Đánh giá kết quả điều trị phẫu thuật trong liệt đám rối thần kinh cánh tay trẻ em do sanh tại Bệnh viện Nhi Đồng 2=Evaluation of neurosurgical repair in obstetric brachial plexus palsy at Children’s Hospital 2

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Tác giả: Thị Ngọc Ngà Nguyễn, Đức Minh Mẫn Phan, Dzư Lê Thắng Phan

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Tạp chí Y học Việt Nam (Tổng hội Y học Việt Nam), 2024

Mô tả vật lý: tr.258-264

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ID: 243617

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Đánh giá kết quả điều trị phẫu thuật các trường hợp mổ thám sát có chuyển hoặc ghép thần kinh trong điều trị liệt đám rối thần kinh cánh tay trẻ em do sanh thực hiện tại Bệnh viện (BV) Nhi Đồng 2 Thành phố Hồ Chí Minh. Phương pháp: Hồi cứu những trường hợp có chỉ định mổ thám sát thần kinh dựa theo tình trạng diễn tiến phục hồi cơ nhị đầu cánh tay tại BV Nhi Đồng 2, chủ yếu nối ghép bằng thần kinh sural. Mức độ tổn thương trước mổ được đánh giá theo phân loại Naraska và kết quả phục hồi chức năng sau thời gian theo dõi dựa trên phân loại Mallet, Chen và thang điểm AMS. Kết quả: Ghi nhận có tổng cộng 31 trường hợp mổ thám sát bao gồm 16 bé nam, 15 bé nữ, được mổ từ 2016 - 2024. Thời điểm mổ từ 3 - 9 tháng tuổi (trong đó 3 - 6 tháng tuổi có 21/31 trường hợp). Tổn thương chủ yếu mức độ nặng và rất nặng ở cấp độ 3 và 4 của Naraska chiếm 29/31 trường hợp (tay liệt hoàn toàn hoặc chỉ nhúc nhích nhẹ vài ngón tay trước mổ), trong đó chỉ có 5 trường hợp nhổ đứt rễ mà không có rễ nhổ rứt sát tủy, có 11 ca bị hội chứng Horner. Phẫu thuật thám sát ghi nhận trong đó chỉ có 3 trường hợp giải ép bao neuroma đơn thuần và bổ sung thêm nối/ ghép thần kinh khác, còn lại 29 trường hợp phải ghép thần kinh sural (có 1 ca phải ghép thần kinh sural cho C7 đối bên). Có 3 ca bị biến chứng sau mổ gồm 1 ca liệt thần kinh hoành, 2 ca khớp giả xương đòn. Phục hồi chức năng ghi nhận trên 21 ca theo dõi trên 1 năm (trong đó 17 ca theo dõi hơn 3 năm) với kết quả rất tốt chủ yếu phục hồi chức năng dạng vai hoàn toàn (10/21 trường hợp), phục hồi chức năng gấp khuỷu còn hạn chế (gấp tốt 9/21 trường hợp) và chức năng bàn tay không đạt ở mức cao (19/21 trường hợp chức năng kém và không có chức năng tương đương mức độ Chen III và IV). Kết luận: Nhóm nghiên cứu bao gồm 31 trường hợp liệt đám rối thần kinh gần hoàn toàn hoặc hoàn toàn trước mổ tương đương mức độ III và IV của phân loại Naraska. Phẫu thuật điều trị chủ yếu ghép thần kinh sural. Phục hồi chức năng chỉ đạt tốt và rất tốt cho dạng vai, nhưng chức năng bàn tay còn rất kém nhiều.Evaluate the results of surgical treatment in cases of exploration and nerve transfer or grafting in the obstetrical brachial plexus palsy at the Children’s Hospital 2 in Ho Chi Minh City. Methods: retrospective study of cases with indications for nerve exploration based on no sign of the bicep muscle ‘s contracture restoration after 3 months old and requiring sural nerve grafting. The severity of the injury was assessed according to the Naraska classification and the functional recovery results after the follow-up 3 years period were based on the Mallet and Chen classification as well as the AMS scale. Results: there were 31 cases recorded, including 16 males and 15 females, making the decision regarding surgery when they are 3 - 9 months of age (of which 3 - 6 months old have 21/31). The never injuries almost noted with Naraska grade of 3 and 4 including 29/31 cases (complete BPBI), of which there were 5 cases having only the nerve rupture injury purely and without according to the other nerve avulsion injury. The Horner syndrome was present in the 11 cases. Surgical exploration recorded that there were only 3 cases of neuroma needed to neurectomy and complemented with suturing or grafting the other nerves. The remaining 29 cases needed to be using the sural nerve grafting (of which one case had to be sural nerve graft for contralateral C7). Complications noted one case relating to phrenic nerve palsy and 2 cases having fault technique including clavicle bone nonUNI0N. There were 21 cases recording functional recovery results from follow up over 3 years. The good results mainly noted in restoring complete shoulder abduction function (10/21 cases), restoration of elbow flexion function was only 9/21 cases of good function and hand function was poor result (19/21 of Chen grade III and IV). Conclusion: our group study included 31 cases with severe injury of Naraska grade 3 and 4. Surgical treatment needed to be using sural nerve grafting almost. Functional restoration noted the good result for the shoulder abduction, but the hand function was poor result and should perfect the technique more.

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