Purpose

Children and adolescents are frequent victims of gunshot wounds (GSW), either by direct intent or accidentaly. Lesions caused by stray bullets represent a specific type of accidental GSW and are usually associated with urban violence or aerial firing. We thereby present a series of surgically treated pediatric patients with peripheral nerve and brachial plexus lesions caused by stray bullets, referring to their clinical presentation, surgical procedures, and outcomes.

Methods

Retrospective study of a series of seven pediatric patients treated from 2012 to 2019 for nerve and/or plexus lesions caused by stray bullets at the Peripheral Nerve Unit of the Division of Neurosurgery of Gaffrée e Guinle University Hospital (HUGG). We used the Visual Analog Scale (VAS) to evaluate pain distress and the British Medical Research Council grading system (BMRC) to assess muscle strength.

Results

Patients’ ages ranged from 6 to 17 years old (median of 16), and two were female. All presented preoperatively with intense pain, with a median VAS of 9 (range 7 to 10), and six also had neurological deficits. External neurolysis was conducted in all cases, whereas reconstruction with grafts was needed in four patients. All experienced improvement of pain, and those with motor deficits also experienced some level of recovery.

Conclusion

Pediatric patients who endure lesions by stray bullets appear to present with debilitating pain, and often with motor deficits. Multidisciplinary management comprising of surgical treatment and physical and occupational therapy may ameliorate symptoms and improve quality of life, as young patients usually fare better after surgery.

中文翻译：

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小子弹引起的小儿周围神经和神经丛病变的小儿手术治疗

目的

儿童和青少年无论是直接意图还是偶然地都是枪伤（GSW）的常见受害者。流弹引起的损伤是特殊类型的意外GSW，通常与城市暴力或空中射击有关。因此，我们介绍了一系列由流浪子弹引起的周围神经和臂丛神经病变的外科治疗的儿科患者，涉及他们的临床表现，手术程序和结果。

方法

在Gaffréee Guinle大学医院（HUGG）神经外科分部的外围神经科对2012年至2019年因散发子弹引起的神经和/或神经丛病变而接受治疗的7例儿科患者进行了回顾性研究。我们使用视觉模拟量表（VAS）评估疼痛困扰，并使用英国医学研究理事会评分系统（BMRC）评估肌肉力量。

结果

患者年龄为6至17岁（中位数16岁），其中两名为女性。术前均表现为剧烈疼痛，VAS中位数为9（7至10），还有6例神经功能缺损。在所有情况下都进行了外部神经溶解，而四名患者需要用移植物重建。所有患者的疼痛均得到改善，运动障碍者的恢复也有所提高。

结论

受流弹侵害而患病的儿科患者表现出使人虚弱的疼痛，并经常出现运动功能障碍。手术治疗，物理和职业治疗等多学科管理可能会改善症状并改善生活质量，因为年轻患者通常在手术后情况会更好。