Secer Halil Ibrahim, Solmaz Ilker, Anik Ihsan, Izci Yusuf, Duz Bulent, Daneyemez Mehmet Kadri, Gonul Engin
Department of Neurosurgery, Gulhane Military Medical Academy, 06018 Etlik-Ankara, Turkey.
J Brachial Plex Peripher Nerve Inj. 2009 Jul 23;4:11. doi: 10.1186/1749-7221-4-11.
The management of brachial plexus injuries due to gunshot wounds is a surgical challenge. Better surgical strategies based on clinical and electrophysiological patterns are needed. The aim of this study is to clarify the factors which may influence the surgical technique and outcome of the brachial plexus lesions caused by gunshot injuries.
Two hundred and sixty five patients who had brachial plexus lesions caused by gunshot injuries were included in this study. All of them were male with a mean age of 22 years. Twenty-three patients were improved with conservative treatment while the others underwent surgical treatment. The patients were classified and managed according to the locations, clinical and electrophysiological findings, and coexisting lesions.
The wounding agent was shrapnel in 106 patients and bullet in 159 patients. Surgical procedures were performed from 6 weeks to 10 months after the injury. The majority of the lesions were repaired within 4 months were improved successfully. Good results were obtained in upper trunk and lateral cord lesions. The outcome was satisfactory if the nerve was intact and only compressed by fibrosis or the nerve was in-contunuity with neuroma or fibrosis.
Appropriate surgical techniques help the recovery from the lesions, especially in patients with complete functional loss. Intraoperative nerve status and the type of surgery significantly affect the final clinical outcome of the patients.
因枪伤导致的臂丛神经损伤的治疗是一项外科挑战。需要基于临床和电生理模式制定更好的手术策略。本研究的目的是阐明可能影响枪伤所致臂丛神经损伤的手术技术及预后的因素。
本研究纳入了265例因枪伤导致臂丛神经损伤的患者。所有患者均为男性，平均年龄22岁。23例患者经保守治疗后病情改善，其余患者接受了手术治疗。根据损伤部位、临床和电生理检查结果以及并存损伤对患者进行分类和治疗。
106例患者的致伤物为弹片，159例患者为子弹。手术在伤后6周至10个月进行。大多数在4个月内修复的损伤均成功改善。在上干和外侧束损伤中取得了良好效果。如果神经完整且仅被纤维化压迫，或者神经与神经瘤或纤维化连续，则预后令人满意。
适当的手术技术有助于损伤恢复，尤其是对于功能完全丧失的患者。术中神经状况和手术类型显著影响患者的最终临床预后。
