Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago, Chicago, IL.
Pritzker School of Medicine, University of Chicago, Chicago, IL.
J Hand Surg Am. 2022 Jan;47(1):88.e1-88.e6. doi: 10.1016/j.jhsa.2021.03.020. Epub 2021 May 24.
Gunshot wounds can result in a spectrum of injuries to nerves, with little data to guide definitive treatment. We performed a retrospective evaluation of gunshot-related upper extremity injuries in an urban trauma center to analyze epidemiology, associated injuries, and short-term outcomes. We hypothesized that gunshot-related injuries would involve soft tissue cavitation, inducing axonotmesis and neuropraxia rather than neurotmesis injuries.
All patients over the age of 16 with upper extremity gunshot trauma from May 2018 to May 2019 were identified through the University of Chicago orthopaedic and general surgery trauma databases. Initial nerve injuries were identified by physical examination. Patient demographic data, soft tissue and skeletal injury, treatment modality, and return of function were collected.
Ballistic injuries in 1302 patients were treated over 12 months. We identified 126 upper extremity gunshot injuries in 117 patients. Thirty-eight upper extremities (38 patients) had a documented nerve deficit (38/126, 30%) with a follow-up rate of 94% (34/36) at a mean of 351 days after injury (median, 202 days; range, 13-929 days). One patient had a subacute transradial amputation, and 1 patient was deceased at final follow-up. The presence of vascular injury and fracture increased the rate of neurologic injury after gunshot injuries. At the most recent follow-up, 68% (23/34) of patients with upper extremity injury had improvement in nerve function as measured by objective clinical assessment, with 24% (8/34) experiencing full recovery at an average of 368 days (median, 261 days; range, 41-929 days).
Nerve injury after ballistic trauma to the upper extremity is common. Vascular injury and fractures were associated with a higher risk of nerve injury. Short-term improvement in nerve function was seen in over half the cohort, suggesting a predominance of neuropraxic effects.
TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic IV.
枪击伤可导致神经损伤谱，目前仅有少量数据可用于指导明确的治疗方法。我们对城市创伤中心的上肢枪击伤进行回顾性评估，以分析其流行病学、相关损伤和短期结果。我们假设枪击伤会导致软组织气穴现象，从而引起轴索断裂和神经失用，而不是神经断裂损伤。
通过芝加哥大学骨科和普通外科创伤数据库，确定 2018 年 5 月至 2019 年 5 月期间年龄在 16 岁以上的上肢枪击伤患者。通过体格检查确定初始神经损伤。收集患者的人口统计学数据、软组织和骨骼损伤、治疗方式以及功能恢复情况。
在 12 个月内治疗了 1302 例弹道伤患者。我们在 117 例患者中发现 126 例上肢枪击伤。38 只上肢（38 例患者）存在记录的神经缺损（38/126，30%），随访率为 94%（34/36），平均随访时间为损伤后 351 天（中位数，202 天；范围，13-929 天）。1 例患者发生亚急性桡动脉截断，1 例患者最终随访时死亡。血管损伤和骨折增加了枪击伤后神经损伤的发生率。在最近的随访中，34 例上肢损伤患者中有 68%（23/34）的神经功能得到客观临床评估改善，24%（8/34）在平均 368 天（中位数，261 天；范围，41-929 天）时完全恢复。
上肢弹道伤后神经损伤很常见。血管损伤和骨折与更高的神经损伤风险相关。超过一半的患者神经功能短期改善，提示以神经失用效应为主。
研究类型/证据水平：预后 IV 级。
