Résultats des réparations nerveuses tardives au-delà de 12 mois chez 16 patients

Abstract

The aim of this study is to estimate the maximum delay following nerve injury at which a nerve can be reconstructed and still recover good function. This is a retrospective study of a series of 16 patients who underwent delayed nerve reconstruction at 12 months or later post-injury with the target muscle showing a fibrillatory pattern on preoperative EMG. There were 16 males and one female, ages ranging from 17 to 74 average 38 years. Thirteen patients had brachial plexus injuries (4 complete) where a nerve was transferred onto the nerve branch directly supplying the target muscle, according to the case. Two had a complete sciatic nerve injury where a graft was used in one and a secondary suture in the other, and two axillary nerve injuries were included with a secondary suture for one and a transfer in the other. Muscle power of the target muscle was assessed using the Medical Research Council grading system from 1 to 5 at a minimum of 9 months follow up. Strength of deltoid abduction and elbow flexion where measured against weights. M3 and M4 were considered good results. Sensory recovery was not measured. We began to observe positive results at 18 months. At final follow up, 2 patients had contraction against 7 kg resistance, 2 against 5 kg, 4 against less than 5 kg, 2 were M3 and 5 were M2, thus 11 good results (69%). The two sural grafts done were of 10–18 cm length, one from spinal nerve to triceps with result M2 at 18 months and the other for the sciatic nerve with result of M3 at 26 months. In the literature a maximum delay for brachial plexus repair of 12 months post injury is usually considered. Our results show that motor function can be restored at more than 12 months delay and up to 24 months. Further investigations are needed to determine the cut-off point of delay after which nerve recovery after repair is unlikely. Our study showed that excellent results of contraction can be obtained even after nerve repair at 24 months preoperative delay. It should therefore be considered as a treatment option besides nerve transfer or tendon transfers.