成年臂丛神经损伤的治疗与研究进展
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摘要
背景:临床上臂丛神经损伤的患者较多,手术方式多样,国内外对该方面的综述较少。目的:通过对臂丛神经损伤的解剖、手术方式及手术历史发展等进行综述,为临床骨科医生提供临床指导。方法:第一作者应用计算机检索1972年1月至2018年10月PubMed数据库、中国期刊全文数据库相关文章,英文检索词"brachial plexus,injury,diagnosis,treatment,classification",中文检索词"臂丛神经,损伤,诊断,治疗,分类"。共检索到478篇相关文献,73篇文献符合纳入标准。结果与结论:(1)经过国内外学者和医生的不断基础研究和临床实践,外科对臂丛神经损伤的治疗手术也逐渐丰富、成熟,取得了较大的进步;(2)对臂丛神经损伤治疗有了很大进展,由于臂丛神经损伤机制、解剖结构的复杂性,所以仍存在许多难题。至今虽然在形态学、电生理学、组化改变方面等有阐述神经损伤后的变化,但是肌肉萎缩尚未阐明其本质,臂丛神经损伤治疗的终极目标是重建手内肌,手内肌决定着手部功能恢复效果;(3)目前臂丛损伤仍是医学界的世界性的难题之一,也是一直以来研究的重点,临床上虽然采用了各种方法,均取得了较好的临床效果,但不可逆肌肉萎缩还是无法避免;(4)如何精准诊断臂丛损伤、对神经移位方法改良和创新、提加速神经再生、恢复手内部肌功能是今后手外科领域里研究的重点和方向,仍需大家艰苦的努力、积极不懈的探索,有待今后更为深入的基础研究和临床实践。
BACKGROUND: There are a large number of patients with brachial plexus injury in clinical practice, and surgical methods are various. The concerning reviews are few.OBJECTIVE: To review the anatomy, surgical methods and surgical history of brachial plexus injury, so as to provide clinical guidance for orthopedic surgeons.METHODS: The first author searched relevant articles in PubMed and CNKI databases from January 1972 to October 2018. The keywords were "brachial plexus, injury, diagnosis, treatment, classification" in English and Chinese, respectively. A total of 478 related articles were retrieved, and 73 articles were eligible for the inclusion criteria.RESULTS AND CONCLUSION:(1) Through the continuous basic researches and clinical practice of domestic and foreign scholars and doctors, the surgical treatment of brachial plexus injury surgery gradually becomes rich and mature, and has achieved great progress.(2)Great progress has been made in the treatment of brachial plexus injury. Due to the complexity of mechanism and anatomical structure of brachial plexus injury, there are still many problems. Although the changes after nerve injury have been described in terms of morphology,electrophysiology and histochemical changes, the essence of muscular atrophy has not been elucidated. The ultimate goal of brachial plexus injury treatment is to reconstruct the internal muscle of the hand, which determines the recovery effect of hand function.(3) Brachial plexus injury is still a worldwide problem in the field of medicine, and is an issue of concern. There are various methods, which have achieved good clinical outcomes, but the irreversible muscle atrophy is difficult to avoid.(4) How to accurately diagnose brachial plexus injury, improve and innovate the nerve displacement method, accelerate the nerve regeneration, and restore hand muscle function is the research focus and direction in the field of hand surgery. A further exploration is needed to provide foundation for further research and clinical practice.
BACKGROUND: There are a large number of patients with brachial plexus injury in clinical practice, and surgical methods are various. The concerning reviews are few.OBJECTIVE: To review the anatomy, surgical methods and surgical history of brachial plexus injury, so as to provide clinical guidance for orthopedic surgeons.METHODS: The first author searched relevant articles in PubMed and CNKI databases from January 1972 to October 2018. The keywords were "brachial plexus, injury, diagnosis, treatment, classification" in English and Chinese, respectively. A total of 478 related articles were retrieved, and 73 articles were eligible for the inclusion criteria.RESULTS AND CONCLUSION:(1) Through the continuous basic researches and clinical practice of domestic and foreign scholars and doctors, the surgical treatment of brachial plexus injury surgery gradually becomes rich and mature, and has achieved great progress.(2)Great progress has been made in the treatment of brachial plexus injury. Due to the complexity of mechanism and anatomical structure of brachial plexus injury, there are still many problems. Although the changes after nerve injury have been described in terms of morphology,electrophysiology and histochemical changes, the essence of muscular atrophy has not been elucidated. The ultimate goal of brachial plexus injury treatment is to reconstruct the internal muscle of the hand, which determines the recovery effect of hand function.(3) Brachial plexus injury is still a worldwide problem in the field of medicine, and is an issue of concern. There are various methods, which have achieved good clinical outcomes, but the irreversible muscle atrophy is difficult to avoid.(4) How to accurately diagnose brachial plexus injury, improve and innovate the nerve displacement method, accelerate the nerve regeneration, and restore hand muscle function is the research focus and direction in the field of hand surgery. A further exploration is needed to provide foundation for further research and clinical practice.
引文
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