RESUMO
We retrospectively reviewed 26 patients who underwent reconstruction of the shoulder for a medial rotation contracture after birth injury of the brachial plexus. Of these, 13 patients with a mean age of 5.8 years (2.8 to 12.9) received an injection of botulinum toxin type A into the pectoralis major as a surgical adjunct. They were matched with 13 patients with a mean age of 4.0 years (1.9 to 7.2) who underwent an identical operation before the introduction of botulinum toxin therapy to our unit. Pre-operatively, there was no significant difference (p = 0.093) in the modified Gilbert shoulder scores for the two groups. Post-operatively, the patients who received the botulinum toxin had significantly better Gilbert shoulder scores (p = 0.012) at a mean follow-up of three years (1.5 to 9.8). It appears that botulinum toxin type A produces benefits which are sustained beyond the period for which the toxin is recognised to be active. We suggest that by temporarily weakening some of the power of medial rotation, afferent signals to the brain are reduced and cortical recruitment for the injured nerves is improved.
Assuntos
Traumatismos do Nascimento/complicações , Toxinas Botulínicas Tipo A/administração & dosagem , Plexo Braquial/lesões , Fármacos Neuromusculares/administração & dosagem , Articulação do Ombro/anormalidades , Criança , Pré-Escolar , Terapia Combinada/métodos , Feminino , Humanos , Injeções Intramusculares , Masculino , Estudos Retrospectivos , Rotação , Articulação do Ombro/cirurgia , Resultado do TratamentoRESUMO
Of 22 infants aged between 11 and 29 months who underwent a combined reconstruction of the upper brachial plexus and shoulder for the sequelae of a birth injury, 19 were followed up for two or more years. The results were evaluated using a modified Gilbert scale. Three patients required a secondary procedure before follow-up. Three patients had a persistent minor internal rotation contracture. All improved by at least two grades on a modified Gilbert scale.
Assuntos
Plexo Braquial/lesões , Paralisia Obstétrica/cirurgia , Articulação do Ombro/cirurgia , Plexo Braquial/cirurgia , Pré-Escolar , Doença Crônica , Contratura/cirurgia , Seguimentos , Humanos , Lactente , Recém-Nascido , Transferência de Nervo/métodos , Procedimentos Ortopédicos/métodos , Índice de Gravidade de Doença , Luxação do Ombro/cirurgia , Fatores de Tempo , Resultado do TratamentoRESUMO
This report details the complications experienced during 100 consecutive cases of brachial plexus surgery in infants. There were eight perioperative complications. There was no mortality or permanent sequelae from any complication.
