IATROGENIC NERVE INJURIES - 08/09/11

Doi : 10.1016/S0733-8619(05)70367-4

Asa J. Wilbourn, MD ^{^{*
From the EMG Laboratory, Department of Neurology, The Cleveland Clinic Foundation; and the Department of Neurology, Case Western Reserve University Medical School, Cleveland, Ohio}}

Résumé

Iatrogenic nerve injuries undoubtedly have occurred since antiquity, beginning soon after the treatment of human injuries and afflictions evolved into a profession. It is inconceivable, for example, that during the Hippocrates era many brachial plexus injuries did not result from the violent methods used to reduce shoulder dislocations.^{13Brockbank W., Griffiths D.L. Orthopaedic surgery in the sixteenth and seventeenth centuries J Bone Joint Surg 1948 ; 30B : 365-375

Cliquez ici pour aller à la section Références} Nonetheless, little information is accessible concerning their (1) overall incidence among peripheral nervous system (PNS) lesions and (2) relative incidence among the general category of iatrogenic disorders. The fragmentary data available, however, suggest that these lesions occur in more than minuscule numbers. Thus, among 2000 patients who had major peripheral nerve injuries seen at two hospitals in England over a 7–year period, nearly 200 (10%) were "the result of medical treatment."^{7Birch R., Bonney G., Dowell J., et al. Iatrogenic injuries of peripheral nerves J Bone Joint Surg 1991 ; 73B : 280-282

Cliquez ici pour aller à la section Références} In regard to brachial plexopathies, for which there are some comparative data, in two large series 7.4% and 9.5% were iatrogenic in nature.^{62Kline D.G., Judice D.J. Operative management of selected brachial plexus lesions J Neurosurg 1983 ; 58 : 631-649 [cross-ref]

Cliquez ici pour aller à la section Références, 81Narakas A.O. The surgical treatment of traumatic brachial plexus lesions Int Surg 1980 ; 6 : 521-527

Cliquez ici pour aller à la section Références}

Iatrogenic PNS injuries are not the province of any particular medical specialty. Although the majority occur perioperatively and therefore are attributed to surgeons and anesthesiologists, the members of almost every clinical specialty are at risk to some degree. Lesions of this nature, for example, can result from the insertion of needles and cannulas for diagnostic and therapeutic purposes, the administration of anticoagulation medication, and the use of radiotherapy, to name a few of the many potential causes.^{10Bonney G. Iatrogenic injuries of nerves J Bone Joint Surg 1986 ; 68B : 9-13

Cliquez ici pour aller à la section Références} Because so many different PNS structures can be injured iatrogenically and in a multitude of manners, no attempt is made in this article to discuss all of them. Instead, several of the more commonly encountered iatrogenic PNS lesions and their principle causes are reviewed.

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