锁骨下血管合并臂丛损伤的处理

目的 探讨锁骨下动脉合并臂丛神经损伤的诊断和处理。方法 5例锁骨下动脉损伤合并臂丛损伤，其中锁骨下动脉第一段损伤1例，第三段损伤4例；2例合并动脉瘤，1例动脉瘤加动静脉瘘．2例血管纤维化自行闭塞。根据锁骨下动脉损伤性质，分别采用静脉移植、直接缝合、血管结扎处理，损伤臂丛神经采取直接缝合、神经松解。结果 3例开放性损伤患者早期手术修复动脉和神经，术后伤肢无疼痛，神经功能有不同程度恢复；2例闭合钝器伤晚期患者，1例行血管、神经松解术，仅疼痛减轻，1例血管臂丛神经广泛粘连，神经松解术后无任何恢复。结论 除原发性损伤外，进行性增大的血肿或假性动脉瘤压迫可加重臂丛神经损害．如能早期处理血肿或动脉瘤，解除压迫，可减轻神经损害，有利于臂丛神经功能恢复。

Treatment of combined subclavian artery and brachial plexus injury

Objective To investigate the treatment of combined subclavian artery and brachial plexus injury. Methods Since 1994, we have treated 5 cases of combined subclavian artery and brachial plexus injury. 2 of them were cut wound, 1 gun shot wound, and 2 blunt trauma. 2 cases had combined aneurysm and 1 had combined aneurysm plus A V fistula. According to the sites of subclavian artery injury, vein graft( 1 case) , suture repair( 1 cases) and ligation (1 case) were performed. The 2 cases of blunt trauma underwent only neurolysis because of masses of hematoma and tissue adhesion. Results The 3 cases of open injury who had underwent early repair of artery and nerve had various degrees of recovery of nerve functions and experienced no pain in the injured extremities. As for the 2 cases of blunt trauma, 1 got only pain relief and 1 had no recovery. Conclusion Dysfunction due to hematoma or progressive pseudoaneurysm compression on the brachial plexus can be relieved and patients can get maximal rehabilitation if hematoma or aneurysm is managed in time and the brachial plexus nerve is decompressed early.