RESUMEN
BACKGROUND: Conventionally, neural transfer of the spinal accessory nerve to the suprascapular nerve for shoulder abduction in traumatic brachial plexus injury is performed via the anterior approach. However, important advantages of the posterior approach have made it an alternative option, such as the proximity of neural coaptation to the muscle to be reinnervated and negating the effects of a second injury to the suprascapular nerve. METHODS: Retrospective data was collected from 30 patients with brachial plexus injury who underwent spinal accessory nerve to suprascapular nerve transfer over 4 years. There were 15 patients in the anterior-approach group (group A) and 15 in the posterior-approach group (group B). Functional outcome at the shoulder was measured as muscle power and active range of motion at 18 months, and data on patients' satisfaction levels and surgeons' perceptions was also collected. RESULTS: No statistical difference was found in the muscle strength achieved in the 2 groups (P = 0.34), but significant recovery was found in the external rotation achieved by group B (P = 0.02). Statistical difference was insignificant in the 2 groups' active range of motion during abduction and external rotation. The satisfaction index of patients was 86.7% in group B as compared to 68% in group A. Surgeons' perspective showed a faster speed of suprascapular nerve exploration in the posterior approach, with better visibility of supraspinatus muscle contraction, and overall surgeons preferred the posterior approach. CONCLUSIONS: External rotation at the shoulder is better via the posterior approach, but no difference in abduction was noted. Patients who underwent the posterior approach were more satisfied with the recovery, and surgeons preferred the posterior approach.
Asunto(s)
Nervio Accesorio , Plexo Braquial , Transferencia de Nervios , Rango del Movimiento Articular , Recuperación de la Función , Humanos , Masculino , Transferencia de Nervios/métodos , Femenino , Adulto , Estudios Retrospectivos , Nervio Accesorio/cirugía , Plexo Braquial/lesiones , Plexo Braquial/cirugía , Resultado del Tratamiento , Persona de Mediana Edad , Adulto Joven , Hombro/inervación , Hombro/cirugía , Satisfacción del Paciente , Neuropatías del Plexo Braquial/cirugía , Articulación del Hombro/cirugía , Cirujanos/psicología , Fuerza Muscular/fisiologíaRESUMEN
Providencia, unlike other enterobacteriaceae, is a lesser known causative agent of hospital-acquired and community-acquired neuroinfection. Two cases of meningitis and one patient with subdural empyema, where Providencia rettgeri was the causative agent, are reported. To the authors' knowledge, this is the first report of hospital-acquired and community-acquired meningitis or empyema caused by P rettgeri.