Search PubMed⌕ Search

Biomedical subjects

Y Allieu

Publications and source records attributed to Y Allieu.

At least 91 records · Page 5Linked to original sources
PubMed1988

Neurotization via the spinal accessory nerve in complete paralysis due to multiple avulsion injuries of the brachial plexus.

The authors report their experience with 21 cases of neurotization via the spinal accessory nerve for multiple nerve root avulsion injuries of the brachial plexus associated with total paralysis of the upper limb. They performed microneuroanastomoses with interposed cable nerve grafts between the spinal accessory nerve taken in the supraclavicular fossa and the musculocutaneous nerve at its entrance into the biceps muscle. Surgical indications depend on the accurate diagnosis of spinal nerve root avulsion, especially C5. The anatomicosurgical basis of this technique is as precise as are the indications. As many as two-thirds of the patients with a neurotized musculocutaneous nerve can be expected to achieve strength of at least Grade 3 on late muscle testing. Nevertheless, these results are always inferior to those obtainable when grafting is performed with carefully selected unavulsed C5 or C6 spinal nerve root fibers in the intervertebral foramina. Therefore, neurotization via donor nerves extrinsic to the plexus should only be considered as a second-choice intervention.

Adult↗
PubMed1988

Is surgical intervention justifiable for total paralysis secondary to multiple avulsion injuries of the brachial plexus?

The authors have studied 28 patients with total paralysis of the upper extremity due to multiple avulsions of the brachial plexus nerve roots or rupture of the primary trunks of the branchial plexus. All 28 patients refused amputation, and the authors describe the value of the overall functional results realized by the patients, obtained by surgery versus amputation.

Adolescent↗
PubMed1987

[A dynamic aid adjusted by a calibrated spiral spring for use in hand splints].

The authors demonstrate the value of a dynamic aid which can be adapted to various situations with known forces of fraction and stretch: the calibrated spiral spring. The maximal stretch is 50 mm and the usable forces range from 50 g to 2,000 g. This range allows the specific use in different hands and allows the splint to be adapted to each finger and to each pathological condition. The long term mechanical constancy of the spring is an additional advantage. The system is used with a set of adjustable parts, allowing the formation of a "low profile" splint.

Hand Injuries↗
PubMed1987

[Total paralysis of the brachial plexus. Value of the preservation of the limb and the restoration of active flexion of the elbow].

Twenty-six cases of complete brachial plexus paralysis treated surgically have been studied with particular regard to the function of the preserved limb after at least four years. A partial reinnervation was attempted in 27 cases including six neurotisations in the absence of a useful nerve stump. Out of these 28 patients, 14 remained completely paralysed and 14 recovered active elbow flexion equal to or greater than grade 3. Examination of these young injured patients showed that: 1. The preservation of the limb was always preferable to amputation which was only requested by one patient. 2. Active flexion of the elbow greatly improved the functional result by allowing certain types of holding and gripping activity and the ability to put the paralysed and insensitive hand into the pocket or supported on a surface. It also limits downward dislocation of the shoulder which is often painful.

Adolescent↗
PubMed1986

[Consequences of adult brachial plexus paralysis and its surgical treatment on respiratory function].

The authors have studied 22 patients suffering from traumatic brachial plexus injuries and the consequences on respiratory function of paralysis of the diaphragm and other respiratory muscles. They have also studied the effects of some surgical treatment on respiratory function. The patients were divided into three groups: post-traumatic paralysis of the diaphragm (5 cases), patients who had had an intercostal neurotization (11 cases) and patients with paralysis of some respiratory muscles with an intact diaphragm (2 cases). Six tests were performed--vital capacity, total pulmonary capacity, residual functional capacity, airway resistance, maximum expiratory volume per second and airflow at 50 p. 100 of the vital capacity. Respiratory function was decreased by about 50 p. 100 in cases of diaphragmatic paralysis. This finding should be taken into consideration in cases of extensive lesions of the brachial plexus. The effects of intercostal neurotization were minimal when performed in cases with respiratory paralysis, but with an intact diaphragm. They were negligible in the absence of any respiratory paralysis. It is concluded that intercostal neurotization should not be performed in cases with diaphragmatic paralysis. In such cases, other types of neurotization are preferred.

Adolescent↗
PubMed1985

Distal radioulnar involvement in trauma of the wrist.

The distal radioulnar joint is the weakest point of the rotational column of the wrist. This joint is a functional part of the radiocarpal joint, united to it by an elastic tightening system, and perfectly controlled by the ulnaris (especially the extensor carpi) tendons. Our anatomic study allowed to define the mechanisms of the lesions and the methods for their correction. The key to success seems to be a functionally dynamic extensor carpi ulnaris and its dorsal position in supination. Our clinical study shows that all injuries to the distal radioulnar joint associated with trauma of the wrist or of the forearm are a factor of severity and they may be responsible for the high rate of complications. Therefore, in Galeazzi's fracture-dislocation, a specific method of stabilization may need to be associated with the radius osteosynthesis. In the absence of degenerative changes, chronic instability of the distal radioulnar joint can benefit from ligament stabilization. Results so far have been very encouraging, as far as young patients are concerned. Complex injuries remain a major obstacle, in which ligamentous and bone lesions must be distinguished by confronting clinical observation with paraclinical investigations. Computerized tomography seems to be of limited value, although this method of investigation is still in its prospective stages. Concerning management, shortening of the ulna with dorsal repositioning of the extensor carpi ulnaris allows to decompress the carpo-ulnar compartment, to stretch the tendinous and ligamentous structures, and, if need, to restore radioulnar congruity. Better knowledge of this pathology will allow to categorize radioulnar tears associated with wrist injuries. Under emergency conditions, surgical or non operative management must be adapted, allowing healing to occur with perfect restoration of the distal epiphysis of the radius. By doing so good functional results may be guaranteed.

Fracture Fixation, Internal↗
PubMed1985

Vascularization, cellular behavior, and union of vascularized bone grafts: experimental study in the rabbit.

The rabbit fibula was used as the experimental model in this study of the biological changes in nonvascularized and vascularized bone grafts (N = 72). Radiological study showed that the time required for union was about the same for both types of graft. Histological study with tetracycline as a marker showed that there were cellular changes in these two types of graft: moderate hematopoietic and osteocytic loss associated with an increase in bone porosity in vascularized grafts and virtually total osteocytic renewal and marrow necrosis in nonvascularized bone grafts. Quantitative study of vascularization by flow measurement using labeled microspheres showed a brief initial phase of hypervascularization in vascularized grafts, while revascularization took place early in nonvascularized grafts and was followed by hyperemia from the first to the third month. Calcium uptake curves for the two types of graft were quite closely superimposable upon blood flow rate curves. However, the comparative results presented in this study may be tempered by the fact that all grafts were applied to a recipient bed of excellent quality, consisting of well-vascularized muscles.

Animals↗
PubMed1985

[Restoration of elbow extension in the tetraplegic by transplantation of the posterior deltoid. Study of 21 cases].

The authors have transferred the posterior part of the deltoid muscle to the triceps in 21 tetraplegics. A modification of Moberg's technique has been employed utilising a strip of fascia lata reinforced by Dacron sutures to allow rehabilitation after only 3 weeks. Despite limited active extension of the elbow and diminished power, results were considered to be satisfactory by the patients. They benefited from a greater range of movement of the hand, an improved possibility of bearing weight, improvement in the use of wheelchairs and better ability to express their bladder.

Adult↗
PubMed1985

[Pain following traumatic lesions of the brachial plexus (radicular avulsions and truncular lesions)].

Pain in avulsions lesions of the brachial plexus is related with deafferentation; experimental studies demonstrate that spontaneous discharges can be recorded with micro electrodes in the dorsal horn, after division of the dorsal roots. These discharges ("firing") are related with the loss of control of the inhibitory effects of the large caliber sensory fibers. This pathophysiological concept drawn from the Melzack and Wall's theory (gate control) allows a good meaning of the paradoxical results observed after neurotization (via accessory or intercostal nerves), namely immediate relief of pain, observed in several cases after surgery. This theory helps to explain the efficiency of the neurostimulation techniques (by inhibition of the "firing") and of the technique of "dorsal root entry zone coagulation" in the avulsed area, on the spinal cord, by direct destruction of the hyperactive cells in the posterior horn. These technical advances and early return to work and to community offer the best prospect of relief of pain. Incidence of intractable pain problem is less than 10% after 10 years.

Brachial Plexus↗