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Geburtstraumatische Armplexusparesen

Eine interdisziplinäre Herausforderung

Birth-related brachial plexus palsy

An interdisciplinary challenge

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Zusammenfassung

Geburtstraumatische Armplexusparesen werden oft als schicksalhaft angesehen, wodurch der richtige Zeitpunkt für eine sinnvolle primäre Operation am Plexus brachialis verpasst werden kann. Zwar liegen in den meisten Fällen leichte Dehnungsverletzungen vor, die sich unter Physiotherapie erholen können, jedoch hinterlassen schwere Ab- oder Ausrissverletzungen oft beachtliche lebenslange Einschränkungen. Die „Arbeitsgruppe geburtstraumatische Armplexusparese München“ hat sich zum Ziel gesetzt, eine kompetente Beratung und Behandlung für Patienten und ihre Eltern anzubieten. In einer monatlichen interdisziplinären Sprechstunde werden Betroffene möglichst im 3. Lebensmonat vorgestellt, klinisch und ggf. elektrophysiologisch untersucht und weitere diagnostische Maßnahmen eingeleitet. Bis spätestens zum 9. Lebensmonat wird entschieden, ob eine direkte Operation am Plexus brachialis sinnvoll ist. Mit der weiteren Entwicklung des Kindes können auch zu einem späteren Zeitpunkt sekundäre therapeutische Maßnahmen sinnvoll sein. Seit 2002 wurden durch die Arbeitsgruppe mehr als 150 Patienten interdisziplinär behandelt. Die gemeinsame Beratung und Behandlung durch Pädiatrie, Entwicklungsneurologie, Neurologie, Handchirurgie und Plastische Chirurgie werden überaus positiv aufgenommen. Die vorliegende Arbeit soll eine Übersicht und ein Behandlungsschema hinsichtlich der aktuellen Vorgehensweise bei Patienten mit geburtstraumatischer Armplexusparese geben sowie die Möglichkeiten chirurgischer Rekonstruktionsverfahren aufzeigen.

Abstract

Birth-related brachial plexus palsy is often considered unavoidable and untreatable. Hence the ideal time for potentially effective brachial plexus surgery is often missed. However, the majority of birth-related brachial plexus lesions are light traction injuries which recover without surgical reconstruction under physiotherapy. This is not true for severe injuries with loss of continuity due to disruption or avulsion of the brachial plexus. These lesions can leave severe functional losses of the upper extremity for the patient’s lifetime. Patients with non-recovering brachial plexus injuries should be referred to an interdisciplinary center for birth-related brachial plexus injuries within the first 3 months of life. A German working group on birth-related brachial plexus palsy based in Munich (Dr. von Haunersches Kinderspital) aims to offer competent advice and treatment for parents and patients. Patients can attend a monthly interdisciplinary clinic, preferably in the third month of life, where they are clinically and electrophysiologically examined and further therapeutic steps are initiated. The decision on whether direct brachial plexus surgery is recommended is taken by the 9th month of life at the latest. According to the child’s development, other techniques, such as Botulinum toxin, tenolysis, tendon lengthening, as well as other tendon transfer methods, can be helpful in restoring everyday function in the affected limb. Since 2002, the working group on birth-related brachial plexus palsy has treated more than 150 patients on an interdisciplinary basis, including pediatrics, developmental neurology, neurology, hand surgery and plastic and reconstructive surgery. Their work as been very positively received both locally and nationally. The current article aims to review diagnostic and therapeutic options and strategies and to focus on the possibilities of both primary and secondary reconstruction of the brachial plexus.

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Giunta, R., Enders, A., Lukas, B. et al. Geburtstraumatische Armplexusparesen. Monatsschr Kinderheilkd 158, 262–272 (2010). https://doi.org/10.1007/s00112-009-2130-7

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