Iordache Sorin Daniel, Gorski Albert, Nahas Marwa, Feintuch Lior, Rahamimov Nimrod, Frenkel Rutenberg Tal
Department of Orthopedic Surgery and Traumatology, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Isr Med Assoc J. 2021 May;23(5):279-285.
The collapse of the Syrian healthcare system during the civil war led numerous citizens to cross the Syrian-Israeli border to seek medical care.
To describe the epidemiology of peripheral nerve injuries (PNIs) sustained in war, their management, and short-term outcomes.
A retrospective case series study was conducted on 45 consecutive patients aged 25.7 ± 9.3 years. These patients were referred to the hand surgery unit of the department of orthopedic surgery and traumatology at Galilee Medical Center between December 2014 and June 2018. Median time between injury and presentation was 60 days. Injury pattern, additional injuries, surgical findings and management, complications, and length of hospital stay were extracted from medical records.
Most injuries were blast (55.6%) followed by gunshot injuries (37.8%). There were 9 brachial plexus injuries, 9 sciatic nerve injuries, and 38 PNIs distal to the plexus: specifically 20 ulnar, 11 median, and 7 radial nerve injuries. In the latter group, neurotmesis or axonotmesis was found in 29 nerves. Coaptation was possible in 21 nerves necessitating cable grafting in 19. A tendon transfer was performed for 13 peripheral nerves, occasionally supplementing the nerve repair. The patients returned to their country after discharge, average follow-up was 53.6 ± 49.6 days.
For nerve injuries sustained in war, early surgical treatment and providing adequate soft tissue conditions is recommended. Tendon transfers are useful to regain early function.
叙利亚内战期间医疗体系的崩溃导致众多公民穿越叙利亚 - 以色列边境寻求医疗救治。
描述战争中遭受的周围神经损伤（PNI）的流行病学、治疗方法及短期预后。
对45例年龄在25.7±9.3岁的连续患者进行回顾性病例系列研究。这些患者于2014年12月至2018年6月间被转诊至加利利医疗中心骨科与创伤科的手外科。受伤至就诊的中位时间为60天。从病历中提取损伤类型、合并损伤、手术所见及治疗方法、并发症和住院时间。
大多数损伤为爆炸伤（55.6%），其次是枪伤（37.8%）。有9例臂丛神经损伤、9例坐骨神经损伤，以及38例神经丛远端的周围神经损伤：具体为20例尺神经损伤、11例正中神经损伤和7例桡神经损伤。在后一组中，29条神经发现有神经断裂或轴索断裂。21条神经可行端端吻合，其中19条需要进行电缆移植。对13条周围神经进行了肌腱转位，偶尔辅助神经修复。患者出院后回国，平均随访时间为53.6±49.6天。
对于战争中遭受的神经损伤，建议早期手术治疗并提供充足的软组织条件。肌腱转位有助于早期恢复功能。
