Department of Handsurgery, Peripheral Nerve Surgery and Rehabilitation, Clinic of Plastic and Reconstructive Surgery, Burn Center, Department of Hand- and Plastic Surgery, BG Trauma Center Ludwigshafen, University of Heidelberg, Heidelberg, Germany.
Arch Orthop Trauma Surg. 2023 Dec;143(12):7245-7253. doi: 10.1007/s00402-023-05009-3. Epub 2023 Aug 18.
Iatrogenic nerve lesions during surgical interventions are avoidable complications that may cause severe functional impairment. Hereby, awareness of physicians and knowledge of structures and interventions at risk is of utmost importance for prevention. As current literature is scarce, we evaluated all patients treated surgically due to peripheral nerve injuries in our specialized nerve center for the presence of iatrogenic nerve lesions.
We evaluated a total of 5026 patients with peripheral nerve injuries treated over a time period of 8 years in our facility for the prevalence of iatrogenic nerve injuries, their clinical presentations, time to treatment, mechanisms and intraoperative findings on nerve continuity.
A total of 360 (6.1%) patients had an iatrogenic cause resulting in 380 injured nerves. 76.6% of these lesions affected the main branch of the injured nerve, which were mainly the radial (30.5%), peroneal (13.7%) and median nerve (10.3%). After a mean delay of 237 ± 344 days, patients presented 23.2% with a motor and 27.9% with a mixed sensory and motor deficit. 72.6% of lesions were in-continuity lesions. Main interventions at risk are displayed for every nerve, frequently concerning osteosyntheses but also patient positioning and anesthesiologic interventions.
Awareness of major surgical complications such as iatrogenic nerve injuries is important for surgeons. An often-seen trivialization or "watch and wait" strategy results in a huge delay for starting an adequate therapy. The high number of in-continuity lesions mainly in close proximity to osteosyntheses makes diagnosis and treatment planning a delicate challenge, especially due to the varying clinical presentations we found. Diagnostics and therapy should therefore be performed as early as possible in specialized centers capable of performing nerve repair as well as salvage therapies.
手术干预过程中产生的医源性神经损伤是可以避免的并发症，可能导致严重的功能障碍。因此，医生需要了解相关知识并认识到哪些结构和操作存在风险，这对于预防此类损伤至关重要。由于目前文献较少，我们评估了在我们的神经专科中心接受手术治疗的所有周围神经损伤患者，以了解医源性神经损伤的发生情况。
我们评估了在我们的机构中接受手术治疗的 5026 例周围神经损伤患者，以了解医源性神经损伤的患病率、临床表现、治疗时机、神经连续性中断的机制和术中发现。
共有 360 例（6.1%）患者存在医源性损伤，导致 380 根神经受损。这些损伤中有 76.6%影响到受伤神经的主要分支，主要是桡神经（30.5%）、腓总神经（13.7%）和正中神经（10.3%）。在平均 237±344 天后，患者出现运动功能障碍的比例为 23.2%，出现运动和感觉混合功能障碍的比例为 27.9%。72.6%的损伤为连续性中断损伤。每个神经都存在高风险的主要干预措施，包括骨切开术，但也包括患者的体位和麻醉干预。
外科医生需要了解医源性神经损伤等主要手术并发症的相关知识。常见的是对这些损伤的轻视或“观察等待”策略，导致开始进行适当治疗的时间严重延迟。大量的连续性中断损伤主要发生在骨切开术附近，这使得诊断和治疗计划变得非常具有挑战性，尤其是因为我们发现了不同的临床表现。因此，在能够进行神经修复和挽救治疗的专科中心，应尽早进行诊断和治疗。
