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Handchir Mikrochir Plast Chir 2024; 56(01): 65-73
DOI: 10.1055/a-2248-5699
Übersichtsarbeit

Die hyperselektive Neurektomie bei spastischen Lähmungen der oberen Extremität

Selective Neurectomy in Spastic Paralysis of the Upper Extremity
Kai Megerle
1   Zentrum für Handchirurgie, Mikrochirurgie und Plastische Chirurgie, Schön Klinik München Harlaching, München, Germany
,
Andreas Gohritz
2   Plastische, Rekonstruktive und Ästhetische Chirurgie, Handchirurgie, Universitätsspital, Basel, Switzerland
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Zusammenfassung

Als hyperselektive Neurektomie wird eine gezielte Durchtrennung motorischer Nervenfasern an ihrem Muskeleintritt bezeichnet, um bei spastischen Lähmungen den gesteigerten Muskeltonus zu reduzieren. Diese Technik hat in den letzten Jahren speziell an der oberen Extremität eine Renaissance erlebt. Wichtigste Grundlage ist die exakte Kenntnis der topographschen Anatomie der Muskelinnervation. Um Ausmaß und Lokalisation der Denervation exakt kontrollieren zu können, ist eine präzise Darstellung der motorischen Nervenäste notwendig. Für eine relevante Tonusminderung ist die Durchtrennung von 2/3 bis 4/5 der Nervenäste erforderlich. Diese Arbeit stellt die Entwicklung, Prinzipien und Anwendung dieser Techniken an der oberen Extremität dar und gibt einen Überblick über die klinischen Ergebnisse.

Abstract

Selective neurectomy refers to the targeted transection of motor nerve fibres at their entry into the muscle in order to reduce the increased muscle tone in cases of spastic paralysis. This procedure has regained popularity in recent years, especially in the upper extremity. First and foremost, it requires an exact knowledge of the topographical anatomy of muscle innervation. To be able to control the extent and localisation of the denervation, the terminal nerve branches must be visualized precisely during the procedure. For a meaningful reduction of muscle tone, 2/3 to 4/5 of nerve fibres must be resected. This article presents the historical development, principles and operative details of this technique as well as clinical results.

Schlüsselwörter

Chirurgie der peripheren Nerven - Spastik - Lähmung - Selektive Neurektomie

Keywords

Selective neurectomy - Spasticity - Denervation, Chirurgie der peripheren Nerven - peripheral nerve surgery - paralysis


Publication History

Article published online:
20 March 2024

© 2024. Thieme. All rights reserved.

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