Bull Hosp Jt Dis (2013). 2022 Jun;80(2):224-227.
Reported rates of nerve injury after upper extremity (UE) gunshot wound (GSW) range from 15% to 45%. Many surgeons prefer initial observation; however, this may delay diagnosis of neurotmesis and surgical treatment. We aimed to determine the incidence of nerve transection in adults after upper extremity GSWs.
This was a retrospective chart review approved by the institutional review board. Operative records of five orthopedic surgeons between 2014 to 2019 were filtered for ICD-10 and CPT codes cross-referenced to include both UE GSW assault and nerve injuries. Inclusion criteria consisted of age greater than 18 at time of injury, neurologic deficit on presentation, and surgical exploration nerve procedure. Records were reviewed for degree of nerve injury, procedure performed, and complications. Postoperative outcomes included nerve recovery, complications, and reoperation rate.
Of the 17 patients that fit the inclusion criteria, the incidence of complete nerve transection was 64.7% and the incidence of a complete or partial nerve transection was 70.6%. The most common location of GSWs was the hand (70.5%). Average time from date of injury to surgery was 26.1 days. There were 14 identifiable nerve injuries-complete transection in 11, partial transection in one, and contusion in two patients. Of patients with nerve transection, 72.7% sustained a fracture. Postoperative complications included stiffness, chronic pain, and wound infection. The re-operation rate was 29.4%. The average postoperative follow-up was 4.4 months. There was longer follow-up among nerve transection patients (5.3 months) compared to neuropraxia patients (2.68 months).
This study demonstrates a higher incidence of nerve transection in upper extremity GSW patients than previously reported. Predictors of nerve transection are GSWs to the hand and associated fracture.
据报道，上肢（UE）枪伤（GSW）后神经损伤的发生率为 15%至 45%。许多外科医生更喜欢初始观察；然而，这可能会延迟神经断裂的诊断和手术治疗。我们旨在确定成年人上肢 GSW 后神经横断的发生率。
这是一项经过机构审查委员会批准的回顾性图表审查。2014 年至 2019 年间，五位骨科外科医生的手术记录经过 ICD-10 和 CPT 代码筛选，交叉引用包括 UE GSW 攻击和神经损伤。纳入标准为受伤时年龄大于 18 岁、就诊时存在神经功能缺损、并进行手术探查神经程序。记录评估神经损伤程度、手术程序和并发症。术后结果包括神经恢复、并发症和再手术率。
符合纳入标准的 17 例患者中，完全性神经横断的发生率为 64.7%，完全或部分性神经横断的发生率为 70.6%。GSW 最常见的部位是手（70.5%）。从受伤日期到手术的平均时间为 26.1 天。有 14 例可识别的神经损伤-11 例完全横断，1 例部分横断，2 例挫伤。神经横断患者中，72.7%有骨折。术后并发症包括僵硬、慢性疼痛和伤口感染。再手术率为 29.4%。平均术后随访 4.4 个月。神经横断患者的随访时间（5.3 个月）长于神经失用症患者（2.68 个月）。
本研究表明，上肢 GSW 患者的神经横断发生率高于以往报道。神经横断的预测因素是手部 GSW 和相关骨折。
