Traitement chirurgical des paralysies du plexus brachial post-traumatique au Cameroun

Surgical treatment of post-traumatic brachial plexus palsies in Cameroon / Introduction : The aim of this study was to identify diagnosis, treatment and outcome of post-traumatic brachial plexus palsies. Method : It was a longitudinal, retrospective, prospective and descriptive study which was done in Douala General Hospital between January 2007 and April 2013. Were included all patients aged 15 and above who presented a brachial plexus palsy following a trauma. We ruled out children and others causes of brachial plexus palsies. Results: 18 patients were operated. The sex ratio was 18/0 in favour men. The mean age was 33 years with a range from 16 to 57 years. The lesions were caused by road traffic accidents in 81.5% of cases. Preoperative electrophysiological studies found axonotmesis in 51.9% and neurotmesis in 44.4% of cases. Supraclavicular lesions were shown in 61.53% of cases and avulsions in 33.3%. The mean time interval between trauma and operation was 269 days (9 months). The average time of post-operative follow up was 16 months (1 year and 4 months). We performed neurolysis in 14 patients (77.7%), neurotization in 7 patients (38.8%) and nerve graft by the sural nerve in 7 patients (38.8%). The improvement of muscular strengths and the sensitivity following different classifications was statistically significant. Conclusion: The surgical treatment of post-traumatic brachial plexus palsies in our study gave encouraging outcomes although a modest sampling and the follow up time relatively short. Key words : Brachial plexus palsies, Trauma, surgery RESUME Introduction : Le but  de la presente  etude  etait de determiner les aspects diagnostiques, therapeutiques et pronostiques des paralysies du plexus brachial post traumatiques. Methodologie  : Il s’agissait d’une etude longitudinale, retrospective et prospective  a visee descriptive qui s’est deroulee a l’Hopital General de  Douala  de janvier 2007 a avril 2013. Etaient  inclus tous les sujets de plus de 15 ans presentant une paralysie du plexus brachial consecutive a un traumatisme.   En etaient exclus les enfants et les autres causes de paralysie du plexus brachial.  Resultats : Nous avons retenu 18  patients  operes. Le sexe ratio  etait de 18/0 en faveur des hommes. La moyenne d’âge etait de 33 ans avec des extremes allant de 16 a 57 ans.  Les accidents de la voie publique representaient 81,5% des causes de traumatisme. L electromyogramme  retrouvait   les axonotmesis  (51,9%) et  les neurotmesis (44,4 %). Les lesions supraclaviculaires  representaient 61,53%  des cas et les  avulsions 33,3%. Le delai moyen pre-operatoire etait de 269 jours, soit 9 mois.  La duree moyenne de suivi etait de 16 mois. La neurolyse a ete effectuee chez 14 patients soit  77,7% des cas, la neurotisation,  chez 7 patients soit 38,8%  et la greffe du nerf sural chez 7 patients soit 38,8%. L’amelioration des forces musculaires et de la sensibilite  suivant differentes  classifications etait  statistiquement significative. Conclusion. Le traitement chirurgical des paralysies du plexus brachial post-traumatiques  dans notre serie a donne  des resultats encourageants malgre un echantillonnage modeste et un suivi relativement court. Mots cles  : Paralysie du Plexus brachial, traumatisme, Chirurgie