Aspectos clínicos de pacientes com lesão traumática do plexo braquial após tratamento cirúrgico

ResumoObjetivoAvaliar aspectos sociodemográficos e clínicos de pacientes operados de lesão traumática do plexo braquial (LTPB).MétodoEstudo retrospectivo, revisão de prontuários, amostra de conveniência, 48 pacientes operados entre 2000 e 2010. Avaliados: 1) ADM – em graus, do ombro, cotovelo e punho/mão; 2) grau de força do ombro, cotovelo e punho/mão; 3) sensibilidade; 4) EVA (0 a 10). Testes de t de Student, qui‐quadrado, Friedman, Wilcoxon e Kruskal‐Wallis (p<0,05).ResultadosIdade de 30,6 anos, 60,4% acidentes motociclísticos. Politraumatismo 52,1%. Tempo até a cirurgia de 8,7 meses (2 a 48). Trinta e um (64,6%) com lesão total do plexo. Cirurgias mais frequentes: neurais em 39 (81,3%). ADM≥30° do ombro 20 pacientes (41,6%) de 30° a 90°, média 73° (p=0,001); 13 (27,1%) já tinham força no ombro≥M3 (p=0,001). Cotovelo≥80° de flexão, 27 pacientes (56,2%) de 30° a 160°, com média de 80,6° (p<0,001); 22 com força≥M3 (p<0,001). Extensão do punho≥30° partindo de 45° de flexão em 22 pacientes (45,8%), de 30° a 90°, média 70° (p=0,003); 27 (56,3%) tinham força de extensão do punho/mão≥M3 (p=0,002); 45 (93,8%) hipoestesia e três (6,2%) anestesia (p=0,006). EVA inicial 4,5 (1 a 9) e EVA final 3 (1 a 7) (p<0,001).ConclusãoAs LTPB tem maior prevalência em jovens (21‐40 anos), homens, urbanos, trabalhadores braçais, acidentes motociclísticos, com politrauma, lesão total do plexo. Cirurgias neurais, seguidas em segundo tempo, pelas transferências miotendíneas. A cirurgia para LTPB mostrou melhoria significativa de ADM e força em ombro, cotovelo e punho/mão, da sensibilidade do membro afetado e diminuição da dor final.AbstractObjectiveTo evaluate sociodemographic and clinical aspects of patients undergoing operations due to traumatic lesions of the brachial plexus.MethodThis was a retrospective study in which the medical files of a convenience sample of 48 patients operated between 2000 and 2010 were reviewed. The following were evaluated: 1) range of motion (ROM) of the shoulder, elbow and wrist/hand, in degrees; 2) grade of strength of the shoulder, elbow and wrist/hand; 3) sensitivity; and 4) visual analogue scale (VAS) (from 0 to 10). The Student's t, chi‐square, Friedman, Wilcoxon and Kruskal‐Wallis tests were used (p<0.05).ResultsThe patients’ mean age was 30.6 years; 60.4% of them had suffered motorcycle accidents and 52.1%, multiple trauma. The mean length of time until surgery was 8.7 months (range: 2 to 48). Thirty‐one patients (64.6%) presented complete rupture of the plexus. The frequent operation was neurosurgery, in 39 cases (81.3%). The ROM achieved was ≥ 30° in 20 patients (41.6%), with a range from 30° to 90° and mean of 73° (p=0.001). Thirteen (27.1%) already had shoulder strength ≥ M3 (p=0.001). Twenty‐seven patients (56.2%) had elbow flexion ≥ 80°, with a range from 30° to 160° and mean of 80.6° (p<0.001). Twenty‐two had strength ≥ M3 (p<0.001). Twenty‐two patients (45.8%) had wrist extension ≥ 30° starting from flexion of 45°, with a range from 30° to 90° and mean of 70° (p=0.003). Twenty‐seven (56.3%) presented wrist/hand extension strength ≥ M3 (p=0.002). Forty‐five (93.8%) had hypoesthesia and three (6.2%) had anesthesia (p=0.006). The initial VAS was 4.5 (range: 1.0 to 9.0) and the final VAS was 3.0 (range: 1.0 to 7.0) (p<0.001).ConclusionTraumatic lesions of the brachial plexus were more prevalent among young adults (21‐40 years), men, people living in urban areas, manual workers and motorcycle accidents, with multiple trauma and total rupture of the plexus. Neurosurgery, with a second procedure consisting of muscle‐tendon transfer, was the commonest operation. Surgery for traumatic lesions of the brachial plexus resulted in significant improvement in the ROM and strength of the shoulder, elbow and wrist/hand, improvement of the sensitivity of the limb affected and reduction of the final pai

Evaluation of elbow flexion following free muscle transfer from the medial gastrocnemius or transfer from the latissimus dorsi, in cases of traumatic injury of the brachial plexus

ABSTRACT OBJECTIVE: To compare the gain in elbow flexion in patients with traumatic injury of the brachial plexus following muscle transfer from latissimus dorsi with the gain following free muscle transfer from the medial belly of the gastrocnemius. METHODS: This was a retrospective study in which the medical files of a convenience sample of 13 patients operated between 2000 and 2010 were reviewed. Group 1 comprised seven patients who underwent transfers from the gastrocnemius and group 2 (controls) comprised six patients who underwent transfers from the latissimus dorsi. The following functions were evaluated: (1) range of motion (ROM) of elbow flexion, in degrees, using manual goniometry and (2) grade of elbow flexion strength, using a muscle strength scale. Satisfactory results were defined as: (1) elbow flexion ROM ≥ 80° and (2) elbow flexion strength ≥ M3. The Fisher exact and Kruskal-Wallis tests were used (p < 0.05). RESULTS: The patients' mean age was 32 years (range: 17-56) and 72% had been involved in motorcycle accidents. Elbow flexion strength ≥ M3 was observed in seven patients (100%) in group 1 and in five patients (83.3%) in group 2 (p = 0.462). None of the patients presented M5, and one patient (16.7%) in group 2 had a poor result (M2). Elbow flexion ROM with a gain ≥ 80° (daily functions) was found in six patients (86%) in group 1 and in three patients (50%) in group 2 ( p = 0.1). CONCLUSION: The patients in group 1 had greater gains in strength and ROM than did those in group 2, but without statistical significance. Thus, transfers from the gastrocnemius become a new surgical option, if other techniques cannot be used