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Nerve reconstruction preganglionic brachial plexus injury

dc.contributor.advisorRasulić, Lukas
dc.contributor.otherRakić, Miodrag
dc.contributor.otherRadulović, Danilo
dc.contributor.otherVuleković, Petar
dc.creatorSimić, Vesna D.
dc.date.accessioned2021-06-11T09:34:20Z
dc.date.available2021-06-11T09:34:20Z
dc.date.issued2021-02-25
dc.identifier.urihttp://eteze.bg.ac.rs/application/showtheses?thesesId=8176
dc.identifier.urihttps://fedorabg.bg.ac.rs/fedora/get/o:23836/bdef:Content/download
dc.identifier.urihttp://vbs.rs/scripts/cobiss?command=DISPLAY&base=70036&RID=40320521
dc.identifier.urihttps://nardus.mpn.gov.rs/handle/123456789/18354
dc.description.abstractdisertaciji je obuhvaćena istorijat operavnog lečenja perifernih nerava odnosno brahijalnog pleksusa u svetu, a tako i u našoj zemlji. Prema podacima iz literature, mehanički pristup rekonstrukciji brahijalnog pleksusa započet je polovinom XIX veka i traje do 1863. kada je publikovana prva epineurijalna sutura( Nelaton). Ekspanzija i evolucija rekonstruktivne hirurgije brahijalnog pleksusa vezuje se za početak XX veka, procvat doživljava uvođenjem mikrohirurške tehnike i operativnog mikroskopa 1964. godine( Smith i Kurze). Prvu suturu nervnih struktura kod povreda brahijalnog pleksusa obavio je Baudens(1836). Rezultati postignuti u rekonstruktivnoj hirurgiji brahijalnog pleksusa u Klinici za neurohirurgiju Kliničkog centra Srbije u zadnjih četrdesetak godina, kao i u svetu, otklanjaju svu sumnju i vraćaju etuzijazam u lečenju ovakvih povreda. Vratiti afukcionalni ekstremitet u funkciju ima nesagladive lične i socijalne aspekte, a setimo se da je u ne tako dalekoj prošlosti ovakav problem rešavan amputacijom- jer je postojalo nepoznavanje hirurške rekonstrukcije i predubeđenje o lošoj prognozi. U daljem tekstu govori se anatomiji, patofiziologiji lezija brahijalnog pleksusa, kliničkoj slici, kao i o preoperativnoj teškoj i dugotrorajnoj dijagnostici za potvrđivanje dijagnoze supraganglionarnih povreda koje predstavlaju veliki problem, a kao i o odluci o terminu operativnog lečenja i izboru operativnog postupka i odabiru donora za reinrevaciju. Radom je obuhvaćena i statistički analizirana serija pacijenata operisanih zbog supraganglionarnih povreda brahijalnog pleksusa. Bolesnici, njih 69 obuhvaćeni studijom operisani su u Kliničkom centru Srbije, Klinici za neurohirurgiju u periodu od 15 godina od 01.01.2001.-31.12.2015.godine. Studija je delom retrospektivnog delom prospektivnog karaktera, s tim da pacijenti koji su operisani do 2011. godine su retrosepektivni deo studije i samim tim su kontrolna grupa, a jedan deo njih pripadaju takodje prospektivnoj studiji, jer je praćenje u toku. Obradjeni su podaci i prikazana procentualna zastupljenost po godinama, polu mehanizmu povredjivanja, vrsti lezije, vremenu operativnog lečenja, oporavak fleksije lakta nakon nervnih transfera u odnosu na nerv donor, takodje i za pokrete u ramenom zglobu, u odnosu na udružene povrede. Prikazana je i značajnost oporavka u odnosu na godine starosti i vreme izvedene operacije. U radu je takodje statsitički izražen opravak muskulokutaneusa i aksilarisa u odnosu na donore i dokazana odnosno isključena značjnost pojedinih parametara. Napredak u poslednje vreme u dijagnostici i mikrohirurškoj reparaciji je poboljšao je prognoze hirurški tretiranih trakcionih povreda brahijalnog pleksusa. Medjutim, u slučajevima avulzije spinalnih korenova rezultati su jos uvek nezadovoljavajući, naročito kompleksna funkcija kao što je abdukcija ramena. Precizna preoperativna evaluacija, a posebno diferencijacija između supraganglionarnih (avulzija spinalnih korenova) i infraganglionarnih ( periferna lezija) povreda je izuzetno teško obzirom na mnoštvo različitih kombinacija mesta, nivoa kao i stepena nervne lezije...sr
dc.description.abstractThis dissertation covers the history of operative treatment of peripheral nerves or brachial plexus both in the world, and in our country. According to literature, the mechanical approach to the reconstruction of the brachial plexus began in the mid-19th century, and lasts until 1863 when the first epineural sutura (Nelaton) was published. The expansion and evolution of reconstructive surgery of the brachial plexus started in the beginning of the 20th century, and it is experienced by the introduction of microsurgical technique and operative microscope in 1964 (Smith and Kurze). Baudens (1836) performed the first suture of nerve structures in the injuries of the brachial plexus. The results achieved in the reconstructive surgery of the brachial plexus at the Clinic of Neurosurgery of the Clinical Center of Serbia in the last forty years, as well as in the world, are removing all doubts and restoring the etushysm in the treatment of such injuries. Restoring the function of unfunctional extremity has huge personal and social aspects. Let us remember that in the past, not so long ago, this problem was solved by amputation - because there was a lack of knowledge of surgical reconstruction and the pretense of a bad prognosis. The following text is about the anatomy, pathophysiology of brachial plexus lesions, clinical features, as well as the difficult and long-term preoperative diagnosis to confirm the diagnosis of supraganglionary injuries that present a major problem, as well as the decision of the right time of operative treatment and the selection of the right operative procedure and also the selection of the donor for reinnervation. This dissertation also included a statistically analyzed series of patients operated due to supraanglionary injuries of the brachial plexus. The patients, 69 of them studied, were operated at the Clinical Center of Serbia, the Clinic for Neurosurgery in the period of 15 years from January 1, 2001 to December 31, The study is partly a retrospective, partly of the prospective character. Patients being operated after 2011.are partly a retrospective in a control group, and part of them also belong to a prospective study, because monitoring is ongoing. The data were processed and the percentage represented by age, sex, injury mechanism, type of lesion, operative treatment time, recovery of elbow flexion after nerve transfer versus nerve donor, as well as for arm movements, in the relation to joint injuries were presented. The significance of the recovery in relation to the age and the time of the operation performed is also shown. In the paper, the musculocutane and axillary nerves in relation to donors are statistically expressed and the significance of certain parameters has been proved or excluded. Lately, the progress in diagnostics and microsurgical reparations has increased the prognosis of surgically treated traction injuries to the brachial plexus. However, in cases of spinal root avulsion, the results are still unsatisfactory, in particular a complex function such as abduction of the shoulders...en
dc.languagesr
dc.publisherУниверзитет у Београду, Медицински факултетsr
dc.rightsopenAccessen
dc.rights.urihttps://creativecommons.org/licenses/by-nc-sa/4.0/
dc.sourceУниверзитет у Београдуsr
dc.subjectpovrede brahijalnog pleksusasr
dc.subjectbrachial plexus injuriesen
dc.subjectsupraganglionary lesionsen
dc.subjectavulsion of nerv rootsen
dc.subjectnerve transferen
dc.subjectextrasplexal nerve transferen
dc.subjectintraplexal nerve transferen
dc.subjectdistal nerve transferen
dc.subjectrecoveryen
dc.subjectsupraganglionarne lezijesr
dc.subjectavulzije koreonovasr
dc.subjectnervni transfersr
dc.subjectekstrapleksusni nervni transfersr
dc.subjectintrapleskusni nervni transfer, distalni nervni transfersr
dc.subjectoporavaksr
dc.titleNervna rekonstrukcija supraganglionarnih povreda brahijalnog pleksusasr
dc.title.alternativeNerve reconstruction preganglionic brachial plexus injuryen
dc.typedoctoralThesisen
dc.rights.licenseBY-NC-SA
dc.identifier.fulltexthttps://nardus.mpn.gov.rs/bitstream/id/71771/IzvestajKomisije28821.pdf
dc.identifier.fulltexthttps://nardus.mpn.gov.rs/bitstream/id/71770/Doktorat_28821.pdf
dc.identifier.rcubhttps://hdl.handle.net/21.15107/rcub_nardus_18354


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