gms | German Medical Science

63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

13. - 16. Juni 2012, Leipzig

Our experience with the Oberlin procedure and triceps branch transfer in adult brachial plexus injury

Meeting Abstract

  • J. Oberhoffer - Abteilung für Neurochirurgie der Universität Ulm am Bezirkskrankenhaus Günzburg
  • M.T. Pedro - Abteilung für Neurochirurgie der Universität Ulm am Bezirkskrankenhaus Günzburg
  • C. Heinen - Abteilung für Neurochirurgie der Universität Ulm am Bezirkskrankenhaus Günzburg
  • R.W. König - Abteilung für Neurochirurgie der Universität Ulm am Bezirkskrankenhaus Günzburg
  • C.R. Wirtz - Abteilung für Neurochirurgie der Universität Ulm am Bezirkskrankenhaus Günzburg
  • G. Antoniadis - Abteilung für Neurochirurgie der Universität Ulm am Bezirkskrankenhaus Günzburg

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocFR.13.11

DOI: 10.3205/12dgnc288, URN: urn:nbn:de:0183-12dgnc2885

Veröffentlicht: 4. Juni 2012

© 2012 Oberhoffer et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: One of the main goals in treating brachial plexus injury is the restoration of shoulder stability and abduction as well as elbow flexion. In the past years, procedures such as the Oberlin transfer (i.e. neurotising ulnar and/or median nerve fascicles directly to musculocutanaeus nerve) and neurotization using triceps branches to the axillary nerve have been established. We present our own experience with these techniques.

Methods: In a retrospective analysis, we studied the data of 22 patients, who underwent the Oberlin procedure between 11/2004 and 09/2010. Moreover, 11 patients from 12/2008 to 07/2011 undergoing a triceps branch transfer were identified. Pre- and postoperative assessment was carried out using the Medical Research Council (MRC) grade to classify muscle strength. Sensory deficits were also detected.

Results: The mean age of the patients was 35,6 years (13–74 yrs) and the mean time from injury to surgery was 8,6 months (3–35 months). Preoperative biceps in all patients showed M0. 9/22 patients, who underwent Oberlin transfers gained MRC 4-5. 5/22 showed a significant improvement with biceps function MRC 3-4. In addition 6/22 had no functional elbow flexion after 20 months follow-up, while 2/22 of the patients were lost to follow-up. None of them had an impairment of the hand function. 2/22 patients experienced a transient paresthesia in the ulnar hand. In our patients no significant difference was seen between only ulnar and median nerve augmented Oberlin transfer. Regarding triceps branch transfer, 2/9 patients displayed shoulder abduction MRC 4-5. 1/9 patient reached MRC 3 after 20 months. 6/9 patients did not benefit. 4 patients, who had a follow-up just for 1 year, were excluded from this study.

Conclusions: In our experience both Oberlin procedure and triceps branch transfer are safe and feasible techniques. However, the Oberlin results are more promising. In patients with brachial plexus injury, independent from pedicle screws both methods should be kept in mind.