Surgical interventions for traumatic lesions of the brachial plexus: a retrospective study of 134 cases.
| Autor: | Kandenwein JA; Department of Neurosurgery, University of Ulm, Bezirkskrankenhaus Guenzburg, Germany. julia.kandenwein@medizin.uni-ulm.de, Kretschmer T, Engelhardt M, Richter HP, Antoniadis G |
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| Jazyk: | angličtina |
| Zdroj: | Journal of neurosurgery [J Neurosurg] 2005 Oct; Vol. 103 (4), pp. 614-21. |
| DOI: | 10.3171/jns.2005.103.4.0614 |
| Abstrakt: | Object: Surgical therapy for traumatic brachial plexus lesions is still a great challenge in the field of peripheral nerve surgery. The aim of this study was to present the results of different surgical interventions in patients with this lesion type. Methods: One hundred thirty-four patients with traumatic brachial plexus lesions underwent surgery between January 1991 and September 1999. In more than 50% of the patients, injury was caused by a motorbike accident. Patients underwent surgery a mean of 6.3 months posttrauma. The following surgical techniques were applied: neurolysis for nerve lesions in continuity (27 cases), grafting for lesions in discontinuity (149 cases), and neurotization for root avulsions (67 cases). Sixty-five patients were evaluated for at least 30 months (mean follow up 42.1 months) after surgery. Function was graded using the Louisiana State University Health Sciences Center classification system. Only 2% of the patients had Grade 3 or better function preoperatively, increasing to 52% postoperatively. The effect of surgical measures on the functional results for different muscles were compared (supra- or infraspinatus, deltoid, biceps, and triceps muscles); the best results were obtained for biceps muscle function (57% of patients with Medical Research Council Grades M3-M5 function). Graft reconstruction yielded a better outcome than neurotization. Surgery within 5 months posttrauma clearly resulted in improved recovery of motor function compared with later interventions. Sural nerve grafts (monofascicular nerves) showed better results. Conclusions: The results of neurosurgical interventions for brachial plexus lesions are satisfactory, especially when the operation is performed between 3 and 6 months after trauma. |
| Databáze: | MEDLINE |
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