Ekstremitelerde Depremle İlişkili Periferik Sinir Yaralanmalarının Tanımlayıcı Özellikleri ve Yaralanma Paternleri

Year 2024, , 27 - 31, 29.02.2024

Mehmet Ozel , Mustafa Altıntaş

https://doi.org/10.54005/geneltip.1322059

Abstract

Amaç: Sağlık ekipler tarafından ekstremite ve hayat kurtarma çabalarının önceliklendirilmesi nedeniyle, depremlerden kaynaklanan periferik sinir yaralanmaları (PSY), sıklıkla göz ardı edilmekte veya tedavileri gecikmektedir. Bu nedenle, depreme bağlı PSY'leri tanımlayıcı özellikleri ve yaralanma paternleri açısından inceledik.
Yöntemler: Çalışma, Kahramanmaraş Depremleri sonrasında bir üçüncü basamak hastanede retrospektif olarak yürütüldü. Çalışmaya 06 Şubat ve 28 Şubat 2023 tarihleri arasında hastaneye kabul edilen ve tıbbi kayıtlarına göre PSY tanısı konulan enkaz altında kalan mağdurlar dahil edildi.
Sonuçlar: Çalışmaya 70 hasta ve toplamda 98 ekstremitede PSY olan hastalar dahil edildi ve hastaların yaş ortalaması 22.31±14.91 yıldı. PSY'lerin %77.6'sı (n=76) alt ekstremiteyi (68 peroneal ve 8 siyatik sinir) etkilerken, PSY'lerin %22.4'ü (n=22) üst ekstremiteyi (14 radial sinir, 5 ulnar sinir, 2 median sinir, 1 brakiyal pleksus) etkilediği bulundu. PSY'lerin %45.9'unun (n=45) sağ ekstremitede, %54.1'inin (n=53) sol ekstremitede meydana geldiği saptandı. Hastaların enkaz altında geçirdiği medyan süre 15 saat (IQR 8.75 - 32 saat) idi. PSY olan ekstremitelerin %54.1'inde (n=43) fasiotomi tedavisi uygulandı. Fasiotomiler en sık olarak krus (42.9%), ayak (26.5%) ve uyluk (16.3%) üzerinde gerçekleştirildi.
Tartışma: Bu çalışmada, deprem mağdurlarında PSY'lerin, üst ekstremitelere kıyasla alt ekstremitelerde daha sık meydana geldiğini bulunmuştur. Alt ekstremite PSY'leri genellikle peroneal sinirde, üst ekstremite PSY'leri ise genellikle radial sinirde meydana geldiği bulunmuştur.

Keywords

Ezilme yaralanması, Periferik sinir yaralanması, Deprem, Mağdurlar, Ekstremite

Descriptive Characteristics and Injury Patterns of Earthquake-Related Peripheral Nerve Injuries in the Extremities

Abstract

Background/Aims:Due to the prioritization of limb and life-saving efforts by medical teams, peripheral nerve injuries (PNIs) resulting from earthquakes are frequently overlooked or receive delayed treatment. Thus, we examined earthquake-related PNIs in terms of their descriptive characteristics and injury patterns
Methods: The study was conducted retrospectively in a tertiary hospital after Kahramanmaraş Earthquakes. The study included victims under rubble admitted to the hospital and diagnosed with PNI according to their medical records between 06 February and 28 February 2023.
Results: The study included 70 patients and a total of 98 limbs with PNIs, with a mean patient age of 22.31±14.91 years. 77.6% (n=76) of PNIs involved the lower limb (68 peroneal and 8 sciatic nerves) and 22.4% (n=22) of PNIs involved the upper limbs (14 radial nerves, 5 ulnar nerves, 2 median nerves, 1 brachial plexus). It was found that 45.9% of PNIs (n=45) occurred in the right and 54.1% (n=53) in the left extremities. The median time under the rubble of the patients was 15 hours (IQR 8.75 - 32 hours). Fasciotomy was treated in 54.1% (n=43) of the extremities with PNI. Fasciotomies were most commonly performed on the cruris (42.9%), foot (26.5%), and thigh (16.3%).
Conclusion: This study found that PNIs occurred most frequently in the lower limbs, compared with the upper limbs, among earthquake victims with CLIs. Lower limb PNIs mainly occurred in the peroneal nerve, while upper limb PNIs mainly occurred in the radial nerve.

Keywords

Crush injury, Peripheral nerve injury, Earthquake, Victims, Extremity

References

• Doocy S, Daniels A, Packer C, Dick A, Kirsch TD. The human impact of earthquakes: a historical review of events 1980-2009 and systematic literature review. PLoS Curr. 2013 Apr 16;5:ecurrents.dis.67bd14fe457f1db0b5433a8e.
• Türkiye acil tıp derneği. Acil Tıp Uzmanları Saha Gözlem Raporu 6 ŞUBAT 2023 Kahramanmaraş Merkezli Depremler. Ulaşım adresi: https://tatd.org.tr/wp-content/uploads/2023/02/2386ba4ace1f5b53491d0d62eb432dfb.pdf
• Ministry of Interior Disaster and Emergency Management Presidency, PRESS BULLETIN 01.03.2023 About the Earthquake in Kahramanmaraş - 36 https://en.afad.gov.tr/press-bulletin-36-about-the-earthquake-in-kahramanmaras
• Zhang L, Zhao M, Fu W, Gao X, Shen J, Zhang Z, et al. Epidemiological analysis of trauma patients following the Lushan earthquake. PLoS One. 2014 May 20;9(5):e97416.
• Celikmen MF, Yilmaz S, Tatliparmak AC, Unal Colak F. Drop, Cover, and Hold On versus Fetal Position in the Triangle of Life to Survive in an Earthquake: A Delphi Study. Prehosp Disaster Med. 2023 Jun;38(3):287-293.
• Moitinho de Almeida M. "Recovering, not recovered" Hospital disaster resilience: a case-study from the 2015 earthquake in Nepal. Glob Health Action. 2022 Dec 31;15(1):2013597.
• Dai ZY, Li Y, Lu MP, Chen L, Jiang DM. Clinical profile of musculoskeletal injuries associated with the 2008 Wenchuan earthquake in China. Ulus Travma Acil Cerrahi Derg. 2010 Nov;16(6):503-7.
• Langer V. Management of major limb injuries. ScientificWorldJournal. 2014 Jan 5;2014:640430.
• Kimuli Balikuddembe J, Zeng X, Chen C. Health-Related Rehabilitation after the 2008 Great Wenchuan Earthquake in China: A Ten Year Retrospective Systematic Review. Int J Environ Res Public Health. 2020 Mar 29;17(7):2297.
• Ahrari MN, Zangiabadi N, Asadi A, Sarafi Nejad A. Prevalence and distribution of peripheral nerve injuries in victims of Bam earthquake. Electromyogr Clin Neurophysiol. 2006 Jan-Feb;46(1):59-62.
• Castillo-Galván ML, Martínez-Ruiz FM, de la Garza-Castro O, Elizondo-Omaña RE, Guzmán-López S. Study of peripheral nerve injury in trauma patients. Gac Med Mex. 2014 Nov-Dec;150(6):527-32.
• Uzun N, Savrun FK, Kiziltan ME. Electrophysiologic evaluation of peripheral nerve injuries in children following the Marmara earthquake. J Child Neurol. 2005 Mar;20(3):207-12.
• Özdemir G, Karlıdağ T, Bingöl O, Sarıkaya B, Çağlar C, Bozkurt İ, et al. Systematic triage and treatment of earthquake victims: Our experience in a tertiary hospital after the 2023 Kahramanmaras earthquake. Jt Dis Relat Surg 2023;34(2):480-487.
• Lathia C, Skelton P, Clift Z. Early Rehabilitation in Conflicts and Disasters. Handicap International: London, UK. 2020
• Burnett MG, Zager EL. Pathophysiology of peripheral nerve injury: a brief review. Neurosurg Focus. 2004 May 15;16(5):E1.
• He CQ, Zhang LH, Liu XF, Tang PF. A 2-year follow-up survey of 523 cases with peripheral nerve injuries caused by the earthquake in Wenchuan, China. Neural Regen Res. 2015 Feb;10(2):252-9.
• Mulvey JM, Awan SU, Qadri AA, Maqsood MA. Profile of injuries arising from the 2005 Kashmir earthquake: The first 72 h. Injury 2008;39:554-60.
• Tang P, Wang Y, Zhang L, He C, Liu X. Sonographic evaluation of peripheral nerve injuries following the Wenchuan earthquake. J Clin Ultrasound. 2012 Jan;40(1):7-13.
• Liu L, Tang X, Pei FX, Tu CQ, Song YM, Huang FG, et al. Treatment for 332 cases of lower leg fracture in "5.12" Wenchuan earthquake. Chin J Traumatol. 2010 Feb;13(1):10-4.
• Deutsch A, Wyzykowski RJ, Victoroff BN. Evaluation of the anatomy of the common peroneal nerve. Defining nerve-at-risk in arthroscopically assisted lateral meniscus repair. Am J Sports Med. 1999 Jan-Feb;27(1):10-5.
• Ormiston RV, Marappa-Ganeshan R. Fasciotomy. 2023 Apr 17. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 January.
• Scalea TM, DuBose J, Moore EE, West M, Moore FA, McIntyre R, et al. Western Trauma Association critical decisions in trauma: management of the mangled extremity. J Trauma Acute Care Surg. 2012 Jan;72(1):86-93.