Browsing by Subject "barnkirurgi, handkirurgi"

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  • Grahn-Shahar, Petra (Helsingin yliopisto, 2021)
    HUS, New Children’s Hospital is the only treatment center for permanent brachial plexus birth injury (BPBI) for the 1.7 million residents of the region of Uusimaa, Finland. The hospital serves as a tertiary treatment center for a population of 2.2 million. The aims of this study are: to calculate the annual incidence of permanent BPBI in the region of the hospital district of Helsinki and Uusimaa in 1995-2019, to analyze whether cervical magnetic resonance imaging (MRI) is reliable in detecting root avulsions, to assess if shoulder dysplasia can be prevented by a protocol including early range of motion (ROM) exercises, ultrasound (US) screening, and Botulinum toxin A (BTX) injections in combination with spica bracing, and to develop a new neurotization technique to restore active shoulder external rotation (ER) in adduction. 431 children with BPBI were referred to our brachial plexus clinic between 1995 and 2019. The injury was permanent in 258 children. Of these, 179 children were born in our primary catchment area, with 437454 births during the 25-year-long study period. Cervical MRI was done to 34 children born between 2007 and 2013 who were clinically potential candidates for plexus surgery. Root avulsion in MRI served as one indication to recommend plexus repair. Our shoulder protocol to prevent shoulder dysplasia, including ROM exercises, US screening, BTX injections, and shoulder ER spica bracing, was developed between 2000 and 2009. The risk for permanent BPBI in the hospital district of Helsinki and Uusimaa from vaginal births varied annually between 0.1 and 0.9 per 1000, with a decreasing tendency. MRI was a reliable imaging modality with both high sensitivity (0.88) and specificity (1.00) for avulsion injuries. Posterior shoulder subluxation, as a result of advancing shoulder dysplasia, was verified by imaging in 48% (114/237) of children with permanent injury. Mean age at detection dropped from 5 years (range 0.3-8.6) in children born before 2000 to 4.9 months (range 1.1-12) in children born 2010 or later. Active shoulder ER in adduction had improved by mean 57° (range 40-95°) in 12/14 children, active ER in abduction by mean 56° (range 30-85) and active abduction mean 27° (range 10-60°) in all 14 patients 4 years (range 2-5) after specific neurotization of the infraspinatus muscle with the spinal accessory nerve (SAN). The annual incidence of permanent BPBI shows marked variation with a decreasing trend. MRI has both high sensitivity and specificity for detecting root avulsion injuries. Half of all children with permanent BPBI develop shoulder dysplasia during the first year, which can be reliably detected with US. ROM exercises, BTX injections and spica bracing seem beneficial in preventing and treating shoulder dysplasia in children 6-12 months old. Active ER in adduction can be reliably restored and maintained by neurotizing the infraspinatus muscle with SAN.