创伤继发臂丛神经急性卡压征

目的　总结创伤继发臂丛神经急性卡压征的病因、症状与体征、治疗及预后。方法　 12例因创伤引起肩锁区肿胀、瘀血、压痛、畸形外 ,肩锁区存在搏动感及血管杂音 ;臂丛下干支配区感觉及 /或功能障碍。伴肋骨、锁骨、多处骨折 7例 ;锁骨下血管损伤 (破裂、假性动脉瘤、动静脉瘘 ) 9例 ,血肿 3例。诊断为创伤继发臂丛神经急性卡压征。采用假性动脉瘤切除动脉直接缝合或静脉移植 3例 ,血管吻合、修补术 4例 ,血管结扎 2例 ,血肿去除 3例。骨折切开复位内固定 8例 ,臂丛神经松解术 12例。结果　 12例术后平均随访 2 6个月 ,患侧的桡动脉搏动良好 ,肩胛带骨折已骨性愈合。臂丛神经功能恢复按中华医学会手外科学会上肢部分功能评定试用标准评定[1] :优 11例 ,可 1例。结论　创伤继发臂丛神经急性卡压的病例起病急 ,在伤后 2～ 3h或 1～ 2d内发生。除有臂丛神经损伤症状外 ,还伴有肩胛带骨折及锁骨下血管损伤。早期手术预后较好。

Acute post-traumatic brachial plexus compression

ObjectiveThe injury mechanisms, clinical manifestation, diagnosis, treatment and prognosis of acute brachial plexus compression after trauma were presented.Methods12 acute trauma cases were involved in this series. Symptoms and signs included swelling, hematoma, tenderness and deformity of the clavicle shoulder region, presence of pulsation and vascular murmur, and impaired sensory and motor function of the territory innervated by lower trunk of the brachial plexus. 7 cases had rib fracture, clavicle fracture or multiple fractures. Injuries of the subclavicle vessels (vessel rupture, pseudoaneurysm, artero venous fistula) were found in 9 cases. Hematoma was seen in 3 cases. Diagnosis of acute brachial plexus compression secondary to trauma was diagnosed and surgical exploration was carried out in all cases.ResultsIn 3 cases, pseudoaneurysm was excised and the subclavicular artery was repaired by direct anastomosis or vein graft. Repair of the ruptured vessels was done in 4 cases, while another 2 were managed with vessel ligation. Removal of hematoma was done in 3 cases. 8 cases underwent open reduction and internal fixation of the fractured bones. All of 12 cases had neurolysis of the brachial plexus. Postoperatively the patients were followed for an average of 26 months. The patients had strong pulsation at the radial artery of the affected side. All fractures were healed. Assessment of the upper limb function using the standard issued by the Hand Surgery Society of Chinese Medical Association graded 11 cases as excellent and 1 case as fair.ConclusionBrachial plexus entrapment secondary to trauma has an acute onset, usually occurring within 2 to 3 hours or 1 to 2 days after the injury. In addition to brachial plexus neuropathy, fractures of the shoulder girdle and subclavicle vessel injuries are often present. Early surgical intervention can lead to satisfactory results.