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Lesiones altas del plexo braquial. Reconstrucción con técnicas combinadas de neurotización e injertos nerviosos.
Upper brachial plexus injuries. Reconstruction with combined techniques of neurotization and nerve grafts
Palabras clave:
plexo braquial, transferencia de nervios, nervio cubital (es)Brachial plexus, Nerve transfer, Ulnar nerve (en)
Antecedentes. Las lesiones altas del plexo braquial son reconstruidas con neurotización e injerto nervioso. El nervio espinal accesorio, la raíz C7, las ramas del tríceps y los nervios mediano y cubital son los más usados para transferencias.
Objetivo. Mostrar la experiencia con neurotización de la rama inferior del nervio espinal accesorio (NEA) al nervio supraescapular (NSE), transferencia nerviosa de fascículos del nervio cubital o del mediano y, en ocasiones, injertos nerviosos hacia el nervio musculocutáneo y al tronco posterior, y reconstrucción del nervio axilar en algunos casos.
Materiales y métodos. Se revisan 42 pacientes con lesiones altas de plexo braquial, operados mediante combinación de neurotización e injertos nerviosos. Se hizo un seguimiento mínimo de 15 meses.
Resultados. Las lesiones de 40 pacientes fueron producidas por accidente en moto. En 22 solo se transfirió el NSE con el NEA; con esto, se recuperó abducción de hombro de 33º. A 8 pacientes se les combinó con reparación del axilar; mejorando la abducción a 81º. En 30 pacientes con neurotización del nervio cubital o mediano para el bíceps, se obtuvo respuesta a los 3 o 4 meses. Al final, la flexión del codo era de 116º y M4.
Conclusión. Los mejores resultados en hombro fueron con la combinación de NSE y del nervio axilar; con esta, se logró 81º de abducción. La rotación externa mejoró en 28,5% de los pacientes, con respuesta tardía. Mientras que la neurotización del bíceps con fascículos del cubital consiguió una flexión de 116º, muy comparable con otras series. Hoy esta técnica es el gold estandard para la reconstrucción de flexión del codo.
Background. The upper brachial plexus injuries are reconstructed with neurotization and nerve grafting. The spinal accessory nerve, C7 root, branches of the triceps, and median and ulnar nerve are most commonly used for transfers.
Objective. To show the experience with neurotization of the lower branch of the spinal accessory nerve (NEA) to suprascapular nerve (NSE), nerve fascicles transfer of median or ulnar nerve, and sometimes nerve grafting to the musculocutaneous nerve and the posterior trunk, and axillary nerve reconstruction in some cases.
Materials and methods. We reviewed 42 patients with upper brachial plexus injuries, operated by the combination transfer and nerve grafts. Minimum follow-up 15 months.
Results. 40 patients were due to motorcycle accidents. In only 22 was transferred the NEA to NSE, recovering shoulder abduction of 33 °. In 8 patients to combine with axillary nerve repair, improved abduction to 81°.
In 30 patients with ulnar or median nerve neurotization to the biceps, the response was obtained between 3 and 4 months. At follow- up elbow flexion was 116° and M4.
Conclusion. The best results in shoulder were obtained with the combination of NSE and axillary nerve, achieving 81 ° of abduction. External rotation improved in 28.5% of patients, with a delayed response.
Shoulder flexion of 116 was obtained with ulnar nerve neurotization, very comparable with other series. Today this technique is the gold standard for reconstruction of elbow flexion.
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Derechos de autor 2015 Revista de la Facultad de Medicina
Esta obra está bajo una licencia Creative Commons Reconocimiento 3.0 Unported.
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