Restoration of Elbow Flexion in Traumatic Upper Brachial Plexus Palsy in Adults: Outcome with Intraplexus Distal Nerve Transfers in 78 Patients

Mario G. Siqueira; Roberto S. Martins; Wilson Faglioni Junior; Luciano Foroni; Carlos Otto Heise

doi:10.1055/s-0038-1676533

Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2018; 37(04): 285-290
DOI: 10.1055/s-0038-1676533

Original Article | Artigo Original

Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Restoration of Elbow Flexion in Traumatic Upper Brachial Plexus Palsy in Adults: Outcome with Intraplexus Distal Nerve Transfers in 78 Patients

Restauração da flexão do cotovelo na paralisia traumática superior do plexo braquial em adultos: resultado com transferências intraplexuais distais em 78 pacientes

Authors

Mario G. Siqueira

¹Peripheral Nerve Surgery Unit, Division of Functional Neurosurgery, Instituto de Psiquiatria, Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
Roberto S. Martins

¹Peripheral Nerve Surgery Unit, Division of Functional Neurosurgery, Instituto de Psiquiatria, Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
Wilson Faglioni Junior

¹Peripheral Nerve Surgery Unit, Division of Functional Neurosurgery, Instituto de Psiquiatria, Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
Luciano Foroni

¹Peripheral Nerve Surgery Unit, Division of Functional Neurosurgery, Instituto de Psiquiatria, Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
Carlos Otto Heise

¹Peripheral Nerve Surgery Unit, Division of Functional Neurosurgery, Instituto de Psiquiatria, Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil

²Division of Clinical Neurophysiology, Department of Neurology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil

Abstract

Objective To present the functional outcomes of distal nerve transfer techniques for restoration of elbow flexion after upper brachial plexus injury.

Method The files of 78 adult patients with C5, C6, ± C7 lesions were reviewed. The attempt to restore elbow flexion was made by intraplexus distal nerve transfers using a fascicle of the ulnar nerve (group A, n = 43), or a fascicle of the median nerve (group B, n = 16) or a combination of both (group C, n = 19). The result of the treatment was defined based on the British Medical Research Council grading system: muscle strength < M3 was considered a poor result.

Results The global incidence of good/excellent results with these nerve transfers was 80.7%, and for different surgical techniques (groups A, B, C), it was 86%, 56.2% and 100% respectively. Patients submitted to ulnar nerve transfer or double transfer (ulnar + median fascicles transfer) had a better outcome than those submitted to median nerve transfer alone (p < 0.05). There was no significant difference between the outcome of ulnar transfer and double transfer.

Conclusion In cases of traumatic injury of the upper brachial plexus, good and excelent results in the restoration of elbow flexion can be obtained using distal nerve transfers.

Resumo

Objetivo Apresentar os resultados funcionais das técnicas de transferências de nervos para a restauração da flexão do cotovelo em lesões traumáticas superiores do plexo braquial.

Método Foram revisados os arquivos de 78 pacientes adultos com lesões de C5, C6, ± C7. Na tentativa de restaurar a flexão do cotovelo, foram realizadas transferência de nervos intraplexuais distais utilizando um fascículo do nervo ulnar (grupo A, n = 43), ou um fascículo do nervo mediano (grupo B, n = 16) ou uma combinação de ambos (grupo C, n = 19). Os resultados do tratamento com diferentes tipos de transferências de nervos foram definidos com base no sistema de graduação do British Medical Research Council: força muscular < M3 foi considerado como mau resultado.

Resultados A incidência global de bons/excelentes resultados com essas transferências de nervos foi de 80,7% e para as diferentes técnicas cirúrgicas (grupos A, B, C), foi de 86%, 56,2% e 100%, respectivamente. Pacientes submetidos à transferência do nervo ulnar ou à dupla transferência (transferência de fascículos ulnar + mediano) alcançaram melhor resultado que aqueles submetidos à transferência isolada de fascículo do nervo mediano (p < 0,05). Não houve diferença estatística significativa entre os resultados da transferência de fascículo do nervo ulnar e a transferência dupla.

Conclusão A transferência distal de nervos pode produzir resultados bons e excelentes na restauração da flexão do cotovelo em pacientes com lesão traumática do plexo braquial superior.

Keywords

brachial plexus palsy - distal nerve transfers - elbow flexion restoration

Palavras-chave

paralisia do plexo braquial - transferências distal de nervos - restauração da flexão do cotovelo

Volltext

Referenzen

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