zusammenfassung
Die kindliche Plexuslähmung ist ein seltener, aber mitunter schwerer peripartaler Traktionsschaden am Plexus brachialis. Die Mikrochirurgie peripherer Nerven (Neurolyse, interfaszikuläre Interponate) und ein Spektrum sekundärer Eingriffe mit Muskel- und Sehnentranspositionen sowie der Korrektur von Gelenkkontrakturen haben die Prognose in den letzten 20 Jahren sehr verbessert.
Diese Arbeit gibt einen historischen Überblick, stellt die aktuelle Diskussion zur Pathophysiologie vor (die kindliche Plexusläsion meist eine Traktionsfolge, sehr selten intrauterine Maladaptation), beschreibt die Klinik und berichtet anhand eines Kollektivs von 500 Patienten mit 100 mikrochirurgischen Plexusrekonstruktionen über die chirurgische Technik und persönliche Erfahrung bei der primären Nervenwiederherstellung. Ein Konzept zu den Sekundäreingriffen wird entsprechend der verschiedenen Gelenke kurz vorgestellt und verschiedene Möglichkeiten der postoperativen Bewertung einschließlich der videogestützten Bewegungsanalyse beschrieben.
Als Fazit gilt, dass schwere obere und vollständige Plexuslähmungen ohne gute Remission mikrochirurgisch exploriert und rekonstruiert werden sollten.
Abstract
Obstetric brachial plexus palsy is a rare but sometimes severe traction injury. Peripheral nerve microsurgery (neurolysis, interfascicular grafting) and secondary procedures including muscle and tendon transfers altogether with contracture releases have improved the prognosis over the last 20 years.
This article includes a historical review, the ongoing discussion about the pathophysiology (frequent traction injury vs. rare intrauterine maladaptation) and the clinics.
Based on a patient group of 500 children with 100 microsurgical plexus reconstructions, we describe the surgical technique and our experience with primary nerve reconstruction. A concept about secondary procedures according to the joint levels is shortly exposed together with various modalities of postoperative evaluation, including video-assisted movement analysis.
We conclude that severe upper and complete plexus palsies without significant recovery should be explored and reconstructed by microsurgical techniques.
Schlüsselwörter
Plexuslähmung - Geburtstrauma - Mikrochirurgie
Key words
Plexus palsy - obstetric injury - microsurgery
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Dr. med. Jörg Bahm
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Morillenhang 27
52074 Aachen
Email: jorg.bahm@belgacom.net
