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1.
Bone Joint J ; 102-B(2): 246-253, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32009423

RESUMO

AIMS: To describe and analyze the mid-term functional outcomes of a large series of patients who underwent the Hoffer procedure for brachial plexus birth palsy (BPBP). METHODS: All patients who underwent the Hoffer procedure with minimum two-year follow-up were retrospectively reviewed. Active shoulder range of movement (ROM), aggregate modified Mallet classification scores, Hospital for Sick Children Active Movement Scale (AMS) scores, and/or Toronto Test Scores were used to assess functional outcomes. Subgroup analysis based on age and level of injury was performed. Risk factors for subsequent humeral derotational osteotomy and other complications were also assessed. A total of 107 patients, average age 3.9 years (1.6 to 13) and 59% female, were included in the study with mean 68 months (24 to 194) follow-up. RESULTS: All patients demonstrated statistically significant improvement in all functional outcomes and active shoulder abduction and external rotation ROM (p < 0.001). Patients < 2.5 years of age had higher postoperative AMS, abduction ROM and strength scores, and aggregate postoperative Toronto scores (p ≤ 0.035) compared to patients ≥ 2.5 years old. There were 17 patients (16%) who required a subsequent humeral derotational osteotomy; lower preoperative AMS external rotation scores and external rotation ROM were predictive risk factors (p ≤ 0.016). CONCLUSION: Patients with BPBP who underwent the Hoffer procedure demonstrated significant improvement in postoperative ROM, strength, and functional outcome scores at mid-term follow-up. Patients younger than 2.5 years at the time of surgery generally had better functional outcomes. Limited preoperative external rotation strength and ROM were significantly associated with requirement for subsequent humeral derotational osteotomy. In our chort significant improvements in shoulder function were obtained after the Hoffer procedure for BPBP. Cite this article: Bone Joint J 2020;102-B(2):246-253.


Assuntos
Plexo Braquial/cirurgia , Paralisia do Plexo Braquial Neonatal/cirurgia , Transferência Tendinosa/métodos , Adolescente , Plexo Braquial/lesões , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Masculino , Paralisia do Plexo Braquial Neonatal/reabilitação , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Estudos Retrospectivos , Articulação do Ombro/fisiopatologia , Transferência Tendinosa/reabilitação , Resultado do Tratamento
3.
Cir. plást. ibero-latinoam ; 45(3): 307-312, jul.-sept. 2019. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-184405

RESUMO

Antecedentes y Objetivo. Las secuelas tardías de las lesiones altas del plexo braquial incluyen el compromiso de la abducción y la rotación externa del hombro. El objetivo de nuestro trabajo es presentar nuestra experiencia inicial con una serie de casos de tratamiento tardío en pacientes en quienes la reconstrucción nerviosa no está indicada. Materiales y método. Presentamos nuestra experiencia preliminar en 5 pacientes con ausencia completa de los movimientos del hombro. Transferimos la parte superior del trapecio para restaurar la abducción en casos en los que otros procedimientos han fallado o no están indicados, por ausencia de actividad del dorsal ancho y largo tiempo de evolución. Resultados. La transferencia muscular permitió restaurar la abducción del hombro en todos los pacientes. Tras el procedimiento, la abducción media fue de 47 grados. Dos casos presentaron rigidez postoperatoria transitoria; otros 2 pacientes sufrieron fractura incompleta del húmero que requirió osteosíntesis con consolidación ósea a las 8 semanas. Conclusiones. Consideramos que este grupo de pacientes de mal pronóstico encuentra en este procedimiento una opción de reconstrucción cuyos resultados deben ser evaluados a más largo plazo y con mayor número de pacientes para dar recomendaciones precisas. Es un procedimiento que ofrece una alternativa a los pacientes con secuelas severas de lesiones de plexo braquial, con mínima morbilidad


Background and Objective. Late sequels of brachial plexus injuries include deficit in abduction and external rotation of the shoulder. The aim of this paper is to present our initial experience with a clinical series of late presentation, in whom primary nerve reconstruction is not indicated. Methods. We present our initial experience including a series of 5 cases. All patients presented a complete paralyzed shoulder. The superior part of the trapezius muscle was transferred to restore shoulder abduction, in cases where other procedures had failed or are not indicated because of latissimus dorsi palsy or late presentation. Results. The trapezius functional transfer was able to restore shoulder abduction in all patients. After the procedure the mean active range of motion was 47 degrees. In 2 cases there was transitory shoulder rigidity. Partial humeral fracture was presented in other 2 cases, but after internal fixation, bone consolidation was achieved after 8 weeks. Conclusions. The trapezius transfer offers minimal morbidity. It continues to be a useful tool in secondary reconstruction in late brachial plexus injuries, but our small series does not allow us to evaluate results and a longer follow up period is needed


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Plexo Braquial/cirurgia , Lesões do Ombro/cirurgia , Trapézio/cirurgia , Ombro/cirurgia , Osteotomia/métodos , Fixação Interna de Fraturas/métodos , Rigidez Muscular/diagnóstico , Síndrome de Colisão do Ombro/cirurgia
4.
Plast Reconstr Surg ; 144(5): 1105-1114, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31441804

RESUMO

BACKGROUND: Loss of elbow flexion commonly occurs following acute brachial plexus injury. The double fascicular transfer is often used in acute C5-C6 and C5-C7 root injuries, but is rarely applied in cases involving concomitant C8 or T1 root injury. The authors designed a rat model using varying severities of lower trunk injury to determine whether partial injury to the lower trunk affects nerve transfers for elbow flexion. METHODS: There were four different rat groups in which 0, 25, 75, or 100 percent of the donor lower trunk remained intact. One-fourth of the cross-sectional area of the ulnar nerve was then transferred to the musculocutaneous nerve immediately. The authors assessed outcomes using a grooming test, muscle mass, retrograde labeling of sensory/motor neurons that regenerated axons, and immunohistochemical stain of regenerated axons. RESULTS: Five months after nerve transfer, rats that underwent partial injury of the lower trunk fared significantly worse than the rats in whom the donor lower trunk remained 100 percent intact, but significantly better than the rats with 0 percent intact lower trunk. Rats with 25 or 75 percent of the lower trunk intact recovered equivalent function, at both the donor and recipient sites. CONCLUSIONS: Although relatively weak compared with the 100 percent intact donor lower trunk group, the partially injured donor nerve was still functional; even though the nerve sustained a partial injury, the residual axons reinnervated the target muscles. The power of the muscles following either 25 percent or 75 percent injuries was equal after the recovery. Resorting to this approach may be useful in cases in which no alternatives are available.


Assuntos
Neuropatias do Plexo Braquial/cirurgia , Plexo Braquial/lesões , Articulação do Cotovelo/inervação , Regeneração Nervosa/fisiologia , Transferência de Nervo/métodos , Doença Aguda , Animais , Plexo Braquial/cirurgia , Modelos Animais de Doenças , Articulação do Cotovelo/fisiologia , Seguimentos , Masculino , Distribuição Aleatória , Amplitude de Movimento Articular/fisiologia , Ratos , Ratos Sprague-Dawley , Fatores de Risco , Estatísticas não Paramétricas , Resultado do Tratamento
5.
J Hand Surg Asian Pac Vol ; 24(3): 283-288, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31438804

RESUMO

Background: Partial ulnar nerve transfer to the biceps motor branch of the musculocutaneous nerve (Oberlin's transfer) is a successful approach to restore elbow flexion in patients with upper brachial plexus injury (BPI). However, there is no report on more than 10 years subjective and objective outcomes. The purpose of this study was to clarify the long-term outcomes of Oberlin's transfer based on the objective evaluation of elbow flexion strength and subjective functional evaluation of patients. Methods: Six patients with BPI who underwent Oberlin's transfer were reviewed retrospectively by their medical records. The mean age at surgery was 29.5 years, and the mean follow-up duration was 13 years. The objective functional outcomes were evaluated by biceps muscle strength using the Medical Research Council (MRC) grade at preoperative, postoperative, and final follow-up. The patient-derived subjective functional outcomes were evaluated using the Quick Disability of the Arm, Shoulder, and Hand (QuickDASH) questionnaire at final follow-up. Results: All patients had MRC grade 0 (M0) or 1 (M1) elbow flexion strength before operation. Four patients gained M4 postoperatively and maintained or increased muscle strength at the final follow-up. One patient gained M3 postoperatively and at the final follow-up. Although one patient achieved M4 postoperatively, the strength was reduced to M2 due to additional disorder. The mean score of QuickDASH was 36.5 (range, 7-71). Patients were divided into two groups; three patients had lower scores and the other three patients had higher scores of QuickDASH. Conclusions: Oberlin's transfer is effective in the restoration of elbow flexion and can maintain the strength for more than 10 years. Patients with upper BPI with restored elbow flexion strength and no complicated nerve disorders have over ten-year subjective satisfaction.


Assuntos
Plexo Braquial/lesões , Plexo Braquial/cirurgia , Articulação do Cotovelo/fisiopatologia , Transferência de Nervo , Amplitude de Movimento Articular/fisiologia , Nervo Ulnar/cirurgia , Adulto , Avaliação da Deficiência , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Força Muscular , Estudos Retrospectivos , Adulto Jovem
6.
Bone Joint J ; 101-B(7): 867-871, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31256676

RESUMO

AIMS: Improvements in the evaluation of outcomes following peripheral nerve injury are needed. Recent studies have identified muscle fatigue as an inevitable consequence of muscle reinnervation. This study aimed to quantify and characterize muscle fatigue within a standardized surgical model of muscle reinnervation. PATIENTS AND METHODS: This retrospective cohort study included 12 patients who underwent Oberlin nerve transfer in an attempt to restore flexion of the elbow following brachial plexus injury. There were ten men and two women with a mean age of 45.5 years (27 to 69). The mean follow-up was 58 months (28 to 100). Repeated and sustained isometric contractions of the elbow flexors were used to assess fatigability of reinnervated muscle. The strength of elbow flexion was measured using a static dynamometer (KgF) and surface electromyography (sEMG). Recordings were used to quantify and characterize fatigability of the reinnervated elbow flexor muscles compared with the uninjured contralateral side. RESULTS: The mean peak force of elbow flexion was 7.88 KgF (sd 3.80) compared with 20.65 KgF (sd 6.88) on the contralateral side (p < 0.001). Reinnervated elbow flexor muscles (biceps brachialis) showed sEMG evidence of fatigue earlier than normal controls with sustained (60-second) isometric contraction. Reinnervated elbow flexor muscles also showed a trend towards a faster twitch muscle fibre type. CONCLUSION: The assessment of motor outcomes must involve more than peak force alone. Reinnervated muscle shows a shift towards fast twitch fibres following reinnervation with an earlier onset of fatigue. Our findings suggest that fatigue is a clinically relevant characteristic of reinnervated muscle. Adoption of these metrics into clinical practice and the assessment of outcome could allow a more meaningful comparison to be made between differing forms of treatment and encourage advances in the management of motor recovery following nerve transfer. Cite this article: Bone Joint J 2019;101-B:867-871.


Assuntos
Plexo Braquial/lesões , Fadiga Muscular , Músculo Esquelético/fisiopatologia , Transferência de Nervo , Traumatismos dos Nervos Periféricos/cirurgia , Complicações Pós-Operatórias/diagnóstico , Adulto , Idoso , Plexo Braquial/cirurgia , Articulação do Cotovelo/fisiologia , Eletromiografia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Dinamômetro de Força Muscular , Músculo Esquelético/inervação , Músculo Esquelético/cirurgia , Complicações Pós-Operatórias/fisiopatologia , Amplitude de Movimento Articular/fisiologia , Recuperação de Função Fisiológica/fisiologia , Estudos Retrospectivos , Resultado do Tratamento
7.
Neurol India ; 67(3): 679-683, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31347534

RESUMO

Objective: The purpose of the study is to conduct the systematic review of literature available on resting-state functional MRI (fMRI) and brachial plexus injury. Methods: We reviewed all the literature that are available on PubMed; keywords used were resting state, brachial plexus injury, and functional imaging. The reference papers listed were also reviewed. The research items were restricted to publications in English. Some papers have also incorporated studies such as task-based fMRI and transcranial magnetic stimulation (TMS), but only resting-state studies were included for this review. Results: A total of 13 papers were identified, and only 10 were reviewed based on the criteria. The reviewed papers were further categorized on the basis of whether or not any surgical intervention was done. Seven papers have surgical management such as contralateral cervical 7 (CC7) neurotisation or intercostal nerve (ICN) musculocutaneous nerve (MCN) neurotisation. Conclusion: There is conclusive evidence showing that there is cortical reorganisation following brachial plexus injury in both birth and traumatic cases. The changes are restricted to some of the resting-state networks only (default mode network, sensorimotor network, in particular). However, no study till date has focused on a far more longitudinal approach at studying these changes. It will be interesting to see the exact time and effect of these changes.


Assuntos
Plexo Braquial/lesões , Plexo Braquial/fisiopatologia , Encéfalo/fisiopatologia , Plexo Braquial/diagnóstico por imagem , Plexo Braquial/cirurgia , Encéfalo/diagnóstico por imagem , Mapeamento Encefálico , Consenso , Humanos , Imagem por Ressonância Magnética , Plasticidade Neuronal
8.
Plast Reconstr Surg ; 144(1): 155-166, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31246823

RESUMO

BACKGROUND: Elbow flexion after upper brachial plexus injury may be restored by a nerve transfer from the ulnar nerve to the biceps motor branch with an optional nerve transfer from the median nerve to the brachialis motor branch (single and double fascicular nerve transfer). This meta-analysis assesses the effectiveness of both techniques and the added value of additional reinnervation of the brachialis muscle. METHODS: Comprehensive searches were performed identifying studies concerning restoration of elbow flexion through single and double fascicular nerve transfers. Only C5 to C6 lesion patients were included in quantitative analysis to prevent confounding by indication. Primary outcome was the proportion of patients reaching British Medical Research Council elbow flexion grade 3 or greater. Meta-analysis was performed with random effects models. RESULTS: Thirty-five studies were included (n = 688). In quantitative analysis, 29 studies were included (n = 341). After single fascicular nerve transfer, 190 of 207 patients reached Medical Research Council grade 3 or higher (random effects model, 95.6 percent; 95 percent CI, 92.9 to 98.2 percent); and after double fascicular nerve transfer, 128 of 134 patients reached grade 3 or higher (random effects model, 97.5 percent; 95 percent CI, 95.0 to 100 percent; p = 0.301). Significantly more double nerve transfer patients reached grade 4 or greater if preoperative delay was 6 months or less (84 of 101 versus 49 of 51; p = 0.035). CONCLUSIONS: Additional reinnervation of the brachialis muscle did not result in significantly more patients reaching Medical Research Council grade 3 or higher for elbow flexion. Double fascicular nerve transfer may result in more patients reaching grade 4 or higher in patients with a preoperative delay less than 6 months. The median nerve may be preserved or used for another nerve transfer without substantially impairing elbow flexion restoration.


Assuntos
Plexo Braquial/lesões , Transferência de Nervo/métodos , Adulto , Idoso , Plexo Braquial/fisiologia , Plexo Braquial/cirurgia , Neuropatias do Plexo Braquial , Articulação do Cotovelo/fisiologia , Humanos , Pessoa de Meia-Idade , Amplitude de Movimento Articular/fisiologia , Recuperação de Função Fisiológica/fisiologia , Resultado do Tratamento , Nervo Ulnar/transplante , Adulto Jovem
10.
Pain Res Manag ; 2019: 4846956, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31198476

RESUMO

Performing a block under ultrasound guidance effectively requires skill; however, inexperienced anesthesiologists often use high-dose LA to ensure success. We aimed to share our experience with the ultrasound-guided infraclavicular brachial plexus block (USGICB) for upper extremity surgeries and to determine changes in failure rate and local anesthetic dose administered with gaining adequate experience. With approval from the local ethics committee, a retrospective review of records of 2953 patients who underwent USGICB between November 2011 and March 2015 was performed for evaluating the following data: age, sex, height, weight, operation type, American Society of Anesthesiologists physical status score, local anesthetic volume, complications, and success of USGICB. The patients were divided into 4 groups of 10 months each from November 2011 to March 2015: first 10-month period, 628 cases (group I); second 10-month period, 672 (group II); third 10-month period, 720 (group III); and the fourth 10-month period, 933 cases (group IV). Nine anesthesiologists with the same baseline experience in USG performed the blocks. During the initial period, when anesthesiologists had insufficient experience, local anesthetic (LA) dose, success rate, failed blocks, and complications were investigated. The LA volume administered in group I (33.7 ± 4.2 ml) was significantly higher than that in groups II, III, and IV (p < 0.05). Although a reduction in LA volume administered with increasing anesthesiologist experience was not statistically significant, a volume reduction of over 30 ml was observed in groups II, III, and IV compared with group I. Furthermore, in group I, failure rate (3.2%) was higher than that in groups II, III, and IV (p < 0.05). We concluded that sonographic guidance ensures a high success rate and that increased experience of anesthesiologists is associated with reduced complications and failure rate of blocks, in addition to prevention of LA overdose.


Assuntos
Anestesiologistas , Anestésicos Locais/administração & dosagem , Competência Clínica , Bloqueio Nervoso/métodos , Ultrassonografia de Intervenção/métodos , Adulto , Anestesia Local/métodos , Plexo Braquial/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
12.
World Neurosurg ; 128: 611-615.e1, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31078807

RESUMO

BACKGROUND: Tetraplegia caused by cervical spinal cord injury is devastating for patients and represents a significant public health problem in both developed and developing countries. Improved functional outcomes after nerve transfers are increasingly reported in the literature, but thus far, no options exist for injuries above the C5 level. CASE DESCRIPTION: We report the cases of 2 patients with C4 spinal cord injury, American Spinal Injury Association A, who underwent successful bilateral spinal accessory nerve transfers, on 1 side to the triceps nerve with long intervening sural graft and on the other side direct transfer to the motor fascicles of the middle trunk. Patients improved from Medical Research Council 0 to 4 on the side of the nerve graft and 0 to 2 or 3 on the side of the direct transfer. Both patients also underwent transfer of the greater auricular nerve to sensory fascicles of the middle trunk, and they experienced sensory recovery in the C6 distribution. Notably, both patients were far removed from the traditional window of nerve transfer surgery at 4 years and almost 11 years out from injury. CONCLUSIONS: We describe 2 successful cases of the first and to date only option for motor and sensory reinnervation in high cervical spinal cord injuries. These procedures provide a robust nerve transfer option capable of improving quality of life in tetraplegic patients. There may be a significant undertreated population of patients with cervical spinal cord injury patients in the United States who were previously considered outside the window for benefiting from nerve transfers but who would benefit from these techniques.


Assuntos
Nervo Acessório/transplante , Plexo Braquial/cirurgia , Transferência de Nervo/métodos , Quadriplegia/cirurgia , Traumatismos da Medula Espinal/cirurgia , Nervo Sural/transplante , Adolescente , Adulto , Plexo Cervical/cirurgia , Vértebras Cervicais , Humanos , Masculino , Quadriplegia/etiologia , Traumatismos da Medula Espinal/complicações
13.
Plast Reconstr Surg ; 143(5): 1017e-1026e, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31033825

RESUMO

BACKGROUND: Infants with brachial plexus birth injury who do not recover motor function spontaneously in a timely manner are candidates for brachial plexus reconstruction with nerve autograft. Outcomes of this intervention are incompletely understood. The authors present the long-term outcomes of brachial plexus reconstruction with sural nerve autograft in infants with brachial plexus birth injury. METHODS: The authors retrospectively reviewed all infants with brachial plexus birth injury who underwent brachial plexus reconstruction with sural nerve autograft between 1992 and 2014 with a minimum 2-year follow-up. The authors used Active Movement Scale scores to determine the presence and timing of shoulder, elbow, and wrist recovery. They assessed recovery of hand function in infants with global brachial plexus birth injury with the Raimondi scale. The number and type of secondary reconstructive procedures were identified. RESULTS: Forty-three infants who underwent brachial plexus reconstruction at age 7 ± 2 months old were followed for 7 ± 5 years. Most infants recovered antigravity elbow flexion (91 percent) and shoulder abduction (67 percent), but fewer recovered antigravity shoulder external rotation (19 percent) and wrist extension (37 percent). Mean postoperative times until observed antigravity motor strength (Active Movement Scale score >5) at the shoulder, elbow, and wrist were all greater than 12 months; evidence of initial motor recovery (Active Movement Scale score >2) was observed earlier. The mean Raimondi score in infants with global brachial plexus birth injury was 2.2 (range, 0 to 5) at final follow-up. Thirty-three children underwent 2 ± 1.2 secondary reconstructive procedures. CONCLUSIONS: Brachial plexus reconstruction with sural nerve autograft reliably results in recovery of shoulder abduction and elbow flexion, but recovery of shoulder external rotation and wrist extension is less predictable, and recovery often takes more than 1 year. Secondary procedures are often performed to optimize function. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Traumatismos do Nascimento/complicações , Neuropatias do Plexo Braquial/cirurgia , Procedimentos Neurocirúrgicos/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Nervo Sural/transplante , Plexo Braquial/lesões , Plexo Braquial/cirurgia , Neuropatias do Plexo Braquial/etiologia , Articulação do Cotovelo/inervação , Articulação do Cotovelo/fisiologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Amplitude de Movimento Articular , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Articulação do Ombro/inervação , Articulação do Ombro/fisiologia , Transplante Autólogo/métodos , Resultado do Tratamento , Articulação do Punho/inervação , Articulação do Punho/fisiologia
14.
J Hand Surg Eur Vol ; 44(6): 628-631, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30871404

RESUMO

We investigated a technique to reconstruct the suprascapular nerve in patients with C5/C6 brachial plexus palsies, using pectoral fascicles from the ipsilateral C7 root. Using a supraclavicular approach in eight cadavers, the suprascapular nerve was placed side by side with an anterior quadrant fascicle from the C7 root. Several criteria were assessed, including the fascicle length, the overlap between the two nerves and their respective diameters. The mean length of the C7 fascicles was 19.3 mm, with a mean overlap of 4.7 mm. The suprascapular nerve and the C7 fascicles had mean diameters of 2.2 mm and 2.1 mm, respectively. Pectoral fascicles from C7 seem to be an option for reconstruction of the suprascapular nerve in C5/C6 palsies. Clinical studies will be required to establish the potential limitations of this transfer, especially in cases with complex lesions of the suprascapular nerve.


Assuntos
Neuropatias do Plexo Braquial/cirurgia , Plexo Braquial/cirurgia , Transferência de Nervo/métodos , Idoso , Idoso de 80 Anos ou mais , Cadáver , Vértebras Cervicais/inervação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
15.
Turk Neurosurg ; 29(4): 594-597, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30875079

RESUMO

AIM: To describe the ultrasound-guided microsurgical excision technique and to evaluate the surgical outcomes of brachial plexus schwannomas. MATERIAL AND METHODS: Eleven patients who underwent ultrasound-guided microsurgery for small ( < 3 cm) brachial plexus schwannomas between 2013 and 2017 were included in our study. RESULTS: The mean age of the patients was 45 years (range: 30-68 years), with six tumors localized on the right and five on the left side. There were no perioperative or postoperative complications. No postoperative deficits were observed in the patients. CONCLUSION: Surgeons can safely and completely excise most of the benign ( < 3 cm and non-palpable) brachial plexus tumors by the ultrasound-guided microsurgical excision technique.


Assuntos
Plexo Braquial/diagnóstico por imagem , Plexo Braquial/cirurgia , Microcirurgia/métodos , Neurilemoma/diagnóstico por imagem , Neurilemoma/cirurgia , Ultrassonografia de Intervenção/métodos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias do Sistema Nervoso Periférico/diagnóstico por imagem , Neoplasias do Sistema Nervoso Periférico/cirurgia , Complicações Pós-Operatórias/cirurgia , Resultado do Tratamento
16.
Acta Neurochir (Wien) ; 161(5): 899-906, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30877474

RESUMO

BACKGROUND: Traumatic brachial plexus injuries are severe lesions, and the incidence of these injuries has been increasing in recent years. METHODS: The clinical data of 510 operated patients with brachial plexus injury recruited from 74 hospitals in Guangxi from 2004 to 2016 were retrospectively studied. RESULTS: Our study included 447 males and 63 females, with an average age of 29.04 years. Traffic accidents were the most common cause of injury (64.71%), especially motorcycle accidents. Closed injuries accounted for 88.24% of cases, and 83.53% of patients had associated injuries, the most common of which were fractures (76.27%). The preoperative predictive value of root injury of MRI and CT was 74.71% and 71.28%, respectively. 44.71% of patients underwent an initial operation within 6 months after the trauma. Regarding the surgery, neurolysis alone, brachial plexus reconstruction, and free functioning gracilis graft accounted for 16.67%, 75.50%, and 4.51%, respectively. A total of 415 patients were followed up with an average time of 47.95 (25-68) months, and anxiety or depression were found among 81.20% of them. Two hundred seventy-six patients suffered from nerve pain, with mild pain present in 67.03% of patients. Additionally, 347 patients were followed up for more than 3 years, 76.81% of patients with C5-C6 injury recovery to useful function, and the procedure of neurolysis alone demonstrated the best efficacy (79.45%). CONCLUSIONS: Brachial plexus injury is still a challenging trauma for surgeons, and traffic accidents are the dominant cause. Timely and effective surgery is important for functional limb recovery.


Assuntos
Neuropatias do Plexo Braquial/cirurgia , Plexo Braquial/lesões , Fraturas Ósseas/cirurgia , Procedimentos Neurocirúrgicos/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Acidentes de Trânsito , Adulto , Plexo Braquial/cirurgia , Neuropatias do Plexo Braquial/etiologia , China , Feminino , Fraturas Ósseas/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
17.
Reg Anesth Pain Med ; 44(5): 561-564, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30867276

RESUMO

BACKGROUNDS AND OBJECTIVES: The anterior approach to the subomohyoid suprascapular (SOS) nerve is a new, technically easy and reliable regional anesthesia technique for postoperative shoulder analgesia. However, due to its proximity, the injectate may spread to the brachial plexus and phrenic nerve. The goal of this anatomic study with dye injection in the subomohyoid space and subsequent cadaver dissection was to establish the likely spread of local anesthesia and the extent of brachial plexus and phrenic nerve involvement resulting from ultrasound-guided SOS nerve block. METHODS: The suprascapular nerve (SSN) under the inferior belly of omohyoid muscle in the posterior triangle of the neck was identified. Using a contrast dye, 10 ultrasound-guided SOS nerve injections of 5 mL were done bilaterally, in five fresh cadavers. The area was then dissected to evaluate the spread of the contrast dye in the immediate proximity of the brachial plexus, phrenic and SSN. RESULTS: The SSN and omohyoid muscle were easily identified on each cadaver. SOS nerve staining with contrast dye was seen in 90% of dissections. The superior trunk was stained in 90% and the middle trunk was stained in 80% of dissections. The inferior trunk was stained in 20% of dissections. A spread of dye around the SSN was observed in 90% and the phrenic nerve was mildly stained in 20% of the dissections. CONCLUSION: In-plane ultrasound-guided needle injection with a 5 mL volume for SOS block was sufficient to stain the SSN. This conservative volume involved other parts of the brachial plexus and may potentially spread to the phrenic nerve. Further clinical studies are required for confirmation.


Assuntos
Anestesia por Condução/métodos , Plexo Braquial/diagnóstico por imagem , Corantes , Bloqueio Nervoso/métodos , Nervo Frênico/diagnóstico por imagem , Ultrassonografia de Intervenção/métodos , Idoso , Idoso de 80 Anos ou mais , Plexo Braquial/cirurgia , Cadáver , Feminino , Humanos , Osso Hioide/diagnóstico por imagem , Osso Hioide/cirurgia , Masculino , Nervo Frênico/cirurgia
18.
Clin Neurophysiol ; 130(5): 701-706, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30875537

RESUMO

OBJECTIVES: Evaluate correlation between donor nerve semi-quantitative electromyography (sqEMG) and strength outcome in nerve transfer surgery. METHODS: Retrospective review of pre-operative donor nerve semi-quantitative neurophysiology and post-operative recipient muscle force after at least one-year follow-up. The semi-quantitative technique is the average motor unit number estimate associated with needle recorded interference patterns in the donor muscle (IP-AMUNE), which was correlated with hand-held manometry, standardized as a percent of the contralateral arm, using multivariable linear regression with backward selection. RESULTS: Twenty-eight nerve transfer cases were included. The correlation between the donor nerve IP-AMUNE and the recipient muscle strength was moderate to strong and highly significant (r = 0.67, p < 0.001). Medical Research Council (MRC) grading did not predict strength (p > 0.54). CONCLUSIONS: IP-AMUNE is a good predictor of strength after nerve transfer surgery and should be considered in the evaluation and planning of patients undergoing nerve transfer to aid in donor nerve selection. SIGNIFICANCE: IP-AMUNE may significantly benefit those undergoing nerve transfer surgery for the restoration of movement.


Assuntos
Plexo Braquial/cirurgia , Eletromiografia/métodos , Transferência de Nervo/métodos , Traumatismos dos Nervos Periféricos/cirurgia , Recuperação de Função Fisiológica/fisiologia , Adulto , Plexo Braquial/lesões , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Resultado do Tratamento
19.
Muscle Nerve ; 59(6): 707-711, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30847944

RESUMO

INTRODUCTION: Brachial plexus trauma related to gunshot (GS) injury requires early examination and characterization to ensure appropriate treatment. Magnetic resonance imaging (MRI) may be contraindicated when there are metal fragments in a patient's body. Ultrasound (US) may present an alternative to imaging GS-related brachial plexus injury. METHODS: Three patients with GS-related brachial plexus injury who underwent US imaging evaluation at our institution were identified. A retrospective review of the patients' medical records was performed. RESULTS: US characterization of nerve abnormalities after GS injury to the brachial plexus was in agreement with electrodiagnostic and intraoperative findings. DISCUSSION: Information from the US reports was useful in preparation for brachial plexus reconstruction surgery. As such, US has unique utility when MRI cannot be performed. US imaging can provide useful characterization of the brachial plexus after GS injury when performed by an experienced operator. Muscle Nerve 59:707-711, 2019.


Assuntos
Plexo Braquial/diagnóstico por imagem , Traumatismos dos Nervos Periféricos/diagnóstico por imagem , Ferimentos por Arma de Fogo/diagnóstico por imagem , Adulto , Plexo Braquial/lesões , Plexo Braquial/fisiopatologia , Plexo Braquial/cirurgia , Neurite do Plexo Braquial/diagnóstico por imagem , Neurite do Plexo Braquial/etiologia , Neuropatias do Plexo Braquial/diagnóstico por imagem , Neuropatias do Plexo Braquial/etiologia , Eletromiografia , Humanos , Masculino , Neuroma/diagnóstico por imagem , Neuroma/etiologia , Procedimentos Neurocirúrgicos , Traumatismos dos Nervos Periféricos/complicações , Traumatismos dos Nervos Periféricos/fisiopatologia , Traumatismos dos Nervos Periféricos/cirurgia , Neoplasias do Sistema Nervoso Periférico/diagnóstico por imagem , Neoplasias do Sistema Nervoso Periférico/etiologia , Procedimentos Cirúrgicos Reconstrutivos , Estudos Retrospectivos , Ferimentos por Arma de Fogo/complicações , Ferimentos por Arma de Fogo/fisiopatologia , Ferimentos por Arma de Fogo/cirurgia , Adulto Jovem
20.
J Am Acad Orthop Surg ; 27(19): 705-716, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-30707114

RESUMO

Adult traumatic brachial plexus injuries are devastating life-altering injuries occurring with increasing frequency. Evaluation includes a detailed physical examination and radiologic and electrodiagnostic studies. Critical concepts in surgical management include knowledge of injury patterns, timing of surgery, prioritization in restoration of function, and management of patient expectations. Options for treatment include neurolysis, nerve grafting, or nerve transfers and should be generally performed within 6 months of injury. The use of free functioning muscle transfers can improve function both in the acute and late setting. Modern patient-specific management can often permit consistent restoration of elbow flexion and shoulder stability with the potential of prehension of the hand. Understanding the basic concepts of management of this injury is essential for all orthopaedic surgeons who treat trauma patients.


Assuntos
Neuropatias do Plexo Braquial/cirurgia , Plexo Braquial/lesões , Plexo Braquial/cirurgia , Procedimentos Neurocirúrgicos/métodos , Traumatismos dos Nervos Periféricos/diagnóstico , Traumatismos dos Nervos Periféricos/cirurgia , Adulto , Plexo Braquial/anatomia & histologia , Neuropatias do Plexo Braquial/complicações , Neuropatias do Plexo Braquial/diagnóstico , Neuropatias do Plexo Braquial/etiologia , Humanos , Traumatismos dos Nervos Periféricos/complicações , Traumatismos dos Nervos Periféricos/etiologia
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