新生儿臂丛神经损伤Neonatal brachial plexus injury转载2008-7-13

天津一个患者家属问：我妻子7天前困产一个孩子9.3斤的孩子，现在被确诊为 新生儿臂丛神经损伤，医院是否有责任，能否回复?

A family member of a patient in Tianjin asked: my wife was pregnant with a child of 9.3 pounds seven days ago. Now she is diagnosed with neonatal brachial plexus nerve injury. Does the hospital have responsibility and can it respond?

答：新生儿臂丛神经麻痹又称新生儿产伤，是因为分娩过程中过度牵拉胎儿肩、颈所致。巨大儿、耻骨弓低平、角度小、宫缩乏力是造成新生儿臂丛神经损伤的原因。轻者出生后2～3个月功能可逐渐恢复，若在生后6个月仍无恢复征象，则会产生永久性瘫痪，必须手术治疗。

A: Neonatal brachial plexus paralysis, also known as neonatal injury, is caused by excessive pulling of the fetal shoulder and neck during childbirth. Large children, low pubic arch, small angle, and weak contractions are the causes of neonatal brachial plexus nerve injury. The function of the light person can be gradually restored 2 to 3 months after birth. If there is no sign of recovery in the 6 months after birth, permanent paralysis will occur and surgical treatment will be necessary.

医生产前要估计胎儿体重，识别臀难产信号，掌握剖宫产指征与头位及臀位的分娩机制，接生时采取正确臀难产的各种处理方法，一般能够避免新生儿臂丛神经损伤，确保母婴安全。如果医生没有注意到这些，盲目处理导致生新生儿臂丛神经损伤，就要负有一定责任了。当然如果医生已经告知，患者家属拒绝剖腹产而致的新生儿臂丛神经损伤，那医生的责任就要小得多。

Before the medical delivery, it is necessary to estimate the fetal weight, identify the signal of hip dystocia, master the delivery mechanism of cesarean section indications and head and hip positions, and adopt various treatment methods for correct hip dystocia during delivery. It is generally possible to avoid neonatal brachial plexus nerve damage. Ensure the safety of mother and child. If the doctor does not notice this, blind treatment leads to the birth of newborn brachial plexus nerve damage, it will be responsible. Of course, if the doctor has told the patient's family to refuse the neonatal brachial plexus injury caused by Caesarean section, the doctor's responsibility is much smaller.

臂丛神经是支配上肢的主要神经，可分为根、干、束3段，各段均有分枝支配相应的肌肉。臂丛神经行经锁骨与第一肋之间时被胸锁筋膜固定在肋骨上，然后在肱骨喙突下经过，当外力使第一肋骨喙突间的距离加宽时，臂丛神经受强力牵拉而损伤。分娩时引起损伤的原因主要为头位分娩的肩难产、胎方位判断错误;臂位分娩时手法不正或后出头娩出困难、强力牵拉胎肩颈部。临床表现根据损伤的部位而异，以上于麻痹最多见，典型表现为:患肢松弛悬重于体侧，不能做外展、外旋及屈肘等活动。新生儿臂丛神经麻痹，对个人、家庭、社会均造成不可估量的损失。

The brachial plexus nerve is the main nerve that dominates the upper limb. It can be divided into three stages: root, stem, and bundle. Each segment has branches that govern the corresponding muscles. The brachial plexus nerve is fixed on the ribs between the clavicle and the first rib and then passes under the sacrum process. When the external force widens the distance between the first ribs, the brachial plexus nerve is strongly pulled and damaged. The main causes of injury during childbirth are shoulder dystocia and misjudgment of fetal position. When the arm position is delivered, the technique is not correct or the head is difficult to deliver, and the neck of the shoulder is strongly pulled. The clinical manifestations vary according to the site of the injury, and the above are most common in paralysis. The typical manifestation is that the limb's relaxation suspension is heavy on the side of the body, and it is not possible to do outreach, rotation, and elbow bending activities. Neonatal brachial plexus paralysis has caused immeasurable losses to individuals, families, and society.

症状体征 (1)上臂型：患肢下垂，肩不能外展，肘部微屈和前臂旋前。

Symptoms and signs(1) upper arm type: limb drooping, shoulder can not spread, elbow bending and forearm forearm rotation.

(2)前臂型：症状不明显，生后多日才发现。表现患侧手大小鱼际肌萎缩，屈指深肌肌力减弱，常有臂部感觉障碍。如颈交感神经受损，则上睑下垂，瞳孔缩小。

(2) Forearm type: The symptoms are not obvious and were discovered several days after birth. The performance of lateral hand size interfish muscle atrophy, flexor deep muscle muscle strength weakened, often arm sensory obstacles. If the cervical sympathetic nerve is damaged, the upper eyelid is drooping and the pupil is narrowed.

(3)全臂型：全上肢完全瘫痪，感觉消失。

(3) Full arm type: Full upper limb completely paralyzed, feeling disappeared.

治疗方案Treatment programmes

固定：用绷带将患儿手吊在床架上，保持手上举姿势。禁忌针灸和按摩，这样会是神经进一步挫伤，而加重。

Fixed: Use a bandage to hang the child's hand on the bed frame and hold the hand up. Tabu acupuncture and massage, this will be further nerve contusion, but aggravated.

手术：修复损伤的神经Surgery: repairing damaged nerves

术前准备：Preoperative preparation:

1.心理护理 患者了解手术的目的及手术后功能恢复情况，并增加营养，注意休息、保暖，避免感冒。

1. Psychological care patients understand the purpose of surgery and post-operative functional recovery, and increase nutrition, pay attention to rest, warmth, and avoid colds.

2.备齐各项常规检查报告，如血常规、出凝血时间、肝、肾功能、心电图、X线片。

2. Prepare all routine reports, such as blood routine, coagulation time, liver, renal function, electrocardiogram, X-ray.

3.手术前1天，作青霉素、普鲁卡因皮皮肤准备认真做好手术野皮肤的清洁，试验，并做好记录。

3. One day before the operation, penicillin and Plucaine skin were prepared to clean, test, and record the skin of the surgical field.

4.手术前可沐浴1次，并修剪指甲，减少术后感染。

4. Wash once before surgery and trim nails to reduce postoperative infections.

5.使患者掌握术后用石膏固定的体位及注意事项。

5. To enable the patient to master the position fixed with gypsum after surgery and pay attention to matters.

6.手术前日晚10时后禁食，必要时给予镇静药物。

6. Fasting after 10 p.m. on the day before the operation and, if necessary, administration of tranquilizers.

7.手术早晨，按医嘱给予术前用药。

7. In the morning of the operation, preoperative medication is given on the advice of the doctor.

健康指导：Health guidance:

1.经常活动患肢手指，防止关节僵硬。1. Frequent movement of the fingers of the affected limbs to prevent joint stiffness.

2.手术后应遵照医嘱长期应用神经营养药物，促进神经再生。

2. After surgery, neurotrophic drugs should be used for a long time in accordance with medical advice to promote nerve regeneration.

3.石膏绷带一般固定3-6周，去除石膏托或石膏简后逐步伸直锻炼。

3. The plaster bandage is generally fixed for 3-6 weeks, and the gypsum or gypsum is removed and gradually straightened.

4.在神经再生过程中，可同时进行物理治疗。

4. In the process of nerve regeneration, physical therapy can be performed simultaneously.