Nerventransfers bei peripheren Nervenläsionen

Zusammenfassung

Hintergrund Schädigungen der Stammnerven der oberen Extremität führen häufig zu anhaltenden, schwerwiegenden Einschränkungen in der Funktion (Motorik) und Wahrnehmung (Sensibilität). Sowohl privat als auch beruflich können erhebliche Einschränkungen auf physischer, psychischer als auch sozioökonomischer Ebene persistieren. Indikationsstellung. Die frühe Indikationsstellung zu einem Nerventransfer kann die Reinnervationsstrecke verkürzen und die Einleitung motorischer oder sensorischer Axone in das Zielorgan optimieren und somit langfristig zur Verbesserung der Motorik und Sensibilität, sowie Vermeidung von Fehlstellungen beitragen. Hierbei sind in der Planung des Operationszeitpunkts, die bereits vergangene Zeit nach dem Trauma, die zu erwartende Reinnervationszeit und die Hebemorbiditäten der Spendernerven individuell abzuwägen.

Ergebnisse Nerventransfers können nach peripheren Nervenverletzungen eine frühere und sicherere Reinnervation erreichen und zur Verbesserung der motorischen und sensiblen Funktionen an der oberen Extremität nach Nervenverletzungen eingesetzt werden.

Abstract

Background Lesions of peripheral nerves of the upper extremities often lead to persistent, serious limitations in motor function and sensory perception. Affected patients suffer from both private and professional restrictions associated with long-term physical, psychological and socioeconomic consequences. Indication. An early indication for a nerve transfer shortens the reinnervation distance and improves the growing of motor and sensory axons into the target organ to facilitate early mobility and sensitivity. When planning the timepoint of the surgical procedure, the distance to be covered by reinnervation as well as the morbidities of donor nerves must be considered individually.

Results Nerve transfers can achieve earlier and safer reinnervation to improve motor and sensory functions after nerve injuries in the upper extremity.

Schlüsselwörter

periphere Nervenläsionen - Nerventransfer - Reinnervation

Key words

peripheral nerve lesions - nerve transfer - reinnervation

• Literatur

• 1 Bergmeister KD, Große-Hartlage L, Daeschler SC. et al. Acute and long-term costs of 268 peripheral nerve injuries in the upper extremity. PLoS ONE 2020; 15: e0229530
• 2 Aman M, Zimmermann KS, Thielen M. et al. An Epidemiological and Etiological Analysis of 5026 Peripheral Nerve Lesions from a European Level I Trauma Center. JPM 2022; 12: 1673
• 3 Czarnecki P, Górecki M, Romanowski L. Factors affecting the final outcomes after reconstruction of the median and ulnar nerve at the level of the forearm: Analysis of 41 patients. Injury 2020; 51: 2910-2915
• 4 Terenghi G, Calder JS, Birch R. et al. A Morphological Study of Schwann Cells and Axonal Regeneration in Chronically Transected Human Peripheral Nerves. Journal of Hand Surgery 1998; 23: 583-587
• 5 Windebank AJ, Mcdonald ES. Neurotrophic Factors in the Peripheral Nervous System. In: Peripheral Neuropathy. Elsevier; 2005: 377-386
• 6 Moldovan M. Comparison of the fastest regenerating motor and sensory myelinated axons in the same peripheral nerve. Brain 2006; 129: 2471-2483
• 7 Fox IK, Davidge KM, Novak CB. et al. Nerve Transfers to Restore Upper Extremity Function in Cervical Spinal Cord Injury: Update and Preliminary Outcomes. Plast Reconstr Surg 2015; 136: 780-792
• 8 Jarvie G, Hupin-Debeurme M, Glaris Z. et al. Supercharge End-to-Side Anterior Interosseous Nerve to Ulnar Motor Nerve Transfer for Severe Ulnar Neuropathy: Two Cases Suggesting Recovery Secondary to Nerve Transfer. J Orthop Case Rep 2018; 8: 25-28
• 9 Aman M, Böcker A, Kneser U. et al. Selektive Nerventransfers zur Reinnervation des motorischen Thenarastes. Oper Orthop Traumatol 2021; 33: 384-391
• 10 Bertelli JA, Ghizoni MF. Very distal sensory nerve transfers in high median nerve lesions. J Hand Surg Am 2011; 36: 387-393
• 11 Aman M, Schwarz D, Stolle A. et al. Modern MRI Diagnostics of Upper-Extremity-Related Nerve Injuries – A Prospective Multi-Center Study Protocol for Diagnostics and Follow Up of Peripheral Nerve Injuries. JPM 2022; 12: 1548
• 12 Dellon AL, Curtis RM, Edgerton MT. Reeducation of sensation in the hand after nerve injury and repair. Plast Reconstr Surg 1974; 53: 297-305
• 13 Novak CB, von der Heyde RL. Rehabilitation of the upper extremity following nerve and tendon reconstruction: when and how. Semin Plast Surg 2015; 29: 73-80
• 14 Bertelli JA. Prior to Repair Functional Deficits in Above- and Below-Elbow Ulnar Nerve Injury. The Journal of Hand Surgery 2020; 45 (552) -552 e1-e10
• 15 Arami A, Bertelli JA. Effectiveness of Distal Nerve Transfers for Claw Correction With Proximal Ulnar Nerve Lesions. The Journal of Hand Surgery 2021; 46: 478-484
• 16 Bazarek S, Sten M, Nin D. et al. Supinator to Posterior Interosseous Nerve Transfer for Restoration of Finger Extension. Oper Neurosurg (Hagerstown) 2021; 21: E408-E413
• 17 Aman M, Zimmermann KS, Pennekamp A. et al. Mechanisms, interventions at risk and clinical presentation of iatrogenic nerve lesions in trauma patients. Arch Orthop Trauma Surg 2023; 143: 7245-7253
• 18 Aman M, Zimmermann KS, Boecker AH. et al. Peripheral nerve injuries in children – prevalence, mechanisms and concomitant injuries: a major trauma center’s experience. Eur J Med Res 2023; 28: 116