Department of Anatomy, Otago School of Medical Sciences, University of Otago, Dunedin, New Zealand.
Int J Clin Pract. 2012 Apr;66(4):409-16. doi: 10.1111/j.1742-1241.2011.02869.x. Epub 2012 Feb 14.
Iatrogenic nerve injury causes distress and disability, and often leads to litigation. The scale and profile of these injuries has only be estimated from published case reports/series and analyses of medicolegal claims.
To determine the current spectrum of iatrogenic nerve injury in New Zealand by analysing treatment injury claims accepted by a national no-fault compensation scheme.
The Accident Compensation Corporation (ACC) provides national no-fault personal accident insurance cover, which extends to patients who have sustained a treatment injury from a registered healthcare professional. Nerve injury claims identified from 5227 treatment injury claims accepted by the ACC in 2009 were analysed.
From 327 claims, 292 (89.3%) documenting 313 iatrogenic nerve injuries contained sufficient information for analysis. Of these, 211 (67.4%) occurred in 11 surgical specialties, particularly orthopaedics and general surgery; the remainder involved phlebotomy services, anaesthesia and various medical specialties. The commonest causes of injury were malpositioning (n = 40), venepuncture (n = 26), intravenous cannulation (n = 21) and hip arthroplasty (n = 21). Most commonly injured were the median nerve and nerve roots (n = 32 each), brachial plexus (n = 26), and the ulnar nerve (n = 25). At least 34 (11.6%) patients were referred for surgical management of their nerve injury.
Iatrogenic nerve injuries are not rare and occur in almost all branches of medicine, with malpositioning under general anaesthesia and venepuncture as leading causes. Some of these injuries are probably unavoidable, but greater awareness of which nerves are at risk and in what context should facilitate the development and/or wider implementation of preventive strategies.
医源性神经损伤会导致痛苦和残疾，且常引发诉讼。这些损伤的规模和特征仅能根据已发表的病例报告/系列和医疗事故分析来估计。
通过分析国家无过错赔偿计划接受的治疗损伤索赔，确定新西兰当前医源性神经损伤的范围。
意外事故赔偿公司（ACC）提供国家无过错人身意外伤害保险，涵盖因注册医疗保健专业人员治疗而受伤的患者。对 ACC 在 2009 年接受的 5227 项治疗损伤索赔中确定的神经损伤索赔进行分析。
在 327 项索赔中，有 292 项（89.3%）记录了 313 次医源性神经损伤，其中有足够信息进行分析。这些索赔中，211 项（67.4%）发生在 11 个外科专业，尤其是矫形外科和普通外科；其余涉及采血服务、麻醉和各种医学专业。受伤的常见原因是定位不当（n=40）、静脉穿刺（n=26）、静脉置管（n=21）和髋关节置换术（n=21）。最常受伤的是正中神经和神经根（n=32 个）、臂丛神经（n=26 个）和尺神经（n=25 个）。至少有 34 名（11.6%）患者因神经损伤接受了手术治疗。
医源性神经损伤并不罕见，几乎发生在医学的所有分支中，全麻下定位不当和静脉穿刺是主要原因。其中一些损伤可能是不可避免的，但更多地了解哪些神经有风险以及在何种情况下，应有助于制定和/或更广泛地实施预防策略。
