Conceptos actuales en la parálisis braquial perinatal. Parte 1: etapa temprana

Abstract

RESUMENLa parálisis braquial perinatal tiene una incidencia similar a otras patologías frecuentes de la ortopedia infantil. Su tratamiento ha sido tradicionalmente conservador, con seguimiento pediátrico y consultas a los distintos especialistas para tratar las secuelas. Existen controversias respecto de la historia natural y el tratamiento. Las secuelas comienzan cada vez más tempranamente, por lo que debe ser pesquisada en las revisaciones y ser considerada en la táctica terapéutica al mismo tiempo que la reparación de los nervios. Se analiza la clasificación clínica y los parámetros de recuperación nerviosa, fundamentales para decidir el momento de indicar una exploración del plexo. Palabras clave: parálisis braquial obstétrica, pará-lisis obstétrica, parálisis braquial, microcirugía, exploración quirúrgica del plexo braquial. SUMMARYThe incidence of perinatal brachial palsy is similar to that of other frequent conditions in children's orthopedics. The treatment has been traditionally conservative with pediatric follow-up and consultations with various specialists to deal with its sequelae. Its natural history and treatment are controversial. Sequelaes tend to appear earlier each time, so that it should be attended to in checkups and taken into consideration in therapeutic tactics at the same time as nerve repair. This paper includes an analysis of its clinical classification and nerve recovery parameters, essential to decide whent to start an exploration of the plexus.

Rehabilitation of Neonatal Brachial Plexus Palsy: Integrative Literature Review

“…NBPP, in addition to being classified by considering the affected nerve roots, is also categorized according to the degree of lesion that affects the nerve and also to the function of the injured limb. According to the degree of lesion of the nerve, we can describe preganglionic and postganglionic avulsion injury (tearing near the dorsal root ganglion o near the spinal cord at an intraforaminal level, and tearing of the postganglionic nerve distant from the dorsal root ganglion and the spinal cord, respectively); neurotmesis lesion, also considered to be a severe injury of the nerve as there is a complete tearing of the axon and the connective tissue [7,8]; axonotmesis lesion, when there is an anatomic interruption of the axon but with no interruption or partial interruption of the connective tissue and the myelin; and, finally, stretching neuropraxic lesion without nerve rupture, implying a momentaneous physiological blockage of the nerve-axon connection, with spontaneous recovery. We must also consider neuroma lesion, which implies an interference of the injured nerve scar tissue that, when healing, does not allow the nervous impulse to the muscle.…”

Presentación de un caso: síndrome de Claude Bernard-Horner post resección de higroma quístico.

“…Anteriormente el estudio publicado en 1852 por el fisiólogo francés Claude Bernard describió el mismo cuadro en animales con lesiones de vías nerviosas. Por tanto, la asociación de miosis, enoftalmos y ptosis palpebral homolateral con compromiso de la cadena simpática cervical se conoce como Síndrome de Claude Bernard-Horner 1,2 .…”