Abstract
We carried out a retrospective review of 32 consecutive patients (30 adults and two children) with total or partial lesions of the brachial plexus who had surgical repair using nerve grafting, neurotisation, and neurolysis between January 1991 and December 2003. The outcome measures of muscular strength were correlated with the type of lesion, age, preoperative time, length and number of grafts, and time to reinnervation of the biceps. The function of the upper limb was also evaluated. There was a significant correlation between muscular strength after surgical repair and both the preoperative time and the length of the nerve graft. There was also a significant correlation between muscular strength and the number of grafts. Muscular strength was better when the neurolysis was done before six months. When neurosurgical repair and reconstructive procedures were performed, the function of the upper limb was improved.
Résumé
Nous avons fait une étude rétrospective de 32 malades consécutifs (30 adultes et 2 enfants) avec une atteinte totale ou partielles du plexus brachial, après réparation chirurgicale utilisant une greffe nerveuse, une neurotization et une neurolyse entre janvier 1991 et décembre 2003. La mesure de la force musculaire a été correlée avec le type de lésion, l'âge, le délai opératoire, la longueur et le nombre des greffes, et le temps de reinervation du biceps. La fonction du membre supérieur a aussi été évaluée. Il y avait une corrélation négative significative entre la force musculaire après réparation chirurgicale et d'une part, le délai préopératoire et, d'autre part la longueur de la greffe du nerf. Il y avait aussi une corrélation positive significative entre la force musculaire et le nombre de greffes. La force musculaire était meilleure quand la neurolyse a été faite avant six mois. Quand la réparation neurochirurgicale et les procédés de reconstruction ont été exécutés, la fonction du membre supérieur était améliorée.
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References
Alnot JY, Abols Y (1984) Réanimation de la flexion du coude par transfers tendineux dans les paralysies traumatiques du plexus brachial de l'adulte. Rev Chir Orthop 70:313
Barnes R (1949) Traction injuries of the brachial plexus in adults. J Bone Joint Surg Br 31:10–12
Bentolila V, Nizard R, Bizot P, Sedel L (1999) Complete traumatic brachial plexus palsy. Treatment and outcome after repair. J Bone Joint Surg Am 81:20–28
Berman J, Anand P, Chen L, Taggart M, Birch R (1996) Pain relief from preganglionic injury to the brachial plexus by late intercostal transfer. J Bone Joint Surg Br 78:986–992
Brooks D, Seddon H (1959) Pectoral transplantation for paralysis of the flexors of the elbow: a new technique. J Bone Joint Surg Br 41:36–43
Comtet JJ, Sedel L, Fredenucci JF, Herzberg G (1988) Duchenne-Erb palsy. Experience with direct surgery. Clin Orthop 237:17–23
Kanaya F, Gonzalez M, Park CM et al (1990) Improvement in motor function after brachial plexus surgery. J Hand Surg Am 15:30–35
Kendall HO, Kendall FP, Wadsworth GE (1971) Muscles—testing and function, 2nd edn. Williams & Wilkins, Baltimore
Millesi H (1977) Surgical management of brachial plexus injuries. J Hand Surg Am 2:367–378
Monreal R (1997) Nervous transfers in order to reestablish the flexión of the elbow in the lesions of the brachial plexus. Rev Cubana Ortop Traumatol 11:41–45
Narakas A (1981) The effects on pain of reconstructive neurosurgery in 160 patients with traction and/or crush injury to the brachial plexus. In: Seigfried J, Zimmerman M (eds) Phantom and stump pain. Springer, Berlin Heidelberg New York, p 126
Narakas A, Hentz V (1988) Neurotization in brachial plexus injuries. Indications and results. Clin Orthop 237:43–56
Narakas A (1993) Muscle transposition in the shoulder and upper arm for sequelae of brachial plexus palsy. Clin Neurol Neurosurg 95(Suppl):89–91
Nagano T, Tsuyama N, Ochiai N et al (1989) Direct nerve crossing with intercostal nerve to treat avulsion of the brachial plexus. J Hand Surg Am 14:980–985
Seddon HJ (1963) Nerve grafting. J Bone Joint Surg Br 45:447–461
Sedel L (1982) The results of surgical repair of brachial plexus injuries. J Bone Joint Surg Br 64:54–66
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Ricardo, M. Surgical treatment of brachial plexus injuries in adults. International Orthopaedics (SICO 29, 351–354 (2005). https://doi.org/10.1007/s00264-005-0017-3
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DOI: https://doi.org/10.1007/s00264-005-0017-3