Ufuk NALBANTOĞLU, Türker ÖZKAN, İ. Metin TÜRKMEN

Onarılması mümkün olmayan radial sinir felcinde tendon transferi sonuçları

Amaç: Primer olarak tedavisi mümkün olmayan radial sinir felci olgularında uyguladığımız tendon transferlerinin sonuçları değerlendirildi. Çalışma planı: Çalışmaya radial sinir yaralanması nedeniyle tendon transferi uygulanan 29 hasta (5 kadın, 24 erkek; ort. yaş 29; dağılım 9-51) alındı. Dört hastada alçak seviyeli, 25 hastada yüksek seviyeli radial sinir felci vardı. Yaralanma sonrası transfer uygulama süresi (paralizi süresi) ortalama 19.7 aydı (dağılım 1 gün-180 ay). Değerlendirme için eklem hareket aralıkları ve kas güçleri ölçüldü. Fonksiyonel değerlendirme Tajima ölçütlerine göre yapıldı. Ortalama takip süresi 56.9 ay (dağılım 5-90 ay) idi. Sonuçlar: Kas kuvveti değerlendirmesinde, el bileği ekstansiyonu üç hastada 3, 10 hastada 4, 12 hastada 5; parmak ekstansiyonu yedi hastada 3, 10 hastada 4, 12 hastada 5; başparmak ekstansiyonu ise altı hastada 3, 13 hastada 4, 10 hastada 5 kuvvetinde bulundu. Ortalama el bileği eklem hareket aralığı 67.4°, ekstansiyon 48.3° (10°-70°), fleksiyon 21.5° (10°-55°) ölçüldü. Ortalama metakarpofalangeal eklem ekstansiyonu 1.7° (0°-12°), başparmak abdüksiyonu 45.6° (34°-56°), interfalangeal eklem ekstansiyonu 18° (0°-30°) derece idi. Tajima ölçütlerine göre fonksiyonel açıdan 15 olguda (%51.7) mükemmel, dokuz olguda (%31) iyi, beş olguda (%17.2) orta sonuç elde edildi. Ameliyat sonrasında sekiz hastada (%27.6) radial deviyasyon deformitesi gelişti. Dört hastada (%13.8) diğer parmaklara göre 1 derece daha güçsüz hareket görüldü. Radial deviyasyon gelişen hastalarda parmak ekstansiyonu için fleksör karpi ulnaris (FKU) transfer edilmişti. Çıkarımlar: Radial sinir felci geç rekonstrüksiyonunda tendon transferleri ile başarılı sonuçlar alınabilmektedir. Parmak ekstansiyonu için FKU transferi yapılan hastalarda radial deviyasyon deformitesi görülebilmektedir.

Anahtar Kelimeler:

El parmakları, Tedavi sonucu, Geriyedönük çalışma, Tendon transferi, El bileği eklemi, Hareket açıklığı, eklem, Radtal nöropati

The results of tendon transfer in irreparable radial nerve palsy

Objectives: The purpose of this study was to evaluate the results of tendon transfers in patients with irreparable radial nerve palsy. Methods: The study included 29 patients (5 females, 24 males; mean age 29 years; range 9 to 51 years) who underwent tendon transfers for radial nerve palsy. Four patients had low- and 25 patients had high-level radial nerve palsy. The mean duration of tendon transfer after injury (paralysis time) was 19.7 months (range 1 day to 180 months). Clinical evaluations included joint range of motion and muscle strengths. Functional evaluation was made using the Tajima criteria. The mean follow-up was 56.9 months (range 5 to 90 months). Results: Muscle strengths were measured as follows: 3 (n=3), 4 (n=10), and 5 (n=12) for the wrist extensor muscle; 3 (n=7), 4 (n=10), and 5 (n=12) for the finger extensor muscle; and 3 (n=6), 4 (n=13), and 5 (n=10) for the thumb extensor muscle. The mean wrist range of motion was 67.4°, extension was 48.3° (10°-70°), and flexion was 21.5° (10°-55°). The mean metacarpophalangeal joint extension was 1.7° (0°-12°), thumb abduction was 45.6° (34°-56°), and thumb interphalangeal joint extension was 18° (0°-30°). According to the Tajima criteria, the results were excellent in 15 patients (51.7%), good in nine patients (31%), and moderate in five patients (17.2%). Eight patients (27.6%) had radial deviation deformity and four patients (13.8%) had 1-level weaker finger extensor muscle strength compared to the other fingers. The flexor carpi ulnaris (FCU) was used in the transfer of patients who developed radial deviation deformity. Conclusion: Treatment of irreparable radial nerve palsy with tendon transfers yields successful results. Radial deviation deformity mostly occurs in patients receiving FCU transfer for finger extension.

Keywords:

Fingers, Treatment Outcome, Retrospective Studies, Tendon Transfer, Wrist Joint, Range of Motion, Articular, Radial Neuropathy,

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