本文選題：多節(jié)段 + 臂叢神經(jīng)損傷　； 參考：《廣西醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的：通過病例觀察,了解和總結(jié)臂叢神經(jīng)多節(jié)段損傷的機制,結(jié)合術(shù)中神經(jīng)探查的結(jié)果,探討臂叢多節(jié)段損傷的診斷和治療,以期今后為此類損傷在臨床診療上提供可靠參考依據(jù)。方法：查閱2012年10月至2015年1月在我科住院手術(shù)治療的臂叢神經(jīng)損傷的病例資料,篩選出臂叢神經(jīng)多節(jié)段損傷患者52例,并對其進行隨訪。以獲得隨訪的24例患者為研究對象,記錄患者性別、傷側(cè)、年齡、職業(yè)、文化程度、合并傷、損傷部位、手術(shù)方式以及術(shù)后療效并進行分析。結(jié)果：2012年10月至2015年1月,在我科住院治療臂叢神經(jīng)損傷患者238例,其中臂叢多節(jié)段損傷患者52例,總發(fā)生率達21.8%(52/238)。其中獲得隨訪者24例,2個節(jié)段損傷患者達91.7%(22/24),3個節(jié)段性損傷達8.3%(2/24)。受傷至首次手術(shù)時間為7天～7個月,平均2.43±2.15月,獲得至少6個月以上隨訪的患者有18例,術(shù)后隨訪2～24個月,平均19.04±14.83月。本組24臂叢多節(jié)段損傷病例中1.男女性別比7：1,平均年齡25.06±13.01歲；2.職業(yè)中工人(農(nóng)民工)達58.3%(14/24),無業(yè)人員達25%(6/24)；3.損傷原因中機器牽拉傷達58.3%(14/24)其次為摩托車傷達20.8%(5/24)；4.本組總共有合并傷患者達83.3%(20/24),合并同側(cè)肢體骨折達62.5%(15/24)、合并腦外傷達20.8%(5/24)、合并血管肌肉損傷達16.7%(4/24)和臟器損傷達12.5%(3/24)；5.在本組中閉合性損傷達87.5%(21/24),開放性損傷達12.5%(3/24),鎖骨上根干部損傷達20.8%(5/24),鎖骨下束支部損傷達79.2%(19/24),上臂分支部損傷達91.6%(22/24),前臂分支部損傷達16.7%(4/24)；6.手術(shù)方式及預(yù)后：本組病例總肌力M3以上達55.0%(33/60),其中神經(jīng)松解優(yōu)良率最高達70.8%(17/24),其次是多組神經(jīng)轉(zhuǎn)位達42.9%(3/7)、神經(jīng)轉(zhuǎn)位41.2%(7/17),神經(jīng)移植、神經(jīng)吻合較差,均達40.0%(2/5)。結(jié)論：1.臂叢神經(jīng)多節(jié)段損傷有較為特殊的受傷機制,損傷定位較為困難。2.考慮臂叢多節(jié)段損傷的患者,應(yīng)盡早手術(shù),分節(jié)段探查臂叢神經(jīng)才能選擇正確的治療方案。
[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 鹵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 鹵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 鹵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.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R688

【參考文獻】

相關(guān)期刊論文 前10條

1 顧立強;;臂叢神經(jīng)損傷的治療進展[J];廣東醫(yī)學(xué);2005年12期

2 何平;許孟君;郟潛新;歐陽林;;MRI神經(jīng)根成像在臂叢節(jié)后神經(jīng)損傷中的應(yīng)用[J];中國骨與關(guān)節(jié)損傷雜志;2010年09期

3 孫達準(zhǔn);杜剛;沙軻;;頸7神經(jīng)移位術(shù)修復(fù)臂叢神經(jīng)損傷的研究進展[J];廣西醫(yī)學(xué);2009年01期

4 王奇才;孔德枝;劉恒方;;神經(jīng)電生理對外傷性臂叢神經(jīng)損害的診斷[J];中國實用神經(jīng)疾病雜志;2008年07期

5 官士兵;侯春林;陳德松;顧玉東;;后入路副神經(jīng)移位修復(fù)肩胛上神經(jīng)術(shù)式的臨床應(yīng)用研究[J];科技導(dǎo)報;2006年06期

6 張豫慶;;成人臂叢神經(jīng)損傷的臨床診治探討[J];中國實用神經(jīng)疾病雜志;2012年16期

7 諸澄;王惠芳;冒海建;沈峰;李佩蘭;;臂叢神經(jīng)損傷四例漏誤診原因分析[J];臨床誤診誤治;2014年08期

8 王樹鋒,張友樂,常萬紳,孫燕琨,韋加寧,張景秀,程小光,王澍寰;CTM診斷臂叢神經(jīng)損傷的臨床研究[J];中華骨科雜志;2003年12期

9 高仕長,陳亮,孟煒,顧玉東;產(chǎn)癱危險因素的病例對照研究[J];中華流行病學(xué)雜志;2005年09期

10 顧玉東;21世紀(jì)臂叢損傷診治的研究方向與任務(wù)[J];中華手外科雜志;2000年01期

，

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