الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 76 |  |  |
| | | from | 76 | | |
Abstract
Obstetric brachial plexus birth injury (OBPBI) is a potentially devastating form of birth injury that frequently leads to significant physical disability. Decisions regarding surgical intervention have been classically made at approximately 3 to 6 months of age if biceps function is lost. Primary reconstructive techniques include neurolysis, nerve grafting and neurotization. The outcomes of different reconstructive microsurgical procedures need to be assessed and compared using clinical and electrophysiological tools for proper selection and prediction of surgical outcomes in patients with OBPBI.
This study aim was to evaluate the outcomes of different surgical techniques performed in patients with OBPBI. The study included thirty infants with OBPBI meeting the surgical criteria of absent active elbow flexion at 3-6 months of age. Clinical and functional assessment of the affected upper limb was done using the Toronto Active Movement Scale from hospital for sick children grading system (AMS). Electrodiagnostic assessment was done using NIHON KOHDEN (JAPAN) (Neuropack S1) EMG/EP Measuring System MEP-9400K.
Electrodiagnostic techniques included sensory testing of the median and ulnar nerves in the hand in addition to motor testing of median, ulnar , radial ,musculocutaneous, axillary and suprascapular nerves. The patients were operated upon at The Microsurgery Unit, Alexandria University Hospitals. Two patients were lost for the follow up so twenty eight patients were available for review .The same clinical and electrophysiological evaluations performed preoperatively were repeated at the end of a one year follow up period.
Results were tabulated and statistically evaluated. Prolonged labour, shoulder dystocia, macrosomia and gestational diabetes were the most recognized risk factors associated with OBPBI . The studied patients overall upper limb function was significantly improved after surgical intervention. patients who underwent reconstruction by nerve grafting improved clinically and functionally more than those who underwent neurotization. Meanwhile, patients who underwent neurotization recovered earlier (i.e. faster) than those who underwent reconstruction by nerve grafting.
Improvement percentage according to the amplitude and the AUC of CMAP was the greatest in the musculocutaneous nerve, followed by the axillary nerve, and the least improvement was in the suprascapular nerve. As regards the correlation between clinical and electrophysiological parameters postoperatively; clinical assessment of shoulder abduction using AMS score was positively correlated with electrophysiological evaluation using the AUC of the CMAP rather than evaluation using the amplitude of CMAP.