Narakas A
Clin Orthop Relat Res. 1978 Jun(133):71-90.
A series of 508 patients with traction injuries of the brachial plexus (birth trauma excluded) has been investigated over a period of 11 years. Severe cases with root avulsions, ruptures of nervous pathways or severe disorganization of funiculi do not heal spontaneously or heal poorly. Whether these patients can benefit from modern microsurgical techniques (neurolyses, autologous nerve grafts and neurotizations with intercostal or other nerves) is presently under investigation. Operations were performed on 164 patients of whom 114 had root avulsions and 16 had 2 level injuries. Surgical treatment was planned according to the severity of the lesion. In about 10% no reconstruction was possible, or was of doubtful value. There is a striking difference in results of supraclavicular and distal, infraclavicular lesions. Only 55% positive of 58 patients of the first group were improved while 85% of 20 patients of the second group were benefited to some extent. None of the patients belonging to the first or second group recovered hand intrinsic function if pathways coming from C8 and T1 were injures. None recovered tactile gnosis. The effect on pain was sometimes ameliorative, but generally unpredictable.
在11年的时间里，对508例臂丛神经牵拉伤患者（不包括产伤）进行了一系列研究。伴有神经根撕脱、神经通路断裂或束严重紊乱的严重病例不会自发愈合或愈合不良。这些患者是否能从现代显微外科技术（神经松解术、自体神经移植以及肋间神经或其他神经的神经转位术）中获益目前正在研究中。对164例患者进行了手术，其中114例有神经根撕脱，16例有二级损伤。根据损伤的严重程度制定手术治疗方案。约10%的患者无法进行重建，或重建价值存疑。锁骨上病变和锁骨下远端病变的结果存在显著差异。第一组58例患者中只有55%好转，而第二组20例患者中有85%在一定程度上受益。如果来自C8和T1的神经通路受损，第一组或第二组患者均未恢复手部固有功能。无一例恢复触觉识别。对疼痛的影响有时有所改善，但总体上不可预测。
