Obstetric brachial plexus palsy: 20 years’ experience at a tertiary center in Turkey

Year 2013, Volume: 48 Issue: 1, 13 - 16, 01.03.2013

Gönül Acar Barış Ekici Feride Bilir Mine Çalışkan Meral Özmen Nur Aydınlı Burak Tatlı

Abstract

Aim: The aim of this study was to examine cases of obstetric brachial plexus palsy OBPP treated over 20 years at a single tertiary center Material and Method: We retrospectively reviewed 777 cases of OBPP who were observed at the Pediatric Neurology Department at Istanbul Medical Faculty between March 1989 and December 2010 The patients were evaluated in terms of demographic characteristics treatment methods surgical approaches complications and functional levels according to Narakas Clasification Scale Results: Out of a total of 777 OBPP patients 393 were female and 384 were male The mean birth weight was 3968 9 g Three of the patients were siblings OBPP was bilateral in 3 patients; right sided in 463 patients and left sided in 311 patients In terms of concomitant conditions 82 patients had torticollis 62 had Horner rsquo;s syndrome 47 had broken clavicle 3 had broken humerus 3 had cerebral palsy and 1 had facial paralysis According to the Narakas classification 430 patients 55 were evaluated as stage 1 OBPP 219 28 5 were evaluated as stage 2 66 8 5 were evaluated as stage 3 and 62 8 were evaluated as stage 4 One third of the patients 33 underwent Vojta and neurodevelopmental therapy in addition to routine physiotherapy Complete recovery was observed in 439 56 of all patients in 66 of the patients with stage 1 OBPP in 56 of the patients with stage 2 OBPP in 35 of the patients with stage 3 OBPP and in 18 of the patients with stage 4 OBPP Botulinum Toxin Type A was applied in 97 cases; 30 patients underwent primary nerve surgery and 94 underwent multiple surgical procedures 25 of them required a second surgery and 15 required a third surgery Various joint contractures were seen in 200 patients Conclusions: Despite physiotherapy Botulinum Toxin Type A application and surgical intervention one out of three patients had difficulty using their arm and developed contractures and disabilities that affected their every day life In conclusion OBPP continues to be a severe problem leading to functional impairment and disability Turk Arch Ped 2013; 48: 13 6

Keywords

Botulinum toxin type A, Narakas classification, obstetric brachial plexus palsy, physiotherapy, torticollis

Doğumsal brakiyal pleksus felçli olgularımız: tek merkezin 20 yıllık deneyimi

Abstract

Amaç: Doğumsal brakiyal pleksus felci tanısı alan olgularımızın klinik özelliklerini ve izlem sonuçlarını ortaya koymaktır. 

Gereç ve Yöntem: Çalışmada Mart 1989 ile Aralık 2010 tarihleri arasında İstanbul Üniversitesi İstanbul Tıp Fakültesi Çocuk Nörolojisi Bilim Dalı rsquo;nda izlenen 777 olgunun demografik özellikleri uygulanan tedavi yöntemleri ve cerrahi yaklaşımları ortaya çıkan komplikasyonlar ve Narakas sınıflamasına göre iyileşme düzeyleri geriye dönük olarak değerlendirildi. 

Bulgular: Doğumsal brakiyal pleksus paralizili 777 hastanın 393 rsquo;ü kız 384 rsquo;ü erkek idi Ortalama doğum kiloları 3968 9 gramdı Üç olgu aynı anneden doğan kardeşlerdi Paralizi 463 hastada sağ 311 hastada sol ve üç hastada iki taraflı olarak gelişmişti Brakiyal pleksus paralizisine ek olarak olguların 82 39;sinde tortikolis 62 39;sinde Horner sendromu 47 39;sinde klavikula kırığı üçünde humerus kırığı üçünde beyin felci ve birinde yüz felci saptandı Narakas sınıflamasına göre 430 55 olgu evre 1 219 28 5 olgu evre 2 66 8 5 olgu evre 3 ve 62 8 olgu evre 4 olarak değerlendirildi Olguların 33 rsquo;üne Vojta ve geleneksel tedavi yaklaşımları 67 rsquo;sine ise sadece geleneksel fizyoterapi yaklaşımı uygulandı Tüm olguların 439 rsquo;unda 56 tam iyileşme sağlandı Narakas rsquo;a göre evre 1 olan olguların 66 rsquo;sında evre 2 olguların 56 rsquo;sında evre 3 olguların 35 rsquo;inde ve evre 4 olguların 18 rsquo;inde tam iyileşme sağlandı Olguların 97 rsquo;sine botilinum toksin A 30 olguya birincil sinir cerrahisi ve 94 olguya ikincil cerrahi uygulandı Bu olgulardan 25 rsquo;i ikinci kez 15 rsquo; i üçüncü kez cerrahi girişim geçirdi İki yüz olguda çeşitli düzeylerde eklem kontraktürleri gelişti.

Çıkarımlar: Düzenli fizyoterapi botilinum toksin A uygulaması ve cerrahi girişimlere rağmen olguların üçte birinde kolda kullanım zorluğu kontraktür ve özürlerin oluştuğu gözlendi Sonuç olarak doğumsal brakiyal pleksus felci işlevsel yetersizlikle sonuçlanan ve özür bırakan önemli bir sorun olmaya devam etmektedir.

Keywords

Botilinum toksin A, doğumsal brakiyal pleksus felci, fizyoterapi, Narakas sınıflandırması, tortikolis

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