Gönül ACAR, Nur AYDINLI, Mine ÇALIŞKAN, Burak TATLI, Barış EKİCİ, Feride BİLİR, Meral ÖZMEN

Doğumsal brakiyal pleksus felçli olgularımız: tek merkezin 20 yıllık deneyimi

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 Dalında 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 393ü kız, 384ü 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'sinde tortikolis, 62'sinde Horner sendromu, 47'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 %33üne Vojta ve geleneksel tedavi yaklaşımları, %67sine ise sadece geleneksel fizyoterapi yaklaşımı uygulandı. Tüm olguların 439unda (%56) tam iyileşme sağlandı. Narakasa göre evre 1 olan olguların %66sında, evre 2 olguların % 56sında, evre 3 olguların %35inde ve evre 4 olguların %18inde tam iyileşme sağlandı. Olguların 97sine botilinum toksin A, 30 olguya birincil sinir cerrahisi ve 94 olguya ikincil cerrahi uygulandı. Bu olgulardan 25i ikinci kez 15 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. (Türk Ped Arfl 2013; 48: 13-6)

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

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 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)

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