Fate of Combat Nerve Injury
Fate of Combat Nerve Injury
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DOI：
10.1097/bot.0b013e31823f000e
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发表时间：
2012-11-01
影响因子：
2.3
通讯作者：
Hsu, Joseph R.
中科院分区：
文献类型：
--
作者：
Beltran, Michael J.;Burns, Travis C.;Hsu, Joseph R.
目的：评估与战斗相关的III型开放性胫骨骨折伴周围神经损伤的队列，以确定损伤机制和神经功能恢复或改善的可能性。设计：回顾性研究。环境：三个军事医疗中心。患者和参与者：在213例III型开放性胫骨骨折的研究队列中，32例骨折（32例患者）共43例腘窝远端周围神经损伤（腓骨或胫骨）符合纳入标准，平均随访20个月（范围2-48个月）。主要观察指标：运动和感觉神经改善的临床评估。结果：研究队列中周围神经损伤发生率为22%。平均随访20个月（范围2-48个月），89%的损伤运动神经功能正常，93%的损伤感觉神经功能正常。50%和27%的运动和感觉损伤分别得到改善（P = 0.043）。根据现有数据，损伤机制、骨折严重程度或位置、软组织损伤或特定神经损伤在运动或感觉改善方面没有差异。在最初感觉检查受损的患者亚组中，完全改善与骨折位置有关（P = 0.0164）。结论：战斗中开放性胫骨III型骨折伴22%的周围神经损伤，且以多发弹穿伤为主。尽管这些损伤的性质很严重，但绝大多数患者在平均2年的随访中仍有神经功能状态。基于这些发现，关于肢体保留和截肢的讨论不应过度受患者周围神经状态的影响。
Objective: Assess a cohort of combat-related type III open tibia fractures with peripheral nerve injury to determine the injury mechanism and likelihood for recovery or improvement in nerve function.Design: Retrospective study.Setting: Three military medical centers.Patients and Participants: Out of a study cohort of 213 type III open tibia fractures, 32 fractures (in 32 patients) with a total of 43 peripheral nerve injuries (peroneal or tibial) distal to the popliteal fossa met inclusion criteria and were available for follow-up at an average of 20 months (range, 2-48 months).Main Outcome Measurements: Clinical assessment of motor and sensory nerve improvement.Results: There was a 22% incidence of peripheral nerve injury in the study cohort. At an average follow-up of 20 months (range, 2-48 months), 89% of injured motor nerves were functional, whereas the injured sensory nerves had function in 93%. Fifty percent and 27% of motor and sensory injuries demonstrated improvement, respectively (P = 0.043). With the numbers available, there was no difference in motor or sensory improvement based on mechanism of injury, fracture severity or location, soft tissue injury, or specific nerve injured. In the subset of patients with an initially impaired sensory examination, full improvement was related to fracture location (P = 0.0164).Conclusions: Type III open tibia fractures sustained in combat are associated with a 22% incidence of peripheral nerve injury, and the majority are due to multiple projectile penetrating injury. Despite the severe nature of these injuries, the vast majority of patients had a functional nerve status by an average of 2-year follow-up. Based on these findings, discussions regarding limb salvage and amputation should not be overly influenced by the patient's peripheral nerve status.