Stiasny Jerzy, Birkeland Peter
Neurokirurgisk Afdeling, Odense Universitetshospital, Søndre Boulevard 29, 5000 Odense C, Denmark.
Dan Med J. 2015 Mar;62(3).
Brachial plexus injuries are usually a result of road traffic accidents and a cause of severe disability that typically affects young adult males. In 2010, a national centre was established for referral of these cases from Danish trauma centres. In this paper, we report on our surgical activity and reflect on the role for this new national centre.
Records from all our operated patients were reviewed retrospectively. For outcome analysis, we focused on patients who had sustained traction injuries with a surgical follow-up exceeding one year. We used either nerve grafting or transfers for nerve repairs based on the pattern of nerve injury seen intraoperatively.
Overall, 24 patients were operated, and 12 patients were included in the outcome analysis. The six patients with upper brachial plexus palsies all regained shoulder function and useful elbow flexion. Of the six patients with complete brachial plexus palsies, four regained shoulder function, while only one regained useful elbow function, and this was after nerve transfers.
Operative treatment provides satisfactory results in patients with upper brachial plexus palsies, while improvement is warranted in patients with complete brachial plexus palsies. Our data suggest that nerve transfers may result in a better functional outcome than nerve grafting. We believe that there is a role for a Danish centre for the treatment of these injuries.
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臂丛神经损伤通常是道路交通事故的结果，是导致严重残疾的原因，通常影响年轻成年男性。2010年，设立了一个国家中心，用于接收丹麦创伤中心转诊的这些病例。在本文中，我们报告了我们的手术活动，并思考了这个新国家中心的作用。
对所有接受手术患者的记录进行回顾性审查。为了进行结果分析，我们重点关注那些遭受牵拉伤且手术随访超过一年的患者。根据术中所见的神经损伤模式，我们使用神经移植或神经移位进行神经修复。
总体而言，24例患者接受了手术，12例患者纳入结果分析。6例上臂丛神经麻痹患者均恢复了肩部功能和有用的肘关节屈曲功能。6例完全性臂丛神经麻痹患者中，4例恢复了肩部功能，而只有1例恢复了有用的肘关节功能，且这是在进行神经移位后实现的。
手术治疗在上臂丛神经麻痹患者中取得了满意的结果，而完全性臂丛神经麻痹患者仍需改善。我们的数据表明，神经移位可能比神经移植产生更好的功能结果。我们认为丹麦有一个治疗这些损伤的中心是有必要的。
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