Langridge Benjamin, Griffin Michelle F, Akhavani M A, Butler Peter E
Department of Plastic Surgery, Royal Free Hospital, London, United Kingdom.
Charles Wolfson Center for Reconstructive Surgery, Royal Free Hospital, London, United Kingdom.
J Hand Microsurg. 2020 Apr;12(1):27-31. doi: 10.1055/s-0039-1692928. Epub 2019 Jul 7.
Peripheral nerve injuries in children are uncommon and can be challenging to diagnose. There is a paucity of data on long-term sensorimotor and functional outcomes following surgical repair. We present a 12-year retrospective analysis of pediatric peripheral nerve repair with long-term functional outcomes. We performed a retrospective analysis of pediatric patients with peripheral nerve injury requiring surgical repair. Clinical records were analyzed for procedure type, time to surgery, mechanism of injury, postoperative recovery, and complications. A total of 108 patients were identified and 87 patients were included. Out of 87 patients, 83 (95.4%) had partial or complete sensorimotor recovery at final follow-up and 4 did not improve. Minor complications occurred in 10.3% of patients, all resolved with conservative management. Mechanisms of injury were predominantly lacerations with sharp objects or crush injuries. Age at time of injury was inversely correlated with sensorimotor recovery, and time to surgical repair was not. Surgical repair with long-term hand therapy results in excellent functional outcomes following pediatric peripheral nerve injury. A low threshold for exploration and repair should be used in instances of diagnostic uncertainty. Timing of surgical repair is dependent on a patient's clinical presentation; however, repair within 48 hours is sufficient for optimal sensorimotor recovery.
儿童周围神经损伤并不常见,诊断起来可能具有挑战性。关于手术修复后长期感觉运动和功能结果的数据很少。我们对小儿周围神经修复及其长期功能结果进行了一项为期12年的回顾性分析。
我们对需要手术修复的小儿周围神经损伤患者进行了回顾性分析。分析临床记录,了解手术类型、手术时间、损伤机制、术后恢复情况和并发症。
共确定了108例患者,纳入87例。在87例患者中,83例(95.4%)在末次随访时获得部分或完全感觉运动恢复,4例未改善。10.3%的患者发生轻微并发症,均经保守治疗后缓解。损伤机制主要为锐器切割伤或挤压伤。受伤时的年龄与感觉运动恢复呈负相关,而手术修复时间则无此关联。
小儿周围神经损伤后,手术修复结合长期手部治疗可带来良好的功能结果。在诊断存在不确定性的情况下,应采用较低的探查和修复阈值。手术修复的时机取决于患者的临床表现;然而,48小时内进行修复足以实现最佳感觉运动恢复。