Mikrochirurgische Nervenrekonstruktion nach kindlicher Plexus-brachialis-Parese : Nachuntersuchung bei Kindern älter als neun Monate

The subject of this dissertation is a comparison of early and late operated children with traumatic brachial plexus lesions suffered during birth. For this dissertation 25 children with traumatic in-birth injuries of the brachial plexus were examined after intraplectic neurotisation. At the time of the operation the children were more than nine month old. The results of the examination were expressed in angular degrees, starting from a neutral (zero) position; the patient’s best possible movement was transferred into a tabel, moreover the results were transformed into the Active Movement Scale to make them compartable to other studies. Eleven children had suffered total lesions (C5, C6, C7, C8, Th1), the other fourteen had lesions of the upper plexus, eleven of them having extended upper lesions (C5, C6, C7), and three having plain upper lesions (C5, C6). This sample of children was compared to a group of children who had been operated on before the age of nine months. This group had suffered comparable injuries and showed a similar nerve morphology and similar transplantation scheme. If possible, children with collateral injuries and of the same sex were compared. Because this second group contained only 22 children, the comparison was made between ten pairs with total lesion, ten pairs with extended upper lesions and two pairs with plain upper lesions. The children were compared on a one-to-one basis. One point was given to the group of early- or late-operated children. The distribution of points was as follows: Among the total lesions each group received five points, which allows the conclusion that for this kind of injury it does not make a difference if the child is treated before or after the age of nine months. Among the extended upper lesions the early-operated group received six points, the late-operated group only four points. This could indicate that with extended upper lesions it is important to aim at an early operation to get better results. Among the plain upper lesions the late-operated group got two points, the early-operated group none. None of the groups shows a statistically significant difference in points (level of significance 0,05). As it is difficult to rule out an injury of nerve root C7 before the operation, the extended upper lesions and the plain upper lesions were combined, so that the result was six points for the early operations and six for the late operations. Similar to the total lesions, this result allows the conclusion that an operation at a later date may be as successful as an early operation. The statistics was analysed by a paired t-test and showed significant differences only for the adduction of the shoulder and the extension of the elbow. For the adduction of the shoulder the early-operated children showed significantly lower figures (m=16.4) than the late-operated ones (m=24.1). For the extension of the elbow the early-operated children showed significantly higher figures (m=0.00) than the late-operated ones (m=-8.2). In conclusion it can be said that there is no clear difference in the success of early and late operations of total as well as upper birth-trauma lesions of the brachial plexus