Matsuyama Takeshi, Okuchi Kazuo, Akahane Manabu, Inada Yuji, Murao Yoshinori
Department of Emergency and Critical Care Medicine, Nara Medical University, Kashihara, Nara.
Neurol Med Chir (Tokyo). 2002 Mar;42(3):114-21; discussion 122. doi: 10.2176/nmc.42.114.
Brachial plexus injury is very rare in neurosurgical practice, so many neurosurgeons have never experienced this problem in Japan. This study describes a clinical analysis of 16 patients aged 5 to 62 years (mean 32.9 years) who presented at our institution with brachial plexus injuries. Nine patients presented with paralysis and seven with paresis. Head injury was the most common associated injury in eight of 16 patients. Six patients were managed conservatively. All patients with C8-T1 paresis spontaneously recovered to a useful level. Surgery was performed in 10 patients: six neurolysis, two neurotization, and three nerve grafting procedures. All six patients who underwent neurolysis of the brachial plexus attained useful recovery. Four of five patients achieved useful recovery after nerve repair. Nerve grafting achieved a better outcome than neurotization in this study. The difference of outcome was attributed to the graft length. The management of brachial plexus injury is a great challenge, but surgical outcome can be improved if the optimal repair procedure is selected for brachial plexus injury.
臂丛神经损伤在神经外科实践中非常罕见，因此在日本许多神经外科医生从未遇到过这个问题。本研究描述了对16例年龄在5至62岁（平均32.9岁）的臂丛神经损伤患者的临床分析，这些患者在我们机构就诊。9例患者表现为瘫痪，7例为轻瘫。头部损伤是16例患者中8例最常见的合并损伤。6例患者采用保守治疗。所有C8-T1轻瘫患者均自发恢复到有用水平。10例患者接受了手术治疗：6例进行神经松解，2例进行神经移植，3例进行神经移植手术。所有6例接受臂丛神经松解的患者均获得了有用的恢复。5例患者中有4例在神经修复后获得了有用的恢复。在本研究中，神经移植比神经移植取得了更好的结果。结果的差异归因于移植长度。臂丛神经损伤的治疗是一项巨大的挑战，但如果为臂丛神经损伤选择最佳的修复程序，手术结果可以得到改善。
