Yusuf GÜRBÜZ, Tahir S. SÜGÜN, Kemal ÖZAKSAR, Murat KAYALAR, Tulgar TOROS, Yalçın ADEMOĞLU

Peroneal nerve injury surgical treatment results

Amaç: Bu çalışmanın amacı siyatik bifurkasyondan dallanma yerine kadar oluşan peroneal sinir yaralanmalarında uygulanan greftli sinir ve uç uca peroneal sinir onarımlarının klinik ve fonksiyonel sonuçlarının geriye dönük değerlendirilmesi idi. Çalışma planı: Çalışmaya 1992-2009 yılları arasında, peroneal sinir onarımı uygulanan 26 hasta (22 erkek, 4 kadın; ortalama yaş: 19.9, dağılım: 5-46) katıldı. Sinir yaralanması 21 hastada açık, 5 hastada kapalı oluşmuştu. On dokuz hastaya sural sinir grefti ile 7 hastaya uç uca cerrahi onarım uygulandı. Ortalama sinir grefti uzunluğu 5.42 (dağılım: 2-15) cm, kullanılan kablo sayısı ortalama 3.1 (dağılım: 2-4) olarak kaydedildi. Ortalama takip süresi 33 (dağılım: 13-96) ay idi. Değerlendirmede tibialis anterior ve peroneal kaslar için İngiltere Tıbbi Araştırma Konseyi (BMRC) ölçeği, koruyucu duyu için Semmes-Weinstein monofilaman testi uygulandı. Bulgular: On dokuz hastada (%73) yeterli ve tam geri kazanım saptandı. Greftli sinir onarımı uygulanan hastaların ortalama takip süresi 39.3 ay, uç uca onarım uygulanan hastaların 30.1 ay olarak kaydedildi. Greftli sinir onarımı uygulanan 19 hastanın 15’inde, uç uca sinir onarımı uygulanan 7 hastanın 4’ünde yeterli veya tam iyileşme saptandı. Onarım sonrası iyileşme gözlenmeyen 7 hastanın 3’üne posterior tibial tendonunun ayak dorsaline transferi yapıldı. Duyu değerlendirmesi yapılan 22 hastanın 16’sında koruyucu duyunun geri döndüğü saptandı. Çıkarımlar: Peroneal sinir onarımında uç uca onarım ve sinir greftlemesi sonrasında iyi sonuçlar elde etmek mümkündür

Peroneal sinir yaralanmalarında cerrahi tedavi sonuçları

Objective: The purpose of this study was to retrospectively evaluate the clinical and functional results of nerve grafting and end-to-end peroneal nerve repair between sciatic bifurcation and distal branching. Methods: The study included 26 patients (22 men, 4 women; mean age: 19.9 years; range: 5 to 46 years) who underwent peroneal nerve repair between 1992 and 2009. Open nerve injuries were seen in 21 patients and closed injuries in 5. Surgical repair was performed with sural nerve grafting in 19 patients and end-to-end in 7. Mean nerve graft length was 5.42 (range: 2 to 15) cm with a mean 3.1 (range: 2 to 4) nerve cables used. Mean follow-up was 33 (range: 13 to 96) months. The British Medical Research Council (BMRC) scale was used for the evaluation of the tibialis anterior and peroneal muscles and Semmes-Weinstein monofilaments were used for protective sensation evaluation. Results: Adequate and full recovery was observed in 19 patients (73%). Mean follow-up time was 39.3 months in patients undergoing nerve grafting and 30.1 months in end-to-end nerve repair. Fifteen of 19 patients with nerve grafting and 4 of 7 patients with end-to-end nerve repair had an adequate or full recovery. Posterior tibial tendon transfer to dorsal foot was applied in 3 of 7 patients without recovery. Protective sensory recovery was determined in 16 of 22 patients. Conclusion: Good results in both end-to-end repair and in repair with grafting is possible in peroneal nerve repair.

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