Brachial plexus kuvulala kwa akhanda

Plexus ya brachial ndi gulu la mitsempha kuzungulira phewa. Kutayika kwa kuyenda kapena kufooka kwa mkono kumatha kuchitika ngati mitsempha iyi yawonongeka. Kuvulala kumeneku kumatchedwa neonatal brachial plexus palsy (NBPP).

Mitsempha ya brachial plexus imatha kukhudzidwa ndi kupsinjika m'mimba mwa mayi kapena panthawi yobereka yovuta. Kuvulala kungayambidwe ndi:

• Mutu ndi khosi la khanda likukoka kumbali pamene mapewa akudutsa ngalande yobadwira
• Kutambasula mapewa a khanda panthawi yobereka mutu woyamba
• Kupanikizika pamanja akukweza mwana panthawi yobereka (poyambira mapazi)

Pali mitundu yosiyanasiyana ya NBPP. Mtunduwo umadalira kuchuluka kwa ziwalo zamanja:

• Brachial plexus palsy nthawi zambiri imakhudza dzanja lakumtunda lokha. Amatchedwanso Duchenne-Erb kapena Erb-Duchenne ziwalo.
• Klumpke ziwalo zimakhudza mkono wakumunsi ndi dzanja. Izi sizachilendo.

Zinthu zotsatirazi zimawonjezera chiopsezo cha NBPP:

• Kutumiza kwa Breech
• Kunenepa kwamayi
• Makanda ochepera kuposa ana wamba (monga khanda la mayi yemwe ali ndi matenda ashuga)
• Zovuta kuperekera phewa la mwana mutu utatuluka kale (wotchedwa phewa dystocia)

NBPP siicheperako kuposa kale. Kuperekera kwa operekera kumagwiritsidwa ntchito nthawi zambiri pakakhala nkhawa zakubereka kovuta. Ngakhale gawo la C limachepetsa chiopsezo chovulala, silimalepheretsa. Gawo la C limakhalanso ndi zoopsa zina.

NBPP itha kusokonezedwa ndi vuto lotchedwa pseudoparalysis. Izi zimawoneka pamene khanda lathyoledwa ndipo silikusuntha mkono chifukwa cha ululu, koma palibe kuwonongeka kwa mitsempha.

Zizindikiro zimawoneka nthawi yomweyo kapena atangobadwa kumene. Zitha kuphatikiza:

• Palibe kusuntha m'manja mwa mwana wakhanda kumtunda kapena kumunsi
• Kutaya kwa Moro komwe kulibe mbali yomwe yakhudzidwa
• Dzanja limatambasula (molunjika) m'gongono ndipo limagwira motsutsana ndi thupi
• Kuchepetsa kumakhudza mbali yomwe yakhudzidwa (kutengera tsamba lazovulala)

Kuyezetsa thupi nthawi zambiri kumawonetsa kuti khanda silimasuntha mkono wakumtunda kapena wotsika kapena dzanja. Dzanja lomwe lakhudzidwa limatha kugundika khanda likakulungidwa kuchokera mbali ndi mbali.

Reflex ya Moro ilibe pambali yovulala.

Wosamalira azaumoyo awunika kolala kuti ayang'ane wovulala. Khanda lingafunike kuti atenge x-ray ya kolala.

Pazovuta, woperekayo angafunse:

• Wofatsa kutikita dzanja
• Zochita zingapo zoyenda

Khanda lingafunikire kuwonedwa ndi akatswiri ngati kuwonongeka kwakukulira kapena mkhalidwewo sukusintha m'masabata angapo oyamba.

Opaleshoni imatha kuganiziridwa ngati mphamvu sizikula pofika miyezi 3 mpaka 9 yakubadwa.

Ana ambiri amachira miyezi itatu kapena inayi. Anthu omwe sachira panthawiyi amakhala ndi malingaliro olakwika. Pazochitikazi, pakhoza kukhala kupatukana kwa mizu ya mitsempha kuchokera kumsana wa msana (avulsion).

Sizikudziwika ngati opaleshoni yothetsa vuto la mitsempha ingathandize. Kuchita opaleshoni kungaphatikizepo kulumikizana kwa mitsempha kapena kusamutsa mitsempha. Zitha kutenga zaka zambiri kuti machiritso achitike.

Pakachitika pseudoparalysis, mwanayo amayamba kugwiritsa ntchito mkono womwe wakhudzidwa pomwe kuphulika kumachira. Kuphulika kwa makanda kumachiritsa mwachangu komanso mosavuta nthawi zambiri.

Zovuta zimaphatikizapo:

• Mitsempha yosalimba (contractures) kapena kukhwimitsa minofu. Izi zitha kukhala zachikhalire.
• Kuthira kwamuyaya, pang'ono pang'ono, kapena kutayika kwathunthu kwa mitsempha yomwe yakhudzidwa, ndikupangitsa kufooka kwa mkono kapena kufooka kwa mkono.

Itanani yemwe akukuthandizani ngati mwana wanu wakhanda akuwonetsa kusayenda kwa mkono uliwonse.

Ndikosavuta kupewa NBPP. Kuchita zinthu popewa kubereka kovuta, ngati zingatheke, kumachepetsa chiopsezo.

Klumpke ziwalo; Erb-Duchenne ziwalo; Kukhazikika kwa Erb; Chifuwa cha brachial; Kusokonekera kwa ubongo Brachial; Obstetrical brachial plexus manjenje; Kubadwa plexus plexus palsy; Neonatal brachial plexus palsy; NBPP

Chidule cha Executive: neonatal brachial plexus palsy. Lipoti la American College of Obstetricians and Gynecologists 'Task Force on neonatal brachial plexus palsy. Gynecol Woletsa. 2014; 123 (4): 902-904. PMID: 24785634 pubed.ncbi.nlm.nih.gov/24785634/.

Park TS, Ranalli NJ. Kubadwa kwa brachial plexus kuvulala. Mu: Winn HR, mkonzi. Opaleshoni ya Youmans ndi Winn Neurological. Wachisanu ndi chiwiri. Philadelphia, PA: Elsevier; 2017: mutu 228.

Prazad PA, Rajpal MN, Mangurten HH, Chipatala cha BL. Kuvulala kwakubadwa. Mu: RJ, Fanaroff AA, Walsh MC, olemba., Eds. Fanaroff ndi Martin's Neonatal-Perinatal Medicine. 11th ed. Philadelphia, PA: Elsevier; 2020: chap 29.