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[PMID]:28739519
[Au] Autor:Jandial R; Hoshide R
[Ad] Endereço:City of Hope Cancer Treatment and Research Center, Los Angeles, California, USA.
[Ti] Título:Bionic-Brain: Controlling a Prosthetic Hand.
[So] Source:World Neurosurg;105:980-982, 2017 Sep.
[Is] ISSN:1878-8769
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Membros Artificiais
Biônica
Neuropatias do Plexo Braquial/reabilitação
Encéfalo/fisiologia
Mãos/fisiologia
[Mh] Termos MeSH secundário: Neuropatias do Plexo Braquial/fisiopatologia
Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171004
[Lr] Data última revisão:
171004
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170726
[St] Status:MEDLINE


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[PMID]:28609352
[Au] Autor:O'Grady KM; Power HA; Olson JL; Morhart MJ; Harrop AR; Watt MJ; Chan KM
[Ad] Endereço:Edmonton and Calgary, Alberta, Canada From the Department of Occupational Therapy, Glenrose Rehabilitation Hospital; the Division of Plastic Surgery, the Department of Pediatrics, Faculty of Medicine, and the Division of Physical Medicine and Rehabilitation, University of Alberta; and the Division of Plastic Surgery, University of Calgary.
[Ti] Título:Comparing the Efficacy of Triple Nerve Transfers with Nerve Graft Reconstruction in Upper Trunk Obstetric Brachial Plexus Injury.
[So] Source:Plast Reconstr Surg;140(4):747-756, 2017 Oct.
[Is] ISSN:1529-4242
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Upper trunk obstetric brachial plexus injury can cause profound shoulder and elbow dysfunction. Although neuroma excision with interpositional sural nerve grafting is the current gold standard, distal nerve transfers have a number of potential advantages. The goal of this study was to compare the clinical outcomes and health care costs between nerve grafting and distal nerve transfers in children with upper trunk obstetric brachial plexus injury. METHODS: In this prospective cohort study, children who underwent triple nerve transfers were followed with the Active Movement Scale for 2 years. Their outcomes were compared to those of children who underwent nerve graft reconstruction. To assess health care use, a cost analysis was also performed. RESULTS: Twelve patients who underwent nerve grafting were compared to 14 patients who underwent triple nerve transfers. Both groups had similar baseline characteristics and showed improved shoulder and elbow function following surgery. However, the nerve transfer group displayed significantly greater improvement in shoulder external rotation and forearm supination 2 years after surgery (p < 0.05). The operative time and length of hospital stay were significantly lower (p < 0.05), and the overall cost was approximately 50 percent less in the nerve transfer group. CONCLUSION: Triple nerve transfer for upper trunk obstetric brachial plexus injury is a feasible option, with better functional shoulder external rotation and forearm supination, faster recovery, and lower cost compared with traditional nerve graft reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.
[Mh] Termos MeSH primário: Traumatismos do Nascimento/cirurgia
Neuropatias do Plexo Braquial/cirurgia
Plexo Braquial/lesões
Transferência de Nervo/métodos
Procedimentos Cirúrgicos Reconstrutivos/métodos
Nervo Sural/transplante
Tronco/inervação
[Mh] Termos MeSH secundário: Plexo Braquial/cirurgia
Feminino
Seguimentos
Seres Humanos
Lactente
Masculino
Estudos Prospectivos
Recuperação de Função Fisiológica/fisiologia
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171012
[Lr] Data última revisão:
171012
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170614
[St] Status:MEDLINE
[do] DOI:10.1097/PRS.0000000000003668


  3 / 1805 MEDLINE  
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[PMID]:28602269
[Au] Autor:Corkum JP; Kuta V; Tang DT; Bezuhly M
[Ad] Endereço:Division of Plastic and Reconstructive Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.
[Ti] Título:Sensory outcomes following brachial plexus birth palsy: A systematic review.
[So] Source:J Plast Reconstr Aesthet Surg;70(8):987-995, 2017 Aug.
[Is] ISSN:1878-0539
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Brachial plexus birth palsy (BPBP) affects approximately 1.5 in 1000 live births and can lead to significant functional impairment and reduced quality of life. To date, studies have focused on grading motor function and strength to assess patient outcomes, with less attention paid to sensory recovery. The authors aimed to systematically review the current literature on sensory outcomes following BPBP. METHODS: A systematic review of the best evidence available assessing sensory outcomes following BPBP was conducted. Two independent reviewers used a predefined search strategy to query Cochrane, MEDLINE, EMBASE, and Web of Science databases. Articles written in English reporting sensory outcomes in patients with BPBP, such as tactile sensation, pain, and proprioception, were included for review. A kappa score was calculated to ensure reviewer agreement. RESULTS: Twenty-nine reports with 1647 cases were included. Tactile sensation was most frequently assessed (75.9%), followed by pain (44.8%) and proprioception (17.2%). Among all cases included in the analysis, 75.8% of articles were found to have patients with suboptimal results in sensory outcomes. The majority of articles (86.2%) were case series or case reports; no level 1 or 2 evidence studies were identified. CONCLUSION: Sensory outcomes are underreported following BPBP, and significant deficits and neuropathic pain are not uncommon and likely underappreciated in this patient population. The current report underscores the need for prospective studies that look beyond motor recovery alone and evaluate sensory outcomes following BPBP.
[Mh] Termos MeSH primário: Traumatismos do Nascimento/complicações
Neuropatias do Plexo Braquial/complicações
Dor/etiologia
Propriocepção
Distúrbios Somatossensoriais/etiologia
Tato
[Mh] Termos MeSH secundário: Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170906
[Lr] Data última revisão:
170906
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170613
[St] Status:MEDLINE


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[PMID]:28587056
[Au] Autor:Chen AM; Yoshizaki T; Velez MA; Mikaeilian AG; Hsu S; Cao M
[Ad] Endereço:Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California. Electronic address: achen5@kumc.edu.
[Ti] Título:Tolerance of the Brachial Plexus to High-Dose Reirradiation.
[So] Source:Int J Radiat Oncol Biol Phys;98(1):83-90, 2017 May 01.
[Is] ISSN:1879-355X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:PURPOSE: To study the tolerance of the brachial plexus to high doses of radiation exceeding historically accepted limits by analyzing human subjects treated with reirradiation for recurrent tumors of the head and neck. METHODS AND MATERIALS: Data from 43 patients who were confirmed to have received overlapping dose to the brachial plexus after review of radiation treatment plans from the initial and reirradiation courses were used to model the tolerance of this normal tissue structure. A standardized instrument for symptoms of neuropathy believed to be related to brachial plexus injury was utilized to screen for toxicity. Cumulative dose was calculated by fusing the initial dose distributions onto the reirradiation plan, thereby creating a composite plan via deformable image registration. The median elapsed time from the initial course of radiation therapy to reirradiation was 24 months (range, 3-144 months). RESULTS: The dominant complaints among patients with symptoms were ipsilateral pain (54%), numbness/tingling (31%), and motor weakness and/or difficulty with manual dexterity (15%). The cumulative maximum dose (Dmax) received by the brachial plexus ranged from 60.5 Gy to 150.1 Gy (median, 95.0 Gy). The cumulative mean (Dmean) dose ranged from 20.2 Gy to 111.5 Gy (median, 63.8 Gy). The 1-year freedom from brachial plexus-related neuropathy was 67% and 86% for subjects with a cumulative Dmax greater than and less than 95.0 Gy, respectively (P=.05). The 1-year complication-free rate was 66% and 87%, for those reirradiated within and after 2 years from the initial course, respectively (P=.06). CONCLUSION: The development of brachial plexus-related symptoms was less than expected owing to repair kinetics and to the relatively short survival of the subject population. Time-dose factors were demonstrated to be predictive of complications.
[Mh] Termos MeSH primário: Neuropatias do Plexo Braquial/etiologia
Plexo Braquial/efeitos da radiação
Neoplasias de Cabeça e Pescoço/radioterapia
Tolerância a Radiação
Reirradiação
[Mh] Termos MeSH secundário: Adulto
Idoso
Plexo Braquial/diagnóstico por imagem
Feminino
Neoplasias de Cabeça e Pescoço/diagnóstico por imagem
Seres Humanos
Hipestesia/etiologia
Masculino
Meia-Idade
Recidiva Local de Neoplasia/radioterapia
Dor/etiologia
Radiocirurgia
Dosagem Radioterapêutica
Radioterapia de Intensidade Modulada
Reirradiação/efeitos adversos
Estudos Retrospectivos
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170721
[Lr] Data última revisão:
170721
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170608
[St] Status:MEDLINE


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[PMID]:28574948
[Au] Autor:Maldonado AA; Bishop AT; Spinner RJ; Shin AY
[Ad] Endereço:Rochester, Minn.; and Frankfurt, Germany From the Department of Neurologic Surgery and the Department of Orthopedic Surgery, Division of Hand Surgery, Mayo Clinic; and the Department of Plastic, Hand and Reconstructive Surgery, BG Unfallklinik Frankfurt.
[Ti] Título:Five Operations That Give the Best Results after Brachial Plexus Injury.
[So] Source:Plast Reconstr Surg;140(3):545-556, 2017 Sep.
[Is] ISSN:1529-4242
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Treatment of brachial plexus injuries has improved slowly over the past 45 years. Changes in strategy, techniques, microsurgical equipment, and technology have expanded the surgical options for reconstructing these life-altering, highly complex injuries. The surgical techniques available include neurolysis, nerve repair, nerve grafting, nerve transfers, tendon transfer, muscle transfer, and other soft- and bony-tissue procedures. In this article, the authors have selected five surgical procedures (i.e., Oberlin procedure, Leechavengvongs procedure, free functional muscle transfer, radial nerve tendon transfers, and C5-C6 nerve grafting in obstetric birth palsy) that have consistently yielded good results in patients who require surgical reconstruction.
[Mh] Termos MeSH primário: Neuropatias do Plexo Braquial/cirurgia
Plexo Braquial/lesões
Plexo Braquial/cirurgia
Procedimentos Neurocirúrgicos/métodos
[Mh] Termos MeSH secundário: Seres Humanos
Músculo Esquelético/transplante
Transferência de Nervo/métodos
Procedimentos Cirúrgicos Reconstrutivos/métodos
Transferência Tendinosa/métodos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170918
[Lr] Data última revisão:
170918
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170603
[St] Status:MEDLINE
[do] DOI:10.1097/PRS.0000000000003620


  6 / 1805 MEDLINE  
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[PMID]:28555780
[Au] Autor:Geerdink Y; Aarts P; van der Holst M; Lindeboom R; Van Der Burg J; Steenbergen B; Geurts AC
[Ad] Endereço:Department of Pediatric Rehabilitation, Sint Maartenskliniek Nijmegen, Nijmegan, The Netherlands.
[Ti] Título:Development and psychometric properties of the Hand-Use-at-Home questionnaire to assess amount of affected hand-use in children with unilateral paresis.
[So] Source:Dev Med Child Neurol;59(9):919-925, 2017 Sep.
[Is] ISSN:1469-8749
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:AIM: To describe the development of the parent-rated Hand-Use-at-Home questionnaire (HUH) assessing the amount of spontaneous use of the affected hand in children with unilateral paresis, and to test its internal structure, unidimensionality, and validity. METHOD: Parents of children with unilateral cerebral palsy (CP) and professionals participated in the development of the HUH. To examine internal validity, data of 322 children (158 males, 164 females; mean age 6y 7mo, standard deviation [SD] 2y 1mo) with unilateral CP (n=131) or neonatal brachial plexus palsy (NBPP) (n=191) were collected. Rasch analysis was used to examine discriminative capacity of the 5-category rating scale as well as unidimensionality and hierarchy of the item set. Additionally, data of 55 children with typical development (24 males, 31 females; 6y 9mo, SD 2y 5mo) were used to examine construct validity. RESULTS: The 5-category rating scale was disordered in all items and was collapsed to obtain the best discriminating sum score. Ten misfitting or redundant items were removed. Eighteen hierarchically ordered bimanual items fitted the unidimensional model within acceptable range. The HUH significantly discriminated between the three groups (children with typical development, NBPP, unilateral CP; H =118.985, p<0.001), supporting its construct validity. INTERPRETATION: The HUH is a valid instrument to assess the amount of spontaneous use of the affected hand in children with unilateral upper-limb paresis.
[Mh] Termos MeSH primário: Atividades Cotidianas
Lateralidade Funcional
Mãos
Paresia/diagnóstico
Inquéritos e Questionários
[Mh] Termos MeSH secundário: Neuropatias do Plexo Braquial/diagnóstico
Neuropatias do Plexo Braquial/fisiopatologia
Paralisia Cerebral/diagnóstico
Paralisia Cerebral/fisiopatologia
Criança
Pré-Escolar
Feminino
Seres Humanos
Masculino
Pais
Paresia/fisiopatologia
Psicometria
[Pt] Tipo de publicação:JOURNAL ARTICLE; VALIDATION STUDIES
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170901
[Lr] Data última revisão:
170901
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170531
[St] Status:MEDLINE
[do] DOI:10.1111/dmcn.13449


  7 / 1805 MEDLINE  
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[PMID]:28245686
[Au] Autor:Wali AR; Park CC; Brown JM; Mandeville R
[Ad] Endereço:Departments of 1 Neurological Surgery and.
[Ti] Título:Analyzing cost-effectiveness of ulnar and median nerve transfers to regain forearm flexion.
[So] Source:Neurosurg Focus;42(3):E11, 2017 Mar.
[Is] ISSN:1092-0684
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE Peripheral nerve transfers to regain elbow flexion via the ulnar nerve (Oberlin nerve transfer) and median nerves are surgical options that benefit patients. Prior studies have assessed the comparative effectiveness of ulnar and median nerve transfers for upper trunk brachial plexus injury, yet no study has examined the cost-effectiveness of this surgery to improve quality-adjusted life years (QALYs). The authors present a cost-effectiveness model of the Oberlin nerve transfer and median nerve transfer to restore elbow flexion in the adult population with upper brachial plexus injury. METHODS Using a Markov model, the authors simulated ulnar and median nerve transfers and conservative measures in terms of neurological recovery and improvements in quality of life (QOL) for patients with upper brachial plexus injury. Transition probabilities were collected from previous studies that assessed the surgical efficacy of ulnar and median nerve transfers, complication rates associated with comparable surgical interventions, and the natural history of conservative measures. Incremental cost-effectiveness ratios (ICERs), defined as cost in dollars per QALY, were calculated. Incremental cost-effectiveness ratios less than $50,000/QALY were considered cost-effective. One-way and 2-way sensitivity analyses were used to assess parameter uncertainty. Probabilistic sampling was used to assess ranges of outcomes across 100,000 trials. RESULTS The authors' base-case model demonstrated that ulnar and median nerve transfers, with an estimated cost of $5066.19, improved effectiveness by 0.79 QALY over a lifetime compared with conservative management. Without modeling the indirect cost due to loss of income over lifetime associated with elbow function loss, surgical treatment had an ICER of $6453.41/QALY gained. Factoring in the loss of income as indirect cost, surgical treatment had an ICER of -$96,755.42/QALY gained, demonstrating an overall lifetime cost savings due to increased probability of returning to work. One-way sensitivity analysis demonstrated that the model was most sensitive to assumptions about cost of surgery, probability of good surgical outcome, and spontaneous recovery of neurological function with conservative treatment. Two-way sensitivity analysis demonstrated that surgical intervention was cost-effective with an ICER of $18,828.06/QALY even with the authors' most conservative parameters with surgical costs at $50,000 and probability of success of 50% when considering the potential income recovered through returning to work. Probabilistic sampling demonstrated that surgical intervention was cost-effective in 76% of cases at a willingness-to-pay threshold of $50,000/QALY gained. CONCLUSIONS The authors' model demonstrates that ulnar and median nerve transfers for upper brachial plexus injury improves QALY in a cost-effective manner.
[Mh] Termos MeSH primário: Neuropatias do Plexo Braquial/economia
Plexo Braquial/lesões
Análise Custo-Benefício/métodos
Nervo Mediano/transplante
Transferência de Nervo/economia
Nervo Ulnar/transplante
[Mh] Termos MeSH secundário: Adulto
Plexo Braquial/cirurgia
Neuropatias do Plexo Braquial/cirurgia
Tomada de Decisão Clínica/métodos
Feminino
Antebraço/inervação
Antebraço/cirurgia
Seres Humanos
Masculino
Transferência de Nervo/métodos
Amplitude de Movimento Articular
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1703
[Cu] Atualização por classe:171116
[Lr] Data última revisão:
171116
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170302
[St] Status:MEDLINE
[do] DOI:10.3171/2016.12.FOCUS16469


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[PMID]:28236051
[Au] Autor:Yu A; Wang S; Cheng X; Liang W; Bai R; Xue Y; Li W
[Ad] Endereço:Department of Radiology, Beijing Jishuitan Hospital, The 4th Medical College of Peking University, 31 Xinjiekou E Rd, Xicheng Qu, Beijing, 100035, China. imaging2008@sina.com.
[Ti] Título:Functional connectivity of motor cortical network in patients with brachial plexus avulsion injury after contralateral cervical nerve transfer: a resting-state fMRI study.
[So] Source:Neuroradiology;59(3):247-253, 2017 Mar.
[Is] ISSN:1432-1920
[Cp] País de publicação:Germany
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: The purpose of this study is to assess the functional connectivity of the motor cortical network in patients with brachial plexus avulsion injury (BPAI) after contralateral C7 nerve transfer, using resting-state functional magnetic resonance imaging (RS-fMRI). METHODS: Twelve patients with total brachial plexus root avulsion underwent RS-fMRI after contralateral C7 nerve transfer. Seventeen healthy volunteers were also included in this fMRI study as controls. The hand motor seed regions were defined as region of interests in the bilateral hemispheres. The seed-based functional connectivity was calculated in all the subjects. Differences in functional connectivity of the motor cortical network between patients and healthy controls were compared. RESULTS: The inter-hemispheric functional connectivity of the M1 areas was increased in patients with BPAI compared with the controls. The inter-hemispheric functional connectivity between the supplementary motor areas was reduced bilaterally. CONCLUSIONS: The resting-state inter-hemispheric functional connectivity of the bilateral M1 areas is altered in patients after contralateral C7 nerve transfer, suggesting a functional reorganization of cerebral cortex.
[Mh] Termos MeSH primário: Neuropatias do Plexo Braquial/cirurgia
Mapeamento Encefálico/métodos
Córtex Motor/diagnóstico por imagem
Córtex Motor/fisiopatologia
Transferência de Nervo/métodos
Vias Neurais/diagnóstico por imagem
Vias Neurais/fisiopatologia
Nervos Espinhais/transplante
[Mh] Termos MeSH secundário: Adolescente
Adulto
Estudos de Casos e Controles
Vértebras Cervicais
Feminino
Seres Humanos
Masculino
Meia-Idade
Plasticidade Neuronal
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171023
[Lr] Data última revisão:
171023
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170226
[St] Status:MEDLINE
[do] DOI:10.1007/s00234-017-1796-0


  9 / 1805 MEDLINE  
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[PMID]:28161491
[Au] Autor:Herisson O; Maurel N; Diop A; Le Chatelier M; Cambon-Binder A; Fitoussi F
[Ad] Endereço:Hôpital Trousseau, Service de chirurgie orthopédique pédiatrique, 26 Avenue du Dr Arnold Netter, 75012 Paris, France. Electronic address: olivierherisson@hotmail.com.
[Ti] Título:Shoulder and elbow kinematics during the Mallet score in obstetrical brachial plexus palsy.
[So] Source:Clin Biomech (Bristol, Avon);43:1-7, 2017 Mar.
[Is] ISSN:1879-1271
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The physical signs of obstetrical brachial plexus palsy range from temporary upper-limb dysfunction to a lifelong impairment and deformity in one arm. The aim of this study was to analyze the kinematics of the upper limb and to evaluate the contribution of glenohumeral and scapulothoracic joints of obstetrical brachial plexus palsy children. METHODS: Six children participated in this study: 2 males and 4 females with a mean age of 11.7years. Three patients had a C5, C6 lesion and 3 had a C5, C6, C7 lesion. They were asked to perform five tasks based on the Mallet scale and the kinematic data were collected using the Fastrak electromagnetic tracking device. FINDINGS: The scapulothoracic protraction and posterior tilt were significantly increased in the involved limb during the hand to mouth task (p=0.006 and p=0.015 respectively). The scapulothoracic Protraction/glenohumeral Elevation ratio was significantly increased in the involved limb during the hand to neck task (p=0.041) and the elevation task (p=0.015). The ratios of scapulothoracic Tilt on the three glenohumeral excursion angles were significantly increased during the hand to mouth task (p≤0.041). The scapulothoracic Mediolateral/glenohumeral Elevation ratio was significantly increased in the involved limb during the elevation task (p=0.038). The glenohumeral elevation excursion was significantly decreased in the involved limb during the hand to neck task (p<0.001) and the elevation task (p=0.0003). INTERPRETATION: This study gives us information about the greater contribution of the scapulothoracic joint to shoulder motion for affected arm of obstetrical brachial plexus palsy patients compared to their unaffected arm. Kinematic analysis could be useful in shoulder motion evaluation during the Mallet score and to evaluate outcomes after surgery.
[Mh] Termos MeSH primário: Neuropatias do Plexo Braquial/fisiopatologia
Articulação do Cotovelo/fisiopatologia
Paralisia Obstétrica/fisiopatologia
Articulação do Ombro/fisiopatologia
[Mh] Termos MeSH secundário: Fenômenos Biomecânicos
Neuropatias do Plexo Braquial/diagnóstico
Criança
Feminino
Seres Humanos
Masculino
Paralisia Obstétrica/diagnóstico
Análise e Desempenho de Tarefas
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170906
[Lr] Data última revisão:
170906
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170206
[St] Status:MEDLINE


  10 / 1805 MEDLINE  
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[PMID]:28148670
[Au] Autor:Macke C; Winkelmann M; Mommsen P; Probst C; Zelle B; Krettek C; Zeckey C
[Ad] Endereço:Trauma Department, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
[Ti] Título:Injuries to the upper extremities in polytrauma: limited effect on outcome more than ten years after injury - a cohort study in 629 patients.
[So] Source:Bone Joint J;99-B(2):255-260, 2017 Feb.
[Is] ISSN:2049-4408
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:AIMS: To analyse the influence of upper extremity trauma on the long-term outcome of polytraumatised patients. PATIENTS AND METHODS: A total of 629 multiply injured patients were included in a follow-up study at least ten years after injury (mean age 26.5 years, standard deviation 12.4). The extent of the patients' injury was classified using the Injury Severity Score. Outcome was measured using the Hannover Score for Polytrauma Outcome (HASPOC), Short Form (SF)-12, rehabilitation duration, and employment status. Outcomes for patients with and without a fracture of the upper extremity were compared and analysed with regard to specific fracture regions and any additional brachial plexus lesion. RESULTS: In all, 307 multiply-injured patients with and 322 without upper extremity injuries were included in the study. The groups with and without upper limb injuries were similar with respect to demographic data and injury pattern, except for midface trauma. There were no significant differences in the long-term outcome. In patients with brachial plexus lesions there were significantly more who were unemployed, required greater retraining and a worse HASPOC. CONCLUSION: Injuries to the upper extremities seem to have limited effect on long-term outcome in patients with polytrauma, as long as no injury was caused to the brachial plexus. Cite this article: Bone Joint J 2017;99-B:255-60.
[Mh] Termos MeSH primário: Traumatismos do Braço/reabilitação
Neuropatias do Plexo Braquial/reabilitação
Plexo Braquial/lesões
Fraturas Ósseas/reabilitação
Traumatismo Múltiplo/reabilitação
Lesões do Ombro/reabilitação
Extremidade Superior/lesões
[Mh] Termos MeSH secundário: Adolescente
Adulto
Neuropatias do Plexo Braquial/etiologia
Criança
Pré-Escolar
Estudos de Coortes
Feminino
Seguimentos
Seres Humanos
Escala de Gravidade do Ferimento
Masculino
Meia-Idade
Traumatismo Múltiplo/terapia
Condições Sociais
Fatores de Tempo
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1702
[Cu] Atualização por classe:170214
[Lr] Data última revisão:
170214
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170203
[St] Status:MEDLINE
[do] DOI:10.1302/0301-620X.99B2.37999



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