Management of brachial plexus missile injuries
| Autor: | Vesna Simic, Milan Lepić, Krešimir Rotim, Filip Vitošević, Nenad Novaković, Vladimir Puzović, Vojin Kovacevic, Miroslav Samardžić, Lukas Rasulić, Andrija Savić |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent Nerve block medicine.medical_treatment lcsh:Medicine Traumatology 030230 surgery Time-to-Treatment 03 medical and health sciences 0302 clinical medicine Peripheral Nerve Injuries Brahijalni pleksus Neurokirurški zahvati Živčana blokada Traumatologija Oporavak funkcije medicine Humans Original Scientific Papers Brachial plexus Neurolysis Nerve grafting business.industry Recovery of function lcsh:R Neurosurgical procedures brachial plexus nerve block neurosurgical procedures recovery of function traumatology General Medicine Middle Aged Surgical procedures medicine.disease 3. Good health Surgery Treatment Outcome Brachial plexus injury Wounds and Injuries Female Wounds Gunshot Gunshot wound business 030217 neurology & neurosurgery |
| Zdroj: | Acta Clinica Croatica Acta clinica Croatica Volume 57. Issue 3. Acta Clinica Croatica, Vol 57, Iss 3., Pp 487-495 (2018) |
| ISSN: | 0353-9466 1333-9451 |
| DOI: | 10.20471/acc.2018.57.03.12 |
| Popis: | Missile injuries are among the most devastating injuries in general traumatology. Traumatic brachial plexus injuries are the most difficult injuries in peripheral nerve surgery, and most complicated to be surgically treated. Nevertheless, missile wounding is the second most common mechanism of brachial plexus injury. The aim was to evaluate functional recovery after surgical treatment of these injuries. Our series included 68 patients with 202 nerve lesions treated with 207 surgical procedures. Decision on the treatment modality (exploration, neurolysis, graft repair, or combination) was made upon intraoperative finding. Results were analyzed in 60 (88.2%) patients with 173 (85.6%) nerve lesions followed-up for two years. Functional recovery was evaluated according to functional priorities. Satisfactory functional recovery was achieved in 90.4% of cases with neurolysis and 85.7% of cases with nerve grafting. Insufficient functional recovery was verified in ulnar and radial nerve lesions after neurolysis, and in median and radial nerve lesions when graft repair was done. We conclude that the best time for surgery is between two and four months after injury, except for the gunshot wound associated with injury to the surrounding structures, which requires immediate surgical treatment. The results of neurolysis and nerve grafting were similar. Ozljede projektilima su među najrazornijim ozljedama u općoj traumatologiji. Traumatske ozljede brahijalnog pleksusa najteže su ozljede perifernog živčanog sustava, a najkompliciranije se liječe kirurški. Ipak, projektilno ranjavanje je drugi najčešći mehanizam ozljede brahijalnog pleksusa. Cilj je bio procijeniti funkcionalni oporavak nakon kirurškog liječenja ovih ozljeda. Naša studija je obuhvatila 68 bolesnika s 202 ozljede živaca liječenih u 207 kirurških zahvata. Odluka o načinu liječenja (eksploracija, neuroliza, direktna reparacija graftom ili kombinacija) donesena je na osnovi intraoperacijskog nalaza. Rezultati su analizirani u 60 (88,2%) bolesnika sa 173 (85,6%) lezije živaca nakon kojih je slijedilo razdoblje praćenja u trajanju od dvije godine. Funkcionalni oporavak ocijenjen je prema funkcionalnim prioritetima. Zadovoljavajući funkcionalni oporavak postignut je u 90,4% neuroliza i 85,7% reparacija graftom. Slučajevi s nedovoljnim funkcionalnim oporavkom bili su povezani s neurolizom ulnarnog i radijalnog živca ili reparacijom graftom srednjih i proksimalnih lezija. Zaključujemo da je najbolje vrijeme za kirurški zahvat između dva i četiri mjeseca nakon ozljede, osim kada postoje udružene ozljede okolnih struktura, što zahtijeva neodložno kirurško liječenje. Rezultati neurolize i reparacije graftom bili su slični. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|