上肢挤压伤后神经损伤机制分析与临床治疗  

Mechanistic analysis and clinical treatment of nerve injuries caused by crush injury of the upper extremity

作　　者：肖强[1] 李德华[2] 张彩顺[1] 张基仁[1] 杨立民[1] 齐勇[1] 

机构地区：[1]辽宁医学院第一附属医院手外科,锦州121001 [2]辽宁医学院解剖教研室

出　　处：《中华手外科杂志》2012年第2期90-91,共2页Chinese Journal of Hand Surgery

摘　　要：目的报告上肢挤压伤后神经损伤机制和治疗方法。方法对2003年3月至2009年5月收治的17例上肢挤压伤后神经损伤患者进行综合性治疗。结果治疗3周后部分轻症患者受压部位肌群肌张力开始恢复，肌力恢复至M2～M3。6周后，大部分患者受压部位以远肌群肌力逐渐恢复至M3-M4。11例获得6个月至2年的随访，6例失访。11例患肢感觉功能完全恢复。7例患肢功能恢复良好；2例遗留轻度手功能障碍，手指总主动活动度（TAM）较健侧减少20°，肌力M4；2例并发一氧化碳中毒后迟发性脑病的患者，遗留明显的功能障碍，但手部感觉和肌张力恢复良好。按中华医学会手外科学会上肢部分功能评定试用标准评定：优7例，良2例，差2例。结论上肢挤压伤后神经损伤具有明显的特殊性，应针对其损伤机制予以积极治疗。Objective To report the clinical characteristics and treatment of nerve injuries caused by upper limb crush injuries. Methods From March 2003 to May 2009, 17 cases of nerve lesion caused by upper extremity crush injuries were treated. Results 3hree weeks after the clinical treatment, muscle tension began to recover in some patients with mild symptoms. Muscle strength recovered to MRC 2 to 3. After 6 weeks, muscle strength gradually recovered to MRC 3 to 4 in most patients. Eleven patients were followed up for 6 months to 2 years, while 6 were lost to follow-up. These 11 patients had complete sensory recovery, while 7 of them recovered well in motor functions. Mild impairment of hand function remained in 2 patients with total active range of motion （TAM） reducing 20~ and muscle strength at MRC 4. Another 2 patients with delayed encephalopathy after carbon monoxide peisening remained severe dysfunction of the hand. However their sensation and muscle tension recovered well. According to the upper limb functional assessment standards of the Hand Surgery Society of the Chinese Medical Association, the outcomes were graded as excellent in 7 eases, good in 2 cases and poor in 2 eases. Coadusioa Nerve injury caused by crush injury of the upper extremity has distinct clineial characteristics. It should be actively treated according to its injury mechanism.

关 键 词：创伤和损伤 周围神经 治疗结果 

分 类 号：R651.3[医药卫生—外科学]