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Iatrogene Nervenverletzungen

Teil 1: Häufigkeitsverteilung, neue Aspekte und Zeitraster der mikrochirurgischen Versorgung

Iatrogenic nerve injuries

Part 1: Frequency distribution, new aspects, and timing of microsurgical treatment

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Zusammenfassung

Einleitung

Ziel war es, die Anzahl und Art iatrogener Verletzungen an einem vergleichsweise aktiven Zentrum für periphere Nervenoperationen während eines Zeitraumes von 13 Jahren zu analysieren.

Methode

Retrospektive Analyse von 191 aufgrund iatrogener Nervenverletzungen operierter Fälle.

Ergebnisse

Die meisten iatrogenen Nervenverletzungen traten infolge einer Operation auf. Die Symptome und Anzeichen einer solchen Verletzung waren regelhaft unmittelbar nach dem Eingriff vorhanden. Die am häufigsten betroffenen Einzelnerven waren der spinale N. accessorius am Nacken (n=27), am häufigsten nach Lymphknotenbiopsie, der N. medianus im Karpaltunnel (n=25), meist nach Karpaltunneloperation und hierbei meist infolge der endoskopischen Variante. Die in der Häufigkeit folgenden Nerven sind der N. peronaeus communis (16 Fälle), der R. superficialis des N. radialis (13 Fälle), der N. genitofemoralis (12 Fälle) und die Nn. peronaeus superficialis und tibialis (je 9 Fälle). Eine klinische Besserung der Symptome nach neurochirurgischer Intervention tritt in 70% der Fälle auf. Häufig werden iatrogene Nervenverletzungen verspätet, d. h, nicht im optimalen Zeitintervall, einer Operation zugeführt.

Schlussfolgerungen

Iatrogene Nervenverletzungen müssen rechtzeitig erkannt und genauso früh wie andere traumatische Verletzungen operiert werden, um beste Chancen auf Reinnervation zu gewährleisten.

Abstract

Objective

The aim of this study was to analyze the number and types of iatrogenic nerve injuries operated on during a 13-year period at a relatively busy nerve center.

Method

Retrospective analysis was done of 191 cases surgically treated because of iatrogenic nerve injuries.

Results

Most iatrogenic nerve injuries occurred after surgical procedures. As a rule, symptoms and signs appeared immediately after the procedure. Single nerves most often involved were the spinal accessory nerve at the neck (n=27), most frequently after lymph node biopsy, and the median nerve in the carpal tunnel (n=25), usually after carpal tunnel release and most frequently after endoscopic technique. Following in frequency are the common peroneal nerve (n=16), superficial sensory radial nerve (n=13), genitofemoral (n=12), and superficial peroneal and tibial nerves (n=9 each). Clinical improvement after neurosurgical intervention appeared in 70% of cases. Frequently iatrogenic nerve lesions are referred with significant delay, that is, not during a time interval deemed appropriate for surgical intervention.

Conclusion

Iatrogenic nerve lesions must be recognized in a timely manner and should be operated upon as early as other traumatic nerve injuries to ensure best chances for successful recovery.

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Literatur

  1. Birch R, Bonney G, Dowell J, Hollingdale J (1991) Iatrogenic injuries of peripheral nerves. J Bone Joint Surg Br 73:280–282

    CAS  PubMed  Google Scholar 

  2. Birke A, Reichel H, Hein W et al. (2000) ROBODOC--a path into the future of hip endoprosthetics or an investment error?. Z Orthop Ihre Grenzgeb 138:395–401

    Article  CAS  PubMed  Google Scholar 

  3. Donner TR, Kline DG (1993) Extracranial spinal accessory nerve injury. Neurosurgery 32:907–910; discussion 911

    CAS  PubMed  Google Scholar 

  4. Dubuisson A, Kline DG (1992) Indications for peripheral nerve and brachial plexus surgery. Neurol Clin 10:935–951

    CAS  PubMed  Google Scholar 

  5. Khan R, Birch R (2001) Latropathic injuries of peripheral nerves. J Bone Joint Surg Br 83:1145–1148

    Article  CAS  PubMed  Google Scholar 

  6. Kierner AC, Zelenka I, Heller S, Burian M (2000) Surgical anatomy of the spinal accessory nerve and the trapezius branches of the cervical plexus. Arch Surg 135:1428–1431

    Article  CAS  PubMed  Google Scholar 

  7. Kline DG (1977) Physiological and clinical factors contributing to the timing of nerve repair. Clin Neurosurg 24:425–455

    CAS  PubMed  Google Scholar 

  8. Kline DG (1990) Surgical repair of peripheral nerve injury. Muscle Nerve 13:843–852

    CAS  PubMed  Google Scholar 

  9. Kline DG, Hudson AR (1990) Acute injuries of peripheral nerves. In: Youmans J (ed) Neurological surgery, III. Saunders, Philadelphia, pp 2423–2510

  10. Kline DG, Hudson AR (1995) Nerve injuries: operative results for major nerve injuries, entrapments, and tumors. W.B. Saunders, Philadelphia

    Google Scholar 

  11. Kretschmer T, Antoniadis G, Braun V et al. (2001) Evaluation of iatrogenic lesions in 722 surgically treated cases of peripheral nerve trauma. J Neurosurg 94:905–912

    CAS  PubMed  Google Scholar 

  12. Muller-Vahl H (1984) Iatrogenic lesions of peripheral nerves in surgery. Langenbecks Arch Chir 364:321–323

    CAS  PubMed  Google Scholar 

  13. Piza-Katzer H, Balogh B, Herczeg E, Vass A (1995) Iatrogenic nerve injury and microsurgical treatment. Chirurg 66:1146–1153

    CAS  PubMed  Google Scholar 

  14. Schmalzried TP, Amstutz HC, Dorey FJ (1991) Nerve palsy associated with total hip replacement. Risk factors and prognosis. J Bone Joint Surg Am 73:1074–1080

    CAS  PubMed  Google Scholar 

  15. Schumm F, Stohr M, Bauer HL, Eck T (1975) Peripheral nerve injury due to total replacement of the hip-joint (author’s transl). Z Orthop Ihre Grenzgeb 113:1065–1069

    CAS  PubMed  Google Scholar 

  16. Stöhr M (1996) Iatrogene Nervenläsionen. Injektion, Operation, Lagerung, Strahlentherapie, 2. Aufl. Thieme, Stuttgart

  17. Tiel RL, Happel LT, Kline DG (1996) Nerve action potential recording method and equipment. Neurosurgery 39:103–108; discussion 108–109

    CAS  PubMed  Google Scholar 

  18. Wilbourn AJ (1998) Iatrogenic nerve injuries. Neurol Clin 16:55–82

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Neurochirurgische Klinik der Universität Ulm am BKH Günzburg, Günzburg

    T. Kretschmer, G. Antoniadis, W. Börm & H.-P. Richter

  2. Neurochirurgische Klinik der Universität Ulm am BKH Günzburg, Ludwig-Heilmeyer-Straße 2, 89312 , Günzburg

    T. Kretschmer

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  1. T. Kretschmer
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  2. G. Antoniadis
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  3. W. Börm
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  4. H.-P. Richter
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Correspondence to T. Kretschmer.

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Kretschmer, T., Antoniadis, G., Börm, W. et al. Iatrogene Nervenverletzungen. Chirurg 75, 1104–1112 (2004). https://doi.org/10.1007/s00104-004-0879-8

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  • DOI: https://doi.org/10.1007/s00104-004-0879-8

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