Brachial plexus injury: A survey of 100 consecutive cases from a single service
Brachial plexus injury: A survey of 100 consecutive cases from a single service
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DOI：
10.1097/00006123-200209000-00011
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发表时间：
2002-09-01
期刊：
影响因子：
4.8
通讯作者：
Kline, DG
中科院分区：
文献类型：
--
作者：
Dubuisson, AS;Kline, DG
目的：我们分析了流行病学，术前管理，手术结果，手术治疗，术后结果在一组99例患者谁持续100伤的臂丛神经injuries.METHODS：100例连续手术患者的图表与臂丛神经injuries.RESULTS：患者组包括80名男性和19名女性，年龄从5到70岁。1例男性患者双侧臂丛神经麻痹。受伤原因是头部、颈部和肩部突然移位，包括27起摩托车事故。开放性伤口23例，其中枪伤8例，其他穿透伤6例，手术或医源性创伤9例。19例患者的C5-C6、15例患者的C5-C7和39例患者的C5-T1出现丢失，8例患者有另一种脊神经根损伤模式。19例患者脊髓或脊髓至神经水平损伤。59例患者存在相关严重创伤。18例患者需要进行血管或神经修复的急诊手术。脊髓造影（n = 57）或磁共振成像（n = 7）显示52例患者至少有一个根异常。从创伤到手术的中位时间为7个月。采用的手术暴露-包括锁骨上前入路、锁骨下入路、锁骨上下联合入路或后路入路，分别为5例、14例、77例和4例患者。进行的外科手术包括12例患者中的单独神经松解术和81例、5例和47例患者中的神经移植、端端吻合和/或神经移位。78%的患者术后随访至少36个月。根据路易斯安那州立大学医学中心标准，3级恢复意味着近端肌肉抵抗一些阻力收缩，远端肌肉至少抵抗重力收缩。在18例开放性伤口患者中，14例（78%）恢复到3级或更好水平，60例拉伸损伤患者中有35例（58%）恢复到3级或更好水平。神经移植修复C5-C6牵张性损伤10例，均恢复了有用的手臂功能。结论：臂丛神经损伤是一种严重的，难以处理的创伤性事件。近年来，此类损伤的发生率和手术指征有所增加。移植修复和神经移植手术在此类损伤患者的治疗中起着重要作用。
OBJECTIVE: We analyzed the epidemiology, preoperative management, operative findings, operative treatment, and postoperative results in a group of 99 patients who sustained 100 injuries to the brachial plexus.METHODS: The charts of 100 consecutive surgical patients with brachial plexus injuries were reviewed.RESULTS: The patient group comprised 80 males and 19 females ranging from 5 to 70 years of age. One male patient had bilateral brachial plexus palsy. Causes of injury were sudden displacement of head, neck, and shoulder and included 27 motorcycle accidents. There were 23 open wounds, including 8 gunshot wounds, 6 other penetrating wounds, and 9 wounds caused by operative or iatrogenic trauma. Loss was exhibited at C5-C6 in 19 patients, at C5-C7 in 15 patients, and at C5-T1 in 39 patients, and 8 patients had another spinal root pattern of injury. Nineteen patients had injury at the cord or the cord to nerve level. Associated major trauma was present in 59 patients. Emergency surgery for vessel or nerve repair was necessary in 18 patients. Myelography (n = 57) or magnetic resonance imaging (n = 7) revealed at least one root abnormality in 52 patients. The median interval from trauma to operation was 7 months. Operative exposures used - included anterior supraclavicular, infraclavicular, combined supra- and infraclavicular, or a posterior approach in 5, 14, 77, and 4 patients, respectively. The surgical procedures performed included neurolysis alone in 12 patients and nerve grafting, end-to-end anastomosis, and/or neurotization in 81, 5, and 47 patients, respectively. Postoperative follow-up of at least 36 months was conducted in 78% of the patients. Grade 3 recovery according to Louisiana State University Medical Center criteria means contraction of proximal muscles against some resistance and of distal muscles against at least gravity. Among the 18 patients with open wounds, 14 (78%) recovered to a Grade 3 or better level, as did 35 (58%) of 60 patients with stretch injuries. In all cases of C5-C6 stretch injuries repaired by nerve grafting (n = 10), the patients recovered useful arm function,CONCLUSION: Brachial plexus injury represents a severe, difficult-to-handle traumatic event. The incidence of such injuries and the indications for surgery have increased during recent years. Graft repair and neurotization procedures play an important role in the treatment of patients with such injuries.