Gupta Rohun, Herzog Isabel, Phung Lauren, Roth Jacquelyn, Weisberger Joseph, Luthringer Margaret, Lee Edward S, Ignatiuk Ashley
Division of Plastic and Reconstructive Surgery St. Louis University School of Medicine, St. Louis, MO, USA.
Department of Plastic Surgery Rutgers New Jersey School of Medicine, Newark, NJ, USA.
Adv Orthop. 2024 Aug 30;2024:7708192. doi: 10.1155/2024/7708192. eCollection 2024.
Brachial plexus injuries (BPI) from gunshot injuries are uncommon but usually severe and can cause chronic pain, loss of function, and permanent nerve damage. Multiple surgical techniques including neurolysis, end-to-end suture repair, and graft repair have been described for the treatment of these injuries. However, surgical indication, timing, and technique for these injuries remain controversial. This systematic review aims to investigate the treatment modalities for patients with BPI due to gunshot-related injuries.
The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) methodology was employed for this review. PubMed, Cochrane Reviews, Embase, and CINAHL databases were included. The following keywords constituted our search criteria: gun-shot-wounds, brachial plexus, traum, and management.
A total of 90 studies were imported for screening, from which 9 papers met our final inclusion/exclusion criteria. The most common studies utilized in this review were retrospective chart reviews followed by case series. In total, there were 628 patients that suffered from gunshot wounds to the brachial plexus. Most patients underwent some form of delayed nerve repair consisting of neurolysis, end-to-end epineural repair, or graft repair with a sural or antebrachial cutaneous nerve graft. Several patients suffered from complications, with neuroma being the most common long-term complication that required reoperation.
The optimal timing for surgeries involving BPIs should be determined after examining the level of nerve damage, associated injuries, operative risks, and electrophysiological workup for indications of spontaneous regeneration. Early surgical interventions were indicated for patients presenting with associated vascular or thoracic injuries, compressive masses, and nerve transection by sharp instruments in most selected papers.
枪伤导致的臂丛神经损伤（BPI）并不常见，但通常较为严重，可引起慢性疼痛、功能丧失和永久性神经损伤。已经描述了多种手术技术，包括神经松解术、端端缝合修复术和移植修复术来治疗这些损伤。然而，这些损伤的手术指征、时机和技术仍存在争议。本系统评价旨在研究因枪伤相关损伤导致臂丛神经损伤患者的治疗方式。
本评价采用系统评价和Meta分析的首选报告项目（PRISMA）方法。纳入了PubMed、Cochrane评价、Embase和CINAHL数据库。以下关键词构成了我们的搜索标准：枪伤、臂丛神经、创伤和管理。
共导入90项研究进行筛选，其中9篇论文符合我们最终的纳入/排除标准。本评价中最常用的研究是回顾性病历审查，其次是病例系列。总共有628例患者臂丛神经遭受枪伤。大多数患者接受了某种形式的延迟神经修复，包括神经松解术、端端神经外膜修复术或使用腓肠神经或前臂皮神经移植的移植修复术。有几名患者出现了并发症，神经瘤是最常见的需要再次手术的长期并发症。
涉及臂丛神经损伤的手术的最佳时机应在检查神经损伤程度、相关损伤情况、手术风险以及用于自发再生指征的电生理检查结果后确定。在大多数入选论文中，对于伴有血管或胸部损伤、压迫性肿块以及锐器导致神经横断的患者，建议早期进行手术干预。
