锁骨下血管损伤继发臂丛神经受压征的治疗

目的探讨创伤致锁骨下血管损伤继发臂丛神经受压的机制、临床分型、诊断及治疗。方法5例创伤致锁骨下血管损伤继发臂丛神经受压征,其中4例为血管损伤后局部血肿压迫臂丛神经，经清除血肿,修补、结扎动脉破口后,作神经外松解术。1例为锁骨下动脉栓塞合并臂丛神经根性撕脱伤,在行血栓取出术的同时行膈神经、副神经移位代肌皮神经与肩胛上神经术。结果术后平均随访13个月,按顾玉东的臂丛评定标准评价疗效优者2例、良1例、可2例。结论该征一旦确诊应立即手术,治疗效果佳。手术时间、血管破裂部位、裂口大小等均与预后有关。

The surgical timing of brachial plexus compression secondary to traumatized subclavicular vessels rupture

Objective To investigate the mechanism ,clinical classification , diagnosis and treatment in patients with brachial plexus compression caused by traumatized subclavicular vessels rupture. Methods Brachial plexus compression caused by traumatized subclavicular vessels rupture in 5 cases were involved. For 4 cases, compression of brachial plexus was due to local hematoma following vessel rupture, in which cases epineurolysis was done after hematoma clearance and repair and litigation of rupture of the vessels. For 1 case, brachial plexus root injury was complicated by thrombus of subclavian artery. Both thrombectomy and nerve transfer were performed. Phrenic nerve and accessory nerve was transferred to muslcutaneous and suprascapular nerve respectively. Results Over an average period of 13 months follow up, assessment criteria described by GU YuDong was done with a result of excellent 2 cases ,good 1 case, fair 2 case. Conclusions Once the diagnosis was made, operation be performed immediately thus satisfactory outcome can be obtained. Prognosis was related with surgical time, the region and size of vessel rupture.