Resumo

VIDE, João et al. Que técnica paliativa para as sequelas gleno-umerais das lesões obstétricas do plexo braquial?. Rev. Port. Ortop. Traum. [online]. 2014, vol.22, n.1, pp.5-23. ISSN 1646-2122.

Objectives: obstetric Brachial Plexus Palsy occurs in 1-4 in every 1000 births. Although most recover, up to 19% will present definitive sequelae, even after primary repair surgeries of the brachial plexus, being the shoulder the most commonly affected area. Palliative surgeries have been developed to increase function and quality of life of these patients, however there’s no agreement in regard to the surgical timing and indications of each technique. We evaluated all the available evidence published in the last 10 years with the goal to determine the improvement in function and the factors that have an influence on the result of these techniques. Determination of the gleno-umeral remodeling capacity was a secondary objective. Source: we have researched 5 databases - Cochrane Review Library, TRIP, Pubmed, Web of Knowledge and Science Direct. We included studies that had obstetric brachial plexus palsy patients who were submitted to palliative techniques of the shoulder, published in the last 10 years (from January 2003 to December 2012). We evaluated the post-operative active range of motion and Mallet classification. In a post-hoc analysis, we evaluated the effect of the technique in glenoid remodelation, through retroversion angle, percentage of humeral head coverage and change in morphology. The methodological quality was assessed independently by two reviewers, through a critical review form. Data syntheses: it was included 1873 patients from a total of 42 studies: 27 studies with soft tissues procedures, 12 studies with bony procedures and 3 with combination of techniques. All the studies have low evidence level, and the majority are case series with multiple biases and high heterogeneity. The main improvement in external rotation was 58º and 61º in abduction. The main improvement in Mallet score was 5,0 points and 1,5 in the parameter of external rotation. We observed improvement in glenoid retroversion between 9 and 21º and percentage of humeral head covereage between 4 and 25%. Conclusions: considering the methodological quality of the included studies, the evidence seems to show an improvement in range of motion, function and gleno-umeral remodelation with palliative techniques. However it’s not possible to establish clear indications to the different techniques, the better surgical timing, neither if the benefits withhold 10 years after surgery. To answer these questions it’s necessary to invest in studies with appropriate designs, of high methodological quality and with strategies to diminish heterogeneity.

Palavras-chave : Brachial plexus palsy; obstetric brachial plexus palsy; surgical procedures; palliative surgery.

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