Midha R
Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada.
Neurosurgery. 1997 Jun;40(6):1182-8; discussion 1188-9. doi: 10.1097/00006123-199706000-00014.
The purpose was to identify the prevalence, causative factors, injury types, and associated injury patterns in multitrauma patients who sustained brachial plexus injuries.
A retrospective review of a prospectively collected and computerized database and a chart review were performed.
Brachial plexus injuries were identified in 54 of 4538 (1.2%) patients presenting to a regional trauma facility. Young male patients predominated. Motor vehicle accidents were the most frequent cause overall, but only 0.67% of such accidents resulted in plexus injuries. Conversely, 4.2% of motorcycle accident victims and 4.8% of snowmobile accident victims suffered brachial plexus injuries. Injuries were supraclavicular for 62% of patients and infraclavicular for 38%. Supraclavicular injuries were more likely to be severe (Sunderland Grade 3 or 4), compared with infraclavicular injuries, which were neurapraxic in 50% of cases (P < 0.01). The former therefore required surgical exploration and reconstruction more often (52 versus 17%; P < 0.05). Associated injuries included closed head injuries with loss of consciousness in 72% of patients (coma in 19%), cervical spine fractures in 13%, and clavicle, scapular, or humeral fractures and shoulder dislocations or sprains in 15 to 22%. Rib fractures were observed in 41% and were complicated by internal thoracic injuries in a similar percentage of cases. The injury severity score ranged from 5 to 59, with a mean of 24, and two patients died.
Brachial plexus injuries afflict slightly more than 1% of multitrauma victims. Motorcycle and snowmobile accidents carry especially high risks, with the incidence of injury approaching 5%. Head injuries, thoracic injuries, and fractures and dislocations affecting the shoulder girdle and cervical spine are particularly common associated injuries. Supraclavicular injuries are more common, are of more severe grade, more often require surgery, and are associated with worse prognosis, compared with infraclavicular injuries.
确定合并臂丛神经损伤的多发伤患者的患病率、致病因素、损伤类型及相关损伤模式。
对前瞻性收集并计算机化的数据库进行回顾性分析，并查阅病历。
在一家地区创伤中心就诊的4538例患者中，有54例（1.2%）被诊断为臂丛神经损伤。以年轻男性患者为主。机动车事故是总体上最常见的病因，但此类事故中仅有0.67%导致臂丛神经损伤。相反，4.2%的摩托车事故受害者和4.8%的雪地摩托事故受害者患有臂丛神经损伤。62%的患者损伤位于锁骨上，38%位于锁骨下。与锁骨下损伤相比，锁骨上损伤更可能较为严重（桑德兰3级或4级），锁骨下损伤50%为神经失用（P<0.01）。因此，前者更常需要手术探查和重建（52%对17%；P<0.05）。相关损伤包括72%的患者存在闭合性颅脑损伤并伴有意识丧失（19%为昏迷），13%有颈椎骨折，15%至22%有锁骨、肩胛骨或肱骨骨折以及肩关节脱位或扭伤。41%的患者有肋骨骨折，且类似比例的病例并发胸内损伤。损伤严重程度评分范围为5至59分，平均为24分，2例患者死亡。
臂丛神经损伤在略多于1%的多发伤受害者中出现。摩托车和雪地摩托事故的风险尤其高，损伤发生率接近5%。头部损伤、胸部损伤以及影响肩带和颈椎的骨折与脱位是特别常见的相关损伤。与锁骨下损伤相比，锁骨上损伤更常见、程度更严重、更常需要手术且预后更差。
