Resultados del tratamiento del nervio radial e influencia de factores pronósticos

Resumen

Objetivo Analizar la respuesta de las lesiones del nervio radial y de sus ramas al tratamiento y la influencia de factores asociados dependientes del tipo de daño y de paciente.

Material y Método Sesenta y seis pacientes con lesiones del nervio radial o de sus ramas terminales fueron sometidos a tratamiento conservador, reconstrucción nerviosa, exoneurólis, recolocación nerviosa, cobertura con colgajo graso o transferencia tenomuscular. Hubo 39 hombres y 27 mujeres con una edad media de 45 años. Valoramos la situación motora antes y después del tratamiento con la escala del Louisiana State University Health Sciences Centre (G0 a G5). En las lesiones de la rama superficial del nervio radial fueron recogidas las alteraciones sensitivas y el dolor. La edad, el momento de la cirugía, el tipo de lesión, su nivel y tratamiento, el tiempo de seguimiento y el momento aproximado de la recuperación nerviosa, fueron analizados y relacionados con los resultados.

Resultados Hubo 37 lesiones del nervio radial entre la axila y el codo, 12 del nervio interóseo posterior y 17 de la rama sensitiva superficial. En 10 pacientes observamos recuperación espontánea. En el 82,3% de los casos de reconstrucción del nervio radial el resultado fue bueno o excelente, siendo desfavorable en el 17,7%. Todos los pacientes con reconstrucción del nervio interóseo posterior tuvieron resultado excelente. Las lesiones nerviosas en continuidad tuvieron un 20% más de resultados G4 y G5 que las neurotmesis. Entre los pacientes con lesión de la rama sensitiva superficial, seis quedaron asintomáticos y 11 sintomáticos después del tratamiento. Los pacientes de mayor edad, los grandes defectos nerviosos injertados en las zonas más proximas de la extremidad superior, o con mayor tiempo transcurrido entre la lesión y la reparación evolucionaron peor.

Conclusión El nervio radial es un nervio agradecido al tratamiento.

Abstract

Background The purpose of this study was to present the response of radial nerve lesions and their branches to treatment, observing the influence of associated factors depending to the damage and the patient.

Methods Sixty-six patients with injuries of the radial nerve or its terminal branches had conservative treatment, nerve reconstruction, exoneurolysis, nerve relocation, fat flap or tendon transfer. Thirty-nine were men and 27 women, with a mean age of 45 years. Motor status of the patients was estimated before and after treatment using the Louisiana State University Health Sciences Center scale (G0 to G5). Sensory disturbances or residual pain were recorded for superficial sensory radial nerve injuries. Patient age, timing of surgery, type of lesion and treatment, level of injury, follow-up, and the approximative time of onset of motor recovery were estimated and related to the results.

Results There were 37 injuries of the radial nerve between the axilla and elbow, 12 injuries of the posterior interosseous nerve and 17 injuries of the radial sensory nerve. Spontaneous recovery was observed in ten patients. There were 82.3% favorable and 17.7% poor outcomes after radial nerve reconstruction. All patients with posterior interosseus nerve reconstruction had good or excellent outcomes. Patients with in-continuity injuries had 20% more G4 and G5 outcomes than those with neurotmesis. In superficial sensory radial nerve injuries, six patients were asymptomatic and 11 symptomatic after treatment. Older patients, large nerve defects treated with grafts in the proximal areas of the upper limb, or longer time between the injury and repair, evolved worse.

Conclusion The radial nerve is grateful to treatment.

Palabras Clave

lesiones nervio radial - tratamiento - pronóstico

Keywords

radial nerve injuries - treatment - prognostic

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