Tung Thomas H H, Mackinnon Susan E
Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Suite 17424 East Pavilion, 1 Barnes-Jewish Hospital Plaza, St. Louis, MO 63110, USA.
Clin Plast Surg. 2003 Apr;30(2):269-87. doi: 10.1016/s0094-1298(02)00094-9.
Severe trauma to the brachial plexus most often occurs in young adult men and is a crippling injury that requires management in a timely fashion for optimal functional recovery and pain control. The surgical management of such injuries is well established, and the techniques continue to evolve. Current management options consist of primary repair in the acute setting, neurolysis, neuroma resection and nerve grafting, motor and sensory nerve transfers, and muscle and tendon transfers. Shoulder andwrist fusion can also play a role in the overall management of these patients. The best operative plan varies depending on the patient's level and extent of injury and the surgeon's preference and experience. The pre- and postoperative care of these patients is ideally managed by a team that has experience with such problems, including personnel knowledgeable in their postoperative rehabilitation. The total reconstructive process generally consists of more than one operation, and the postoperative rehabilitation is long and intensive. Nevertheless, with a highly motivated patient and a dedicated and specialized surgical team, the prognosis for functional recovery is good, and these patients can still lead productive and satisfying lives.
臂丛神经严重创伤最常发生于年轻成年男性，是一种致残性损伤，需要及时处理以实现最佳功能恢复和疼痛控制。此类损伤的外科治疗方法已很成熟，且技术仍在不断发展。目前的治疗选择包括急性期的一期修复、神经松解术、神经瘤切除术和神经移植、运动和感觉神经移位，以及肌肉和肌腱移位。肩关节和腕关节融合术在这些患者的整体治疗中也可发挥作用。最佳手术方案因患者的损伤水平和范围以及外科医生的偏好和经验而异。这些患者的术前和术后护理理想情况下应由有此类问题处理经验的团队进行管理，包括熟悉术后康复的人员。整个重建过程通常需要不止一次手术，术后康复时间长且强度大。然而，有积极性高的患者以及专注且专业的外科团队，功能恢复的预后良好，这些患者仍可过上有意义且满意的生活。
