ORIGINAL
Introdução: a técnica de Oberlin, desenvolvida por Philippe Oberlin, envolve a transferência de fascículos motores do nervo ulnar para o nervo musculocutâneo para restaurar a flexão do antebraço em pacientes com lesões altas do plexo braquial. Este artigo fornece uma descrição detalhada do procedimento cirúrgico, acompanhada de ilustrações passo-a-passo, com o objetivo de auxiliar na formação de neurocirurgiões. Objetivo: o objetivo principal é apresentar um guia com procedimentos detalhados e avaliar sua eficácia avaliando os resultados funcionais de uma coorte de pacientes. Métodos: para a realização deste estudo, foi realizada uma análise retrospectiva com 10 pacientes submetidos à técnica de Oberlin entre 2020 e 2022. A idade dos pacientes variou de 18 a 40 anos, e sua evolução foi acompanhada por um período médio de 14,8 meses. A força de flexão do cotovelo foi avaliada usando o sistema de classificação de potência do Medical Research Council (MRC) e os níveis de dor foram avaliados usando a Escala Visual Analógica (EVA). Além disso, a causa da lesão, o nível de lesão, o intervalo de tempo entre a lesão e a cirurgia e a fisioterapia pré e pós-operatória também foram analisados. Resultados: dos 10 pacientes, 4 alcançaram excelente recuperação de força de flexão do cotovelo (M4), 4 alcançaram força moderada (M2) e 1 paciente demonstrou força fraca (M1). De forma encorajadora, todos os pacientes apresentaram uma melhora na parestesia e a redução nos níveis de dor foi observada após a cirurgia. Em média, o intervalo entre a lesão e a cirurgia foi de aproximadamente 7,4 meses, e todos os pacientes receberam fisioterapia pré e pós-operatória. Conclusão: os achados deste estudo demonstram a eficácia da técnica de Oberlin na restauração da força de flexão do cotovelo e na redução da dor em pacientes com lesões do plexo braquial. O tamanho da amostra foi limitado, portanto, nenhuma análise estatística foi realizada, os resultados indicam fortemente que a intervenção cirúrgica precoce dentro de alguns meses após a lesão produz resultados funcionais superiores. A descrição detalhada do procedimento fornecida neste artigo serve como um recurso valioso para a formação de jovens neurocirurgiões durante sua residência médica.
Introduction: the Oberlin technique, developed by Philippe Oberlin, involves the transfer of ulnar nerve motor fascicles to the musculocutaneous nerve to restore forearm flexion in patients with high brachial plexus injuries. This paper provides a detailed description of the surgical procedure, accompanied by step-by-step illustrations, aiming to assist in the training of neurosurgeons. Objective: the primary aim is to present a detailed procedural guide and assess its effectiveness by evaluating the functional outcomes of a patient cohort. Methods: to conduct this study, a retrospective analysis was performed with 10 patients who underwent the Oberlin technique between 2020 and 2022. The patients’ ages ranged from 18 to 40 years, and their progress was tracked for an average period of 14.8 months. Elbow flexion strength was assessed using the Medical Research Council (MRC) power grading system, and pain levels were evaluated using the Visual Analogue Scale (VAS). Additionally, injury cause, injury level, time gap between injury and surgery, and pre- and post-operative physical therapy were also analyzed. Results: among the 10 patients, 4 achieved excellent elbow flexion strength (M4), 4 achieved moderate strength (M2), and 1 patient demonstrated weak strength (M1). Encouragingly, all patients experienced an improvement in paresthesia, and reduction in pain levels was observed post-surgery. On average, the interval between injury and surgery was approximately 7.4 months, and all patients received pre- and post-operative physical therapy. Conclusion: in conclusion, the findings of this study demonstrate the effectiveness of the Oberlin technique in restoring elbow flexion strength and reducing pain for patients with brachial plexus injuries. The sample size was limited, therefore, no statistical analysis was performed, the results strongly indicate that early surgical intervention within a few months of the injury yields superior functional outcomes. The detailed procedural description provided in this article serves as a valuable resource for the training of young neurosurgeons during their medical residency.
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1 MD, Neurosurgeon, Department of Neurosurgery, Hospital da Restauração, Recife, PE, Brazil.
2 MD, PhD, Neurosurgeon, Department of Neurosurgery, Hospital da Restauração, Recife, PE, Brazil.
3 MS, Faculdade Pernambucana de Saúde, Recife, PE, Brazil.
4 MS, Center for Medical Sciences, Federal University of Pernambuco, Recife, PE, Brazil.
Received Oct 7, 2023
Accepted Oct 26, 2023
