Department of Orthopedic Surgery.
Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
Curr Opin Neurol. 2022 Dec 1;35(6):708-717. doi: 10.1097/WCO.0000000000001124. Epub 2022 Oct 27.
Traumatic brachial plexus injuries (BPI) are devastating life-altering events, with pervasive detrimental effects on a patient's physical, psychosocial, mental, and financial well-being. This review provides an understanding of the clinical evaluation, surgical indications, and available reconstructive options to allow for the best possible functional outcomes for patients with BPI.
The successful management of patients with BPI requires a multidisciplinary team approach including peripheral nerve surgeons, neurology, hand therapy, physical therapy, pain management, social work, and mental health. The initial diagnosis includes a detailed history, comprehensive physical examination, and critical review of imaging and electrodiagnostic studies. Surgical reconstruction depends on the timing of presentation and specific injury pattern. A full spectrum of techniques including neurolysis, nerve grafting, nerve transfers, free functional muscle transfers, tendon transfers, and joint arthrodesis are utilized.
Despite the devastating nature of BPI injuries, comprehensive care within a multidisciplinary team, open and practical discussions with patients about realistic expectations, and thoughtful reconstructive planning can provide patients with meaningful recovery.
创伤性臂丛神经损伤（BPI）是毁灭性的改变生活的事件，对患者的身体、心理社会、精神和经济福祉都有普遍的不利影响。本综述旨在了解临床评估、手术指征和现有的重建选择，以实现 BPI 患者的最佳功能结果。
BPI 患者的成功管理需要多学科团队方法，包括周围神经外科医生、神经科、手治疗师、物理治疗师、疼痛管理、社会工作者和心理健康专家。初始诊断包括详细的病史、全面的体格检查以及对影像学和电诊断研究的仔细审查。手术重建取决于就诊时间和特定的损伤模式。利用了一系列技术，包括神经松解术、神经移植术、神经转移术、游离功能性肌肉转移术、肌腱转移术和关节融合术。
尽管 BPI 损伤具有破坏性，但在多学科团队内进行全面护理、与患者进行开放和实际的讨论以了解现实期望、以及深思熟虑的重建计划，可以为患者提供有意义的康复。
