Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University and Military University Hospital Prague, Prague, Czech Republic.
Department of Anesthesiology and Critical Care Medicine, Third Faculty of Medicine, Charles University and Hospital Královské Vinohrady, Prague, Czech Republic.
Neurosurg Rev. 2020 Apr;43(2):443-452. doi: 10.1007/s10143-018-1009-2. Epub 2018 Jul 17.
The literature describing epidemiology, etiology, and types of serious brachial plexus injuries (BPIs) is sparse. The aim of this review was to investigate the epidemiological and etiopathogenetical data of serious BPIs undergoing surgical reconstruction. A systematic search was conducted from January 1985 to December 2017. All studies that reported data about prevalence of specific types and causes of BPIs in adults treated surgically were included and cumulatively analyzed. Ten studies including 3032 patients were identified. The pooled prevalence of closed BPIs was 93% (95% CI: 87-97%), lacerations accounted for 3% (95% CI: 1-6%), and gunshot wounds (GSWs) for 3% (95% CI: 0-7%). The prevalence of male patients was 93% (95% CI: 90-96%) and female cases 7% (95% CI: 4-10%). The most common cause of closed BPI was motorcycle accidents with 67% (95% CI: 49-82%) prevalence followed by car crashes with 14% (95% CI: 8-20%). Other causes were rare. Ninety percent (95% CI: 78-98%) of patients suffered from a supraclavicular or combined supra-/infraclavicular trauma, while 10% (95% CI: 2-22%) from isolated infraclavicular injury. The prevalence of complete lesions was 53% (95% CI: 47-58%) followed by upper plexus lesion with 39% (95% CI: 31-48%) and lower plexus injury with 6% (95% CI: 1-12%). This meta-analysis demonstrates that the typical patient suffering from severe BPI is a male after motorcycle accident with closed supraclavicular injury causing complete or slightly less commonly upper plexus palsy. Lacerations and GSWs of brachial plexus are rare.
描述严重臂丛神经损伤（BPI）的流行病学、病因学和类型的文献很少。本综述的目的是调查接受手术重建的严重 BPI 的流行病学和病因数据。从 1985 年 1 月至 2017 年 12 月进行了系统搜索。纳入并累积分析了所有报告成人特定类型和 BPI 病因发生率数据的研究。确定了 10 项研究，共纳入 3032 例患者。闭合性 BPI 的总患病率为 93%（95%CI：87-97%），撕裂伤占 3%（95%CI：1-6%），枪伤占 3%（95%CI：0-7%）。男性患者的患病率为 93%（95%CI：90-96%），女性为 7%（95%CI：4-10%）。闭合性 BPI 最常见的原因是摩托车事故，患病率为 67%（95%CI：49-82%），其次是车祸，患病率为 14%（95%CI：8-20%）。其他原因很少见。90%（95%CI：78-98%）的患者患有锁骨上或合并锁骨上/下臂丛神经损伤，10%（95%CI：2-22%）的患者患有孤立性锁骨下损伤。完全性损伤的患病率为 53%（95%CI：47-58%），其次是上丛神经损伤，患病率为 39%（95%CI：31-48%），下丛神经损伤，患病率为 6%（95%CI：1-12%）。这项荟萃分析表明，患有严重 BPI 的典型患者是男性，因摩托车事故导致锁骨上闭合性损伤，造成完全性或稍不常见的上丛神经麻痹。臂丛神经撕裂伤和枪伤很少见。
