Topuz Ali Kıvanç, Eroğlu Ahmet, Atabey Cem, Cetinkal Ahmet
Department of Neurosurgery, GATA Haydarpaşa Training Hospital, İstanbul, Turkey.
Ulus Travma Acil Cerrahi Derg. 2013 May;19(3):235-40. doi: 10.5505/tjtes.2013.02073.
In this retrospective study, we present the results and outcomes in our clinic of 28 patients over 8 years who received surgical treatment for peripheral nerve lesions due to gunshot injury.
The patients came to our clinic between January 2002 and February 2010. All came within 1-6 months after the initial gunshot injury and underwent surgery due to the diagnosis of peripheral nerve lesion. Preoperative and postoperative electromyographic analysis (EMG) and motor strength rating were performed on all patients. All patients were called for postoperative follow-up at 1, 6 and 12 months after surgery.
The mean time after initial injury before being seen at our clinic was 3.6 months (1 day - 6 months). The most commonly injured nerve was the sciatic nerve, in 14 cases (50%). Of the patients, 23 came due to a bullet injury (9 were civilian injury with a gun, 14 were military injury with a rifle) and 5 came due to shrapnel injury. Since in all cases integrity of the nervous tissue was fully intact, nerve grafting was not required during surgery. Relatively improved EMG findings, and recovery in motor functions were detected in cases who had undergone postoperative external epineurolysis plus decompression.
We recommend surgical treatment within the first six months in neural lesions, depending on gunshot injury, on the condition that surgical technique rules are obeyed (except infection, skin defect, vascular injury, and the presence of bone fracture).
在这项回顾性研究中,我们展示了8年间在我们诊所接受手术治疗的28例因枪伤导致周围神经损伤患者的结果和转归。
患者于2002年1月至2010年2月前来我们诊所。所有患者均在初次枪伤后1 - 6个月内就诊,因诊断为周围神经损伤而接受手术。对所有患者进行术前和术后肌电图分析(EMG)及肌力评级。所有患者在术后1、6和12个月进行随访。
在我们诊所初次就诊前距初次受伤的平均时间为3.6个月(1天 - 6个月)。最常受伤的神经是坐骨神经,共14例(50%)。其中23例患者因子弹伤就诊(9例为平民枪支伤,14例为军人步枪伤),5例因弹片伤就诊。由于所有病例神经组织完整性完全完好,手术期间无需进行神经移植。在接受术后外膜松解加减压术的病例中,检测到肌电图结果相对改善以及运动功能恢复。
我们建议,对于神经损伤,在遵守手术技术规则的情况下(除感染、皮肤缺损、血管损伤和存在骨折外),根据枪伤情况,在伤后前六个月内进行手术治疗。