Diagnostisches und therapeutisches Prozedere bei geburtstraumatischer Plexus-brachialis-Läsion: Review und Empfehlungen einer interdisziplinären Arbeitsgruppe

Zusammenfassung

Fragestellung: Die Behandlung von Kindern mit geburtstraumatischer Plexus-brachialis-Parese ist ein komplexer interdisziplinärer Prozess, der bisher nicht einheitlich gestaltet war. Ziel dieser Arbeit war es, optimale und individuell abgestimmte Managementstrategien für Diagnostik und Therapie zu erarbeiten, die den betreuenden Ärzten als Richtlinie und Entscheidungshilfe dienen sollen.

Methode: Auf Basis der bestehenden Literatur, ergänzt durch eigene experimentelle Ergebnisse und die klinische Expertise einer interdisziplinären Arbeitsgruppe (Physikalische Medizin und Rehabilitation, Plastische und Rekonstruktive Chirurgie, Radiologie) wurden die vorliegenden Empfehlungen erarbeitet.

Ergebnisse: Es wurde ein Algorithmus der klinischen und diagnostischen Schritte entworfen, der die Lagerung des betroffenen Armes, die Gestaltung der Bewegungstherapie unter Einbeziehung der Eltern, die Möglichkeiten der Elektrotherapie, die elektrophysiologische und radiologische Diagnostik, die Indikationsstellung zu chirurgischen Maßnahmen, sowohl nervenchirurgisch als auch Korrektur- und Umlagerungsoperationen und die notwendigen Kontrollintervalle abhandelt. Ein Großteil der Kinder zeigt mit konservativer Therapie ein gutes funktionelles Ergebnis. Bei ungenügender Remission oder Auftreten von Sekundärkomplikationen, wie Schultergelenkspathologien, ist eine weiterführende Diagnostik einzuleiten, um diejenigen Patienten herauszufiltern, die eine operative Intervention benötigen.

Schlussfolgerung: Eine strukturierte Betreuung und gezielte Therapieplanung für Kinder mit geburtstraumatischer Plexus-brachialis-Läsion soll durch die Entwicklung eines einheitlichen Schemas gewährleistet werden. Die konstruktive Zusammenarbeit eines interdisziplinären Ärzte- und Therapeutenteams ist dabei von entscheidender Bedeutung.

Abstract

Problem: Treatment of children with obstetric plexus brachialis palsy is a complex interdisciplinary process, which has not been organised in a standardized way up to day. The aim of the present study was to develop optimal and individually adapted management strategies for diagnosis and therapy, which should serve the physicians as a guideline and decision-making aid.

Method: The recommendations are based on the literature, experimental results and the clinical expertise of an interdisciplinary study group (physical medicine and rehabilitation, plastic and reconstructive surgery, radiology).

Results: An algorithm of clinical and diagnostic steps was designed which includes the positioning of the affected arm, the kinesitherapy including instructions of the parents, the electrotherapy, the electrophysiological and radiological diagnoses, the diagnosis for surgical procedures (nerve repair as well as corrective and rearrangement surgery) and control intervals. A majority of children shows a good functional result with conservative therapy. In the case of insufficient remission or the occurrence of secondary complications such as pathologies of the shoulder joint, further diagnosis is important to decide where surgical intervention will be necessary.

Conclusion: Structured medical care and therapy planning for children with obstetric plexus brachialis palsy was developed to improve outcome parameters. A continuous cooperation of an interdisciplinary team of physicians and therapists is of utmost importance.

Schlüsselwörter

Plexus brachialis - Geburtstrauma - Leitlinien - Parese - Therapie - Läsion

Key words

plexus brachialis palsy - obstetric - guidelines - delivery - trauma - therapy

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