Gutkowska Olga, Martynkiewicz Jacek, Mizia Sylwia, Bąk Michał, Gosk Jerzy
Department of Traumatology, Clinical Department of Traumatology and Hand Surgery, Wroclaw Medical University, Wroclaw, Poland.
Department of Traumatology, Clinical Department of Traumatology and Hand Surgery, Wroclaw Medical University, Wroclaw, Poland.
World Neurosurg. 2017 Sep;105:623-631. doi: 10.1016/j.wneu.2017.06.059. Epub 2017 Jun 15.
Injury to the infraclavicular brachial plexus is an uncommon but serious complication of shoulder dislocation. This work aims to determine the effectiveness of operative treatment in patients with this type of injury.
Thirty-three patients (26 men and 7 women; mean age, 45 years and 3 months) treated operatively for brachial plexus injury resulting from shoulder dislocation between the years 2000 and 2013 were included in this retrospective case series. Motor function of affected limbs was assessed pre- and postoperatively with the use of the British Medical Research Council (BMRC) scale. Sensory function in the areas innervated by ulnar and median nerves was evaluated with the BMRC scale modified by Omer and Dellon and in the remaining areas with the Highet classification. Follow-up lasted 2-10 years (mean, 5.1 years).
Good postoperative recovery of nerve function was observed in 100% of musculocutaneous, 93.3% of radial, 66.7% of median, 64% of axillary, and 50% of ulnar nerve injuries. No recovery was observed in 5.6% of median, 6.7% of radial, 10% of ulnar, and 20% of axillary nerve injuries. Injury to a single nerve was associated with worse treatment outcome than multiple nerve injury.
Obtaining improvement in peripheral nerve function after injury resulting from shoulder dislocation may require operative intervention. The type of surgical procedure depends on intraoperative findings: sural nerve grafting in cases of neural elements' disruption, internal neurolysis when intraneural fibrosis is observed, and external neurolysis in the remaining cases. The outcomes of surgical treatment are good, and the risk of intra- and postoperative complications is low.
锁骨下臂丛神经损伤是肩关节脱位一种罕见但严重的并发症。本研究旨在确定手术治疗此类损伤患者的有效性。
本回顾性病例系列纳入了2000年至2013年间因肩关节脱位导致臂丛神经损伤而接受手术治疗的33例患者（26例男性和7例女性；平均年龄45岁3个月）。使用英国医学研究委员会（BMRC）量表在术前和术后评估患侧肢体的运动功能。采用经奥默和德龙改良的BMRC量表评估尺神经和正中神经支配区域的感觉功能，其余区域采用希格特分类法评估。随访持续2至10年（平均5.1年）。
肌皮神经损伤患者术后神经功能恢复良好率为100%，桡神经为93.3%，正中神经为66.7%，腋神经为64%，尺神经为50%。正中神经损伤患者中有5.6%、桡神经损伤患者中有6.7%、尺神经损伤患者中有10%以及腋神经损伤患者中有20%未出现恢复情况。单根神经损伤的治疗效果比多根神经损伤更差。
肩关节脱位导致的损伤后要改善周围神经功能可能需要手术干预。手术方式取决于术中所见：神经成分断裂时采用腓肠神经移植，观察到神经内纤维化时进行神经内松解，其余情况进行神经外松解。手术治疗效果良好，术中和术后并发症风险较低。
