Pleksopatilerde Cerrahi Tedavi
Özet
Brakial ve lumbosakral pleksopatilerde cerrahi tedavi yöntemlerini ele alan bu çalışmada, obstetrik ve travmatik yaralanmalar başta olmak üzere farklı etiyolojilere yönelik yaklaşımlar incelenmektedir. Obstetrik brakial pleksopatilerde dirsek fleksiyonunun (M. Biceps Brachii fonksiyonu) 3. ayda düzelmemesi önemli bir cerrahi endikasyon olup, postganglionik yaralanmalarda nöroliz, nöroma eksizyonu ve sural sinir gibi greftlerle tamir uygulanır. Tamirin yetersiz kaldığı veya kök avulsiyonlarının varlığında intrapleksal ya da ekstrapleksal sinir transferlerine, kas-iskelet deformitelerini önlemek için ise tendon ve kas transferlerine başvurulur. Kapalı travmatik yaralanmalarda nörolojik düzelme olmaması, nörojenik ağrı veya vasküler kompresyon varlığında 3. ayda cerrahi düşünülürken, açık ve ezilme tarzı yaralanmalarda erken cerrahi veya sekonder greftleme tercih edilir; kök avulsiyonlarında sinir re-implantasyonu bir alternatiftir. Radyasyona bağlı pleksopatilerde eksternal nöroliz ve omentum ile sarma uygulanırken, Torasik Outlet Sendromu'nda konservatif tedaviye yanıt vermeyen gerçek nörojenik vakalarda servikal/birinci kosta rezeksiyonu ve skalenektomi yapılır. Lumbosakral pleksopatiler ise derin yerleşimleri nedeniyle travmalardan daha az etkilenir, çoğunlukla tümör kaynaklıdır ve tedavileri primer tümör tedavisine yöneliktir.
This study, which discusses surgical treatment methods in brachial and lumbosakral plexopathies, examines approaches for different etiologies, particularly obstetric and traumatic injuries. In obstetric brachial plexopathies, the absence of elbow flexion (M. Biceps Brachii function) at the 3rd month is an important surgical indication, and neurolysis, neuroma excision, and repair with grafts such as the sural nerve are performed in postganglionic injuries. When repair is insufficient or in the presence of root avulsions, intraplexal or extraplexal nerve transfers are utilized, and tendon or muscle transfers are performed to prevent musculoskeletal deformities. In closed traumatic injuries, surgery is considered at the 3rd month in case of lack of neurological improvement, neurogenic pain, or vascular compression, whereas early surgery or secondary grafting is preferred in open and crush-type injuries; nerve re-implantation is an alternative for root avulsions. External neurolysis and omentum wrapping are performed in radiation-induced plexopathies, and cervical/first rib resection and scalenectomy are performed in true neurogenic Thoracic Outlet Syndrome cases that do not respond to conservative treatment. Lumbosacral plexopathies are less affected by trauma due to their deep localization, are mostly tumor-induced, and their treatment is directed towards the primary tumor treatment.
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