肱骨骨折伴桡神经损伤的治疗  

Treatment of humeral fracture associated with radial nerve injury

作　　者：刘勇章[1] 胡小鹏[1] 王耀南[1] 朱彤[1] 丁勇[1] 陶海荣[1] 王立[1] 许志兴[1] 

机构地区：[1]上海第二医科大学附属宝钢医院骨科,上海201900

出　　处：《临床骨科杂志》2005年第4期360-361,共2页Journal of Clinical Orthopaedics

摘　　要：目的分析肱骨骨折伴桡神经损伤的病因及治疗结果.方法肱骨骨折伴桡神经损伤43例,其中医源性桡神经损伤5例.手法复位+外固定6例,切开复位+内固定37例.术中见完全断裂8例(包括撕脱伤1例),挫伤18例,瘢痕挤压4例,骨折断端嵌压2例.行桡神经瘢痕粘连松解4例,神经外膜对端间断缝合7例(骨缩短3例),前臂外侧皮神经移植修复神经缺损1例.结果肱骨骨折均于6～12周愈合.桡神经损伤随访1～24个月,优(S3 +,M4以上)36例;良(S3,M3)6例;差(S1,M1)1例,优良率97.7%.结论桡神经在肱骨干部位的损伤能取得良好的治疗效果,须注意手术时机宜早不宜迟,能选择截骨缩短术者不要考虑神经移植术.医源性桡神经损伤的预防和处理应引起重视.Objective To study the causes and outcome of humeral fracture associated with radial nerve injury. Methods 43 cases of humeral fractures associated with radial nerve injuries were enrolled, including 5 cases of iatrogenic radial nerve injuries. The treatment methods were closed reduction and external stabilization for 6 cases and open reduction and internal fixation for 37. Intraoperative findings included complete radial nerve rupture in 8 cases （ 1 avulsion）, contusion in 18, scar compression in 4 and fragment entrapment in 2. The operations were performed with radial nerve scar release in 4 cases, epineural terminal-terminal anasmatosis for 7 （ with 3 humeral shortening osteotomies）, and neural graft for radial nerve defect repair with forearm lateral cutaneous nerve for 1. Results The humeral fractures healed in 6 - 12 weeks. In 1-24 months＇ follow-up, the radial nerve function recovery was excel- lent （S3^＋ , over M4） in 36 cases, good （ S3 M3 ） in 6, and poor （S1 , M1 ） in 1. The excellent and good rate was 97.7%. Conclusions Satisfactory outcome can be obtained in the radial nerve injury in humeral shaft. The operation should be preformed as early as possible, and neural transplantation shouldn＇t be concerned when humeral shortening osteotomy is possible. The prevention and treatment of iatrogenic radial nerve injury shoulded be cautioned.

关 键 词：肱骨骨折 桡神经损伤 

分 类 号：R683.41[医药卫生—骨科学] R651.1[医药卫生—外科学]