Chambers James A, Hiles Claire L, Keene Brian P
Office of the Air Force Surgeon General, AFMSA/SG3XI, 7700 Arlington Boulevard, Suite 5156, Falls Church, VA 22042.
Department of Internal Medicine, San Antonio Military Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, TX 78234.
Mil Med. 2014 Jun;179(6):640-4. doi: 10.7205/MILMED-D-13-00457.
The Global War on Terrorism has achieved an unprecedented 90% casualty survival rate because of far forward surgical support, rapid transport, and body armor. Despite the remarkable protection body armor affords, peripheral nerve injuries continue to occur. The brachial plexus in particular is still susceptible to penetrating trauma through the axilla as well as blunt mechanisms. We report 1,818 individuals with reported cases of peripheral nerve injury, 97 of which had brachial plexus injury incident from Operation Iraqi Freedom and Operation Enduring Freedom. We suspect that true prevalence is higher as initial focus on vascular and orthopedic reconstruction in complex shoulder injuries may overlook brachial plexus lesions. Accordingly, emergency physicians, general and orthopedic trauma surgeons, and vascular surgeons should all consider the possibility of brachial plexus and other peripheral nerve injury for early and appropriate referral to surgeons (plastic, orthopedic, or neurosurgical) for further evaluation and reconstruction. The latter group should be familiar with appropriate modern diagnostic and initial as well as salvage therapeutic options.
由于前沿外科支持、快速转运和防弹衣，全球反恐战争取得了前所未有的90%的伤亡存活率。尽管防弹衣提供了显著的保护，但周围神经损伤仍不断发生。特别是臂丛神经，仍然容易受到通过腋窝的穿透性创伤以及钝性机制的影响。我们报告了1818例有周围神经损伤报告的个体，其中97例臂丛神经损伤发生在伊拉克自由行动和持久自由行动中。我们怀疑实际患病率更高，因为在复杂肩部损伤中最初对血管和骨科重建的关注可能会忽略臂丛神经损伤。因此，急诊医生、普通外科和骨科创伤外科医生以及血管外科医生都应考虑臂丛神经和其他周围神经损伤的可能性，以便早期并适当地将患者转诊给外科医生（整形外科、骨科或神经外科）进行进一步评估和重建。后一组医生应熟悉适当的现代诊断方法以及初始和挽救治疗方案。
