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左髋臼骨折切开复位内固定术后臂丛神经失用症

Brachial Plexus Neuropraxia Post Open Reduction and Internal Fixation of Left Acetabulum Fracture.

作者信息

Alshehri Turki, Alhassan Mohammed Abdulhadi, Muharraq Ali Ahmed, Pasha Abdulrahman Adil

机构信息

Department of Trauma and Orthopedic Surgery, Armed Forces Hospital Southern Region, Khamis Mushait, Saudi Arabia.

Department of Orthopedic, King Saud Medical City, Riyadh, Saudi Arabia.

出版信息

J Orthop Case Rep. 2025 May;15(5):43-49. doi: 10.13107/jocr.2025.v15.i05.5550.

DOI:10.13107/jocr.2025.v15.i05.5550
PMID:40351609
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12064220/
Abstract

INTRODUCTION

Acetabular fractures are often sustained injuries linked to high-energy trauma, such as falls from a considerable height or road traffic incidents. The modified Stoppa technique is currently used approach to treat acetabular fractures. The brachial plexus injury following open reduction and internal fixation (ORIF) of the left acetabulum fracture wasn't reported before.

CASE REPORT

Herein we presented a case of a 16-years-old male with a history of road traffic accident sustained an isolated close left acetabulum fracture. X-ray shows associated both column acetabulum fracture with central subluxation. He was managed with open reduction and internal fixation through a modified Stoppa approach with a lateral window. The patient underwent ORIF on the 6th day of the trauma. Fixation was done with plates and screws. At recovery room he could not move whole left upper limb and no sensation while the operated limb DNV was intact. After 15 min of recovery, sensation returned, but motor deficit persisted, indicating brachial plexus neuropraxia. The brain CT scan of was performed and unremarkable finding. After 6 months, the patient restores his sensation on his own, and improved power 5/5 of the left upper limb.

CONCLUSION

Long stays under general anesthesia and patient position are considerable causes of BPI. Early diagnosis (clinical/imaging) and management typically involve conservative measures, with most patients achieving full recovery. Prevention procedures are essential, including monitoring the patient and proper intraoperative positioning to avoid such nerve injury.

摘要

引言

髋臼骨折通常是与高能量创伤相关的连续性损伤，如从相当高度坠落或道路交通事故。改良的Stoppa技术是目前用于治疗髋臼骨折的方法。此前未见左髋臼骨折切开复位内固定（ORIF）术后臂丛神经损伤的报道。

病例报告

在此，我们报告一例16岁男性，有道路交通事故史，单纯闭合性左髋臼骨折。X线显示双侧髋臼柱骨折伴中心性半脱位。通过改良的Stoppa入路并带有外侧窗口对其进行切开复位内固定治疗。患者在受伤后第6天接受了ORIF。使用钢板和螺钉进行固定。在恢复室，他整个左上肢无法活动且无感觉，而手术肢体的远端神经血管功能正常。恢复15分钟后，感觉恢复，但运动功能障碍持续存在，提示臂丛神经失用。进行了脑部CT扫描，结果未见异常。6个月后，患者自行恢复了感觉，左上肢力量改善至5/5。

结论

全身麻醉下的长时间停留和患者体位是臂丛神经损伤的重要原因。早期诊断（临床/影像学）和处理通常包括保守措施，大多数患者可实现完全康复。预防措施至关重要，包括对患者的监测和正确的术中体位摆放以避免此类神经损伤。

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