Travmatik Periferik Sinir Lezyonlarýnda Etyoloji

AMAÇ: Periferik sinirlerin akut yaralanmalarýnda, periferdeki lezyonun derecesi hakkýnda yaralanmalarýn oluþ þekli çok faydalý bilgiler verebilir. Bu çalýþmada, travmatik periferik sinir lezyonlarýnýn lokalizasyonlarý ve etyolojileri araþtýrýlmýþtýr. Ocak 1997-Temmuz 1999 tarihleri arasýnda ENMG tetkiki yapýlan 105 hasta retrospektif olarak deðerlendirilmiþtir. Hastalar tekrar çaðýrýlýp nörolojik muayeneleri yapýlarak, klinik düzelmeleri gözlenmiþtir. Hastalarýn 77’si (%73) erkek, 28’i (%27) kadýn olup, ortalama yaþý 33'tür (1-90). 105 hastada 118 sinir lezyonu saptanmýþtýr. 96 (%91.4) hastada tek sinir veya pleksus lezyonu, 9 (%8.6) hastada birden fazla sinir lezyonu görülmüþtür. Hastalarda 27 (%23) siyatik, 21 (%17.8) radial, 17 (%14.4) median, 16 (%13.5) ulnar, 10 (%8.5) peroneal, 10 (%8.5) fasiyal, 4 (%3.4) tibial, 2 (%1.7) abduscens, 1 (%0.8) femoral, 1 (%0.8) sural sinir, 8 (%6.8) brakial ve 1 (%0.8) lumbosakral pleksus lezyonu tespit edilmiþtir. En sýk (%24.8) trafik kazalarýna baðlý periferik sinir yaralanmalarý dikkat çekmekte, bunu %21.9 ile iyatrojenik lezyonlar takip etmektedir. Hastalarýn 26’sýnda (%24.8) trafik kazalarý, 23’ünde (%21.9) iyatrojenik nedenler, 16’sýnda (%15.3) kesici alet ve cisim yaralanmalarý, 16’sýnda (%15.3) kýrýklar ve açýk yaralar, 10’unda (%9.5) ateþli silah yaralanmalarý, 7’sinde (%6.6) künt kapalý travmalar, 3’ünde (%2.9) iþ kazalarý, 2’sinde (%1.9) idyopatik basý, 1’inde (%0.9) elektrik çarpmasý ve 1’inde (%0.9) koltuk deðneði basýsý saptanmýþtýr. Sadece 5 (%4.8) olguya cerrahi giriþim yapýlmýþtýr. Cerrahi giriþim uygulanmayan 100 (%95) olgunun tümünde sekel kaldýðý gözlenmiþtir. Hastalarýn sinir cerrahisine yönlendirilmediði dikkat çekmiþtir.
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Etiology Of Traumatic Peripheral Nerve Lesions

OBJECTIVE: After the acute injuries of peripheral nerves, mechanism of the injury can give important knowledge about the degree of the nerve lesions. In this study, etiology and localizations of traumatic peripheral nerve injuries was investigated. 105 patients detected in ENMG laboratory between January 1997-July 1999 were evaluated retrospectively. All the patients were invited again, checked neurologically and clinical outcome was observed. 77 (73%) of the patients were males and 28 (27%) were females. The mean age was 33 (1-90). 118 nerve lesions were seen at 105 patients. There were single nerve or plexus lesions at 96 (91.4%) patients while multiple lesions at 9 (8.6%). There were 27 (23%) sciatic, 21 (17.8%) radial, 17 (14.4%) median, 16 (13.5%) ulnar, 10 (8.5%) peroneal, 10 (8.5%) fasiyal, 4 (3.4%) tibial, 2 (1.7%) abduscens, 1 (0.8%) femoral, 1 (0.8%) sural nerve, 8 (6.8%) brachial and 1 (0.8%) lumbosacral plexus lesions. Peripheral nerve lesions due to traffic accidents (24.8%) were the most common injuries and followed by iatrogenic lesions (21.9%). In 26 (24.8%) patients traffic accidents, in 23 (21.9%) iatrogenic causes, in 16 (15.3%) penetrating traumas, in 16 (15.3%) fractures and open wounds, in 10 (9.5%) gunshot injuries, in 7 (6.6%) closed blunt traumas, in 3 (2.9%) occupational accidents, in 2 (1.9%) idiopathic pressure, in 1 (0.9%) electricity accident and in 1 (0.9%) pressure with crutches were the cause of nerve lesion. Only 5 (4.8%) patients were treated surgically. Sequels were seen in all the 100 (95%) patients who had not surgical procedures. It was pointed out that the patients were not been directed to nerve surgery.
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