Washington University School of Medicine, St. Louis, MO, USA.
Hand (N Y). 2023 Jan;18(1_suppl):14S-21S. doi: 10.1177/15589447211014613. Epub 2021 May 21.
There is variability in treatment strategies for patients with brachial plexus injury (BPI). We used qualitative research methods to better understand surgeons' rationale for treatment approaches. We hypothesized that distal nerve transfers would be preferred over exploration and nerve grafting of the brachial plexus.
We conducted semi-structured interviews with BPI surgeons to discuss 3 case vignettes: pan-plexus injury, upper trunk injury, and lower trunk injury. The interview guide included questions regarding overall treatment strategy, indications and utility of brachial plexus exploration, and the role of nerve grafting and/or nerve transfers. Interview transcripts were coded by 2 researchers. We performed inductive thematic analysis to collate these codes into themes, focusing on the role of brachial plexus exploration in the treatment of BPI.
Most surgeons routinely explore the supraclavicular brachial plexus in situations of pan-plexus and upper trunk injuries. Reasons to explore included the importance of obtaining a definitive root level diagnosis, perceived availability of donor nerve roots, timing of anticipated recovery, plans for distal reconstruction, and the potential for neurolysis. Very few explore lower trunk injuries, citing concern with technical difficulty and unfavorable risk-benefit profile.
Our analysis suggests that supraclavicular exploration remains a foundational component of surgical management of BPI, despite increasing utilization of distal nerve transfers. Availability of abundant donor axons and establishing an accurate diagnosis were cited as primary reasons in support of exploration. This analysis of surgeon interviews characterizes contemporary practices regarding the role of brachial plexus exploration in the treatment of BPI.
对于臂丛神经损伤（BPI）患者的治疗策略存在差异。我们使用定性研究方法来更好地理解外科医生治疗方法的原理。我们假设远端神经转移将优先于臂丛神经探查和神经移植。
我们对 BPI 外科医生进行了半结构化访谈，讨论了 3 个案例：全臂丛损伤、上干损伤和下干损伤。访谈指南包括有关整体治疗策略、臂丛神经探查的适应证和实用性以及神经移植和/或神经转移的作用的问题。采访记录由 2 位研究人员进行编码。我们进行了归纳主题分析，将这些代码整理成主题，重点关注臂丛神经探查在 BPI 治疗中的作用。
大多数外科医生在全臂丛和上干损伤的情况下常规探查锁骨上臂丛。探查的原因包括获得明确的神经根水平诊断的重要性、认为有供体神经根的可用性、预期恢复的时机、远端重建的计划以及神经松解的可能性。很少有探查下干损伤的情况，主要是因为担心技术难度和不利的风险效益比。
我们的分析表明，尽管越来越多地使用远端神经转移，但锁骨上探查仍然是 BPI 外科治疗的基础组成部分。丰富的供体轴突可用性和准确的诊断建立被认为是支持探查的主要原因。对外科医生访谈的分析描述了当前关于臂丛神经探查在 BPI 治疗中的作用的实践情况。
