Ferguson John Scott, Franco Johnny, Pollack Jonathan, Rumbolo Peter, Smock Michael
Department of Surgery, Division of Plastic Surgery, Saint Louis University Hospital, St. Louis, MO 63110, USA.
J Burn Care Res. 2010 May-Jun;31(3):458-61. doi: 10.1097/BCR.0b013e3181db5183.
Nerve compression syndromes may cause postburn morbidity that can often be difficult to recognize and manage. This study reviewed patients in the authors' institution who needed nerve decompression secondary to thermal or electrical burns. The objective was to evaluate the timing of nerve decompression in the burn population. A 4-year review of the authors' institution's database found 22 patients who underwent peripheral neuroplasty. This patient population included both thermal and electrical burn patients. Two patients were excluded from the study because they underwent rapid forearm amputation, and a third patient who had his initial burn care done in Europe was also excluded. The authors reviewed the mechanism of burn: percentage of body surface area burned, which nerves underwent decompression, and time from burn to decompression. Nerve compression syndromes were diagnosed and treated in this group of patients from day 46 to 1530 post-burn. Carpal tunnel was the most common site of compression accounting for 46% of the nerve decompressions. Sixteen of the 19 (84%) patients required that synchronous nerves be decompressed. The average body surface area burn in the thermal group was 43 and 5% in the electrical burn group. Nerve compression syndromes secondary to burns can be a challenging problem to diagnose and treat. Multiple studies have shown the importance of treating nerve compressions in the acute setting; however, this study shows the importance of long-term surveillance, secondary to the late presentation of nerve compression syndromes. Late nerve compression neuropathies were present in both the electrical and thermal burn patients. The authors also found that presentation of a single nerve compression should raise the suspicion of a synchronous nerve compression. Patients with thermal burns greater than 20% body surface area and electrical burns should be routinely questioned and examined for the peripheral nerve compression syndromes during long-term follow-up.
神经压迫综合征可能导致烧伤后发病，其往往难以识别和处理。本研究回顾了作者所在机构中因热烧伤或电烧伤而需要进行神经减压的患者。目的是评估烧伤人群中神经减压的时机。对作者所在机构数据库进行的为期4年的回顾发现，有22例患者接受了周围神经成形术。该患者群体包括热烧伤和电烧伤患者。两名患者因接受了快速前臂截肢而被排除在研究之外，另一名最初在欧洲接受烧伤治疗的患者也被排除。作者回顾了烧伤机制、烧伤体表面积百分比、哪些神经接受了减压以及从烧伤到减压的时间。在这组患者中，神经压迫综合征在烧伤后第46天至1530天被诊断和治疗。腕管是最常见的受压部位，占神经减压的46%。19例患者中有16例（84%）需要对同步神经进行减压。热烧伤组的平均体表面积烧伤为43%，电烧伤组为5%。烧伤继发的神经压迫综合征可能是一个难以诊断和治疗的挑战性问题。多项研究表明在急性情况下治疗神经压迫的重要性；然而，本研究表明了长期监测的重要性，因为神经压迫综合征的表现较晚。电烧伤和热烧伤患者中均存在晚期神经压迫性神经病。作者还发现，单一神经压迫的表现应引起对同步神经压迫的怀疑。对于体表面积烧伤大于20%的热烧伤患者和电烧伤患者，在长期随访期间应常规询问并检查是否存在周围神经压迫综合征。
