severe obstetric brachial plexus palsies can be identified at one month of age严重的产科臂丛神经麻痹可以确定在一个月的年龄.pdfVIP

Severe Obstetric Brachial Plexus Palsies Can Be Identified at One Month of Age 1 1 2 1,3 Martijn J. A. Malessy *, Willem Pondaag , Lynda J.-S. Yang , Sonja M. Hofstede-Buitenhuis , Saskia le Cessie4, J. Gert van Dijk5 1 Department of Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands, 2 Department of Neurosurgery, University of Michigan Hospitals, Ann Arbor, Michigan, United States of America, 3 Department of Neurosurgery Physical Therapy, Leiden University Medical Center, Leiden, the Netherlands, 4 Department of Neurosurgery Medical Statistics, Leiden University Medical Center, Leiden, the Netherlands, 5 Department of Neurosurgery Neurology and Clinical Neurophysiology, Leiden University Medical Center, Leiden, the Netherlands Abstract Objective: To establish whether severe obstetric brachial plexus palsy (OBPP) can be identified reliably at or before three months of age. Methods: Severe OBPP was defined as neurotmesis or avulsion of spinal nerves C5 and C6 irrespective of additional C7- T1 lesions, assessed during surgery and confirmed by histopathological examination. We first prospectively studied a derivation group of 48 infants with OBPP with a minimal follow-up of two years. Ten dichotomous items concerning active clinical joint movement and needle electromyography of the deltoid, biceps and triceps muscles were gathered at one week, one month and three months of age. Predictors for a severe lesion were identified using a two-step forward logistic regression analysis. The results were validated in two independent cohorts of OBPP infants of 60 and 13 infants. Results: Prediction of severe OBPP at one month of age wa