臂丛神经多节段损伤的临床分析

发布时间：2018-06-17 19:52

本文选题：多节段 + 臂丛神经损伤　；参考：《广西医科大学》2015年硕士论文

【摘要】：目的：通过病例观察,了解和总结臂丛神经多节段损伤的机制,结合术中神经探查的结果,探讨臂丛多节段损伤的诊断和治疗,以期今后为此类损伤在临床诊疗上提供可靠参考依据。方法：查阅2012年10月至2015年1月在我科住院手术治疗的臂丛神经损伤的病例资料,筛选出臂丛神经多节段损伤患者52例,并对其进行随访。以获得随访的24例患者为研究对象,记录患者性别、伤侧、年龄、职业、文化程度、合并伤、损伤部位、手术方式以及术后疗效并进行分析。结果：2012年10月至2015年1月,在我科住院治疗臂丛神经损伤患者238例,其中臂丛多节段损伤患者52例,总发生率达21.8%(52/238)。其中获得随访者24例,2个节段损伤患者达91.7%(22/24),3个节段性损伤达8.3%(2/24)。受伤至首次手术时间为7天～7个月,平均2.43±2.15月,获得至少6个月以上随访的患者有18例,术后随访2～24个月,平均19.04±14.83月。本组24臂丛多节段损伤病例中1.男女性别比7：1,平均年龄25.06±13.01岁；2.职业中工人(农民工)达58.3%(14/24),无业人员达25%(6/24)；3.损伤原因中机器牵拉伤达58.3%(14/24)其次为摩托车伤达20.8%(5/24)；4.本组总共有合并伤患者达83.3%(20/24),合并同侧肢体骨折达62.5%(15/24)、合并脑外伤达20.8%(5/24)、合并血管肌肉损伤达16.7%(4/24)和脏器损伤达12.5%(3/24)；5.在本组中闭合性损伤达87.5%(21/24),开放性损伤达12.5%(3/24),锁骨上根干部损伤达20.8%(5/24),锁骨下束支部损伤达79.2%(19/24),上臂分支部损伤达91.6%(22/24),前臂分支部损伤达16.7%(4/24)；6.手术方式及预后：本组病例总肌力M3以上达55.0%(33/60),其中神经松解优良率最高达70.8%(17/24),其次是多组神经转位达42.9%(3/7)、神经转位41.2%(7/17),神经移植、神经吻合较差,均达40.0%(2/5)。结论：1.臂丛神经多节段损伤有较为特殊的受伤机制,损伤定位较为困难。2.考虑臂丛多节段损伤的患者,应尽早手术,分节段探查臂丛神经才能选择正确的治疗方案。
[Abstract]:Objective: to understand and summarize the mechanism of brachial plexus multisegmental injury through case observation, and to explore the diagnosis and treatment of brachial plexus multilevel injury combined with the results of intraoperative nerve exploration. In order to provide a reliable reference for the clinical diagnosis and treatment of this kind of injury in the future. Methods: from October 2012 to January 2015, 52 cases of brachial plexus injury were selected and followed up. The sex, side, age, occupation, education level, combined injury, location, operative method and postoperative outcome were recorded and analyzed in 24 patients who were followed up. Results: from October 2012 to January 2015, 238 cases of brachial plexus injury were treated in our department, including 52 cases of brachial plexus multisegmental injury. Among them, 24 cases were followed up, 91.7% 22 / 24% in 2 patients with segmental injury and 8.3% / 24% in 3 segmental injuries. The time from injury to the first operation was from 7 days to 7 months (mean 2.43 卤2.15 months). 18 patients were followed up for at least 6 months. The follow-up period was 2 to 24 months (mean 19.04 卤14.83 months). In 24 cases with multiple brachial plexus injury, 1. The ratio of male to female is 7: 1, with an average age of 25.06 卤13.01 years. The number of workers (migrant workers) in the occupation is 58.3%, 14 / 24%, and 25 / 25% of the unemployed. Of the causes of the injury, the mechanical strain was 58.3%, followed by the motorcycle injury of 20. 8%. A total of 83.3% of the patients were complicated with injury, 62.5% with ipsilateral limb fracture, 20 / 24 with brain injury, 16.775% with vascular and muscle injury and 12.5% with visceral injury. In this group, the closed injury was 87.5%, the open injury was 12.5%, the upper clavicular root injury was 20.8 / 24, the subclavian branch was 79.2% / 24%, the upper arm branch was 91.622% / 24%, the forearm branch was 16.77% / 424%. Operation mode and prognosis: in this group, the total muscle strength M _ 3 was over 55.0% and 33 / 60%, in which the excellent and good rate of nerve release was up to 70.8% and 17 / 24%, followed by the transposition of the nerve to 42.9% / 7%, the nerve transposition to 41.2% / 17%, the nerve graft and the nerve anastomosis were all 40.02% / 5 ~ (th) and the second was the nerve transposition of the multiple groups (42.9 / 7 / 7), the nerve transposition was poor, the nerve anastomosis was poor, and the nerve anastomosis was 40.02 / 5. Conclusion 1. The multiple segment injury of brachial plexus has a special injury mechanism, and the location of injury is difficult. 2. Patients with multiple brachial plexus injuries should be operated as early as possible and segmental exploration of brachial plexus nerve should be performed in order to select the correct treatment plan.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R688

【参考文献】