Department of Orthopaedic Surgery, The University of Chicago, 5758 S. Maryland Avenue, Dept. 4B, Chicago, IL, 60637, USA.
Eur J Orthop Surg Traumatol. 2023 May;33(4):851-856. doi: 10.1007/s00590-022-03220-3. Epub 2022 Feb 7.
The purpose of this study was to describe the frequency of nerve injury associated with lower extremity ballistic trauma, the associated skeletal and soft tissue injuries, and the rate of neurologic recovery.
A retrospective review of an institutional trauma database was completed at a single level 1 trauma academic medical center.
This was an institutional review board approved retrospective cohort study of patients over 16 years of age presenting with ballistic-related traumatic injury to the lower extremities between May 2018 and May 2019. All patients identified with lower extremity ballistic trauma were included in this study. The rate of nerve palsy, associated skeletal injury, and operative fixation were recorded for each anatomic zone. Rates of associated concomitant vascular injury, fracture, and compartment syndrome were collected through a review of the electronic medical records. Chart review was performed to evaluate outcomes and nerve recovery.
Twenty-one patients (21 extremities, 21/148, 14%) were diagnosed by attending physicians, fellowship-trained in orthopedic trauma, as having ballistic-related nerve injuries. Seventy-three percent of patients with a documented neurologic injury (11/15) demonstrated complete nerve recovery as measured by the MRC and sensory scale assessment at most recent follow-up, while the rest demonstrated no improvement in their neurologic deficits from presentation. The rate of associated vascular injury in patients with lower extremity nerve palsies was 38% (8/21). While the rate of vascular injury in the absence of neurologic injury was 3% (4/127).
This series of lower extremity nerve injuries in a large sample of urban lower extremity ballistic trauma noted a high rate of concomitant nerve injuries. An associated diagnosis of a vascular injury appears to portend a higher risk of neurologic injury. Treating surgeons should have a high index of suspicion for associated vascular injury in patients presenting with a ballistic lower extremity nerve palsy.
本研究旨在描述下肢弹道性创伤相关神经损伤的频率、相关的骨骼和软组织损伤以及神经恢复的比率。
在一家一级创伤学术医疗中心，对机构创伤数据库进行了回顾性分析。
这是一项经机构审查委员会批准的回顾性队列研究，纳入了 2018 年 5 月至 2019 年 5 月期间因下肢弹道性创伤而就诊的 16 岁以上患者。本研究纳入了所有下肢弹道性创伤患者。记录了每个解剖区域的神经麻痹率、相关骨骼损伤和手术固定率。通过查阅电子病历收集了相关伴随血管损伤、骨折和筋膜室综合征的发生率。通过病历回顾评估了结局和神经恢复情况。
21 名（21 条肢体，21/148，14%）经主治医生诊断为与弹道相关的神经损伤。15 名有记录的神经损伤患者中，73%（11/15）的患者在最近的随访中通过 MRC 和感觉量表评估显示完全神经恢复，而其余患者的神经功能缺损与就诊时相比没有改善。下肢神经麻痹患者的伴发血管损伤率为 38%（8/21），而无神经损伤患者的伴发血管损伤率为 3%（4/127）。
在大量的城市下肢弹道性创伤患者中，本系列下肢神经损伤中神经损伤的发生率很高。伴发血管损伤的诊断似乎预示着更高的神经损伤风险。治疗医生在遇到下肢弹道性神经麻痹的患者时，应高度怀疑伴发血管损伤。
