Narakas A O
Int Orthop. 1985;9(1):29-36. doi: 10.1007/BF00267034.
The author describes 1068 patients with brachial plexus lesions who were referred to him during a period of 18 years. Seventy two percent of the injuries were caused by road traffic accidents. Traction or crush injuries were the usual type encountered. They may occur at five levels above, behind and below the clavicle. Of 329 patients who underwent operation, 23% had an associated injury of a major vessel and 80% had multiple injuries elsewhere. The operative approach preferred is described and the principles governing the choice of nerve repair, nerve graft and nerve transfer are discussed. The details of the problems encountered and the procedures carried out in this group of patients are given, and the results obtained are closely analysed. In about 15% of supraclavicular injuries reconstruction of the plexus is worthwhile. The results in infraclavicular lesions are much better with a high level of success if treated early. Only 5 patients had direct lacerations of nerves of the plexus and another 5 had suffered gunshot wounds. Only 11 out of 80 cases of obstetric palsy seen since 1976 have been operated on. The majority of the patients were seen late. At operation similar lesions were encountered as in adults, and useful improvement was obtained in some cases. In post-irradiation lesions of the plexus good results may be obtained if operation is undertaken early. Otherwise surgery should only be performed to relieve severe pain.
作者描述了18年间转诊给他的1068例臂丛神经损伤患者。72%的损伤由道路交通事故所致。牵拉伤或挤压伤是常见类型。这些损伤可发生于锁骨上方、后方及下方的五个平面。在329例行手术治疗的患者中，23%伴有主要血管损伤，80%在其他部位有多处损伤。文中描述了首选的手术入路，并讨论了神经修复、神经移植及神经移位选择的原则。给出了该组患者所遇到问题及实施手术的细节，并对所获结果进行了深入分析。约15%的锁骨上损伤值得进行臂丛神经重建。锁骨下损伤若早期治疗成功率较高，效果要好得多。仅有5例患者为臂丛神经直接撕裂伤，另有5例为枪伤。自1976年以来所见的80例产瘫患者中仅11例接受了手术治疗。大多数患者就诊较晚。手术中遇到的病变与成人相似，部分病例获得了有效的改善。在臂丛神经放疗后损伤中，若早期手术可取得良好效果。否则，手术仅应作为缓解剧痛的手段。
