锁骨下臂丛神经损伤手术中的损伤模式、成像结果和肌力恢复预后

Q3 Medicine Journal of Hand Surgery Global Online Pub Date : 2024-11-01 DOI:10.1016/j.jhsg.2024.08.012

Julia S. Retzky MD , Clara Straus BA , Anil Bhatia MD , Darryl B. Sneag MD , Ogonna K. Nwawka MD , Steve K. Lee MD

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引用次数: 0

摘要

目的从历史上看，锁骨下臂丛神经损伤（IBPIs）被认为是神经缺氧性损伤，通过非手术干预即可改善。然而，最近的研究表明，这些损伤可能会从手术干预中获益。这项回顾性研究的目的是：(1) 描述孤立性外伤性 IBPIs 的损伤模式和相关损伤；(2) 评估接受手术治疗的 IBPIs 患者的术前超声和磁共振神经影像学检查结果与手术结果的一致性；(3) 描述手术治疗这些损伤的结果。结果最常见的受伤原因是机动车事故（74%）。22%的患者肩胛骨骨折与IBPI有关。孤立的分支损伤最常见（58.8%），其中孤立的肌皮神经损伤最常见（40.6%）。术前超声波和磁共振神经成像与手术结果一致的患者分别占 9 人中的 8 人和 9 人中的 7 人。神经转移是最常见的干预措施（46%）。结论锁骨臂丛神经损伤与高能量创伤和并发上肢骨折有关。在接受手术治疗的 IBPI 患者中，超声和磁共振神经影像学检查与手术结果大多一致。IBPIs 患者术后肌肉恢复的预后良好。临床意义锁骨臂丛神经损伤可通过手术干预得到改善。

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Injury Patterns, Imaging Findings, and Prognosis for Muscle Strength Recovery in Surgical Infraclavicular Brachial Plexus Injuries

Purpose

Historically, infraclavicular brachial plexus injuries (IBPIs) were considered neuropraxic injuries that would improve with nonsurgical intervention. However, more recent studies suggest that these injuries may benefit from surgical intervention. The aims of this retrospective study were to (1) describe injury patterns and associated injuries of isolated, traumatic IBPIs, (2) evaluate the concordance of preoperative ultrasound and magnetic resonance neurography with surgical findings of patients who underwent surgical intervention for IBPIs, and (3) describe outcomes of surgical intervention for these injuries.

Methods

A total of 148 patients who underwent surgical intervention for traumatic injury to the IBP by one of three hand/upper-extremity fellowship-trained surgeons from 1995 to 2021 were included. Patients with supraclavicular brachial plexus injuries, stretch injuries, nonsurgical IBPIs, and brachial plexus dysfunction without traumatic injury were excluded.

Results

The most common cause of injury was motor vehicle accident (74%). Scapular fractures were associated with IBPI in 22% of patients. Isolated branch injuries were the most common (58.8%), of which isolated musculocutaneous nerve injury was the most frequent (40.6%). Preoperative ultrasound and magnetic resonance neurography were concordant with surgical findings in eight of nine and seven of nine patients, respectively. Nerve transfers were the most common intervention (46%). Muscle strength improved after surgery, with an increase from 1 to 5 points on the Medical Research Council scale at 14–50 months after surgery.

Conclusions

Infraclavicular brachial plexus injuries are associated with high-energy trauma and concomitant upper-extremity fractures. Ultrasound and magnetic resonance neurography are mostly concordant with surgical findings in patients undergoing surgical intervention for IBPIs. Prognosis for muscle recovery after surgery is good in patients with IBPIs.