彩超定位辅助桡神经显露治疗肱骨中下段骨折  

Ultrasound guided radial nerve exploration during surgical treatment for humeral diaphyseal fracture

作　　者：郭玉冬[1] 钱方媛[1] 王善正[1] 贾军 王宸[1] GUO Yu-dong;QIAN Fang-yuan;WANG Shan-zheng;JIA Jun;WANG Chen(Department of Traumatology,Zhongda Hospital Affiliated to Southeast University,Nanjing 210009,China)

机构地区：[1]东南大学附属中大医院创伤骨科,江苏南京210009

出　　处：《中国矫形外科杂志》2019年第2期97-100,共4页Orthopedic Journal of China

基　　金：国家自然科学基金资助项目(编号:81572188)

摘　　要：[目的]探讨术前超声定位桡神经,辅助术中显露桡神经治疗肱骨中下段骨折的临床疗效。[方法]回顾性分析2013年1月～2016年12月本院收治入院的64例肱骨中下段骨折患者资料,其中男42例,女22例,年龄18～65岁,平均(41.38±13.45)岁,4例患者术前合并有桡神经麻痹。术前用彩超标记桡神经位置,明确桡神经受损情况及桡神经大小。术中采用上臂背侧后正中切口,松解并保护桡神经,复位骨折行钢板固定。术后常规检查桡神经功能支配区感觉运动功能,观察桡神经损伤恢复时间及骨折愈合情况。末次随访根据Mayo肘关节功能评分标准评估肘关节功能。[结果]术前桡神经前后径1.28～1.82 mm,平均(1.59±0.15) mm,4例桡神经麻痹患者中有1例出现神经挤压。桡神经显露时间2～15 min,平均(7.52±3.14) min。随访12～36个月,平均(18.63±6.37)个月。所有术前无桡神经损伤患者术后桡神经支配区感觉运动正常。4例术前桡神经麻痹患者术后2～6个月均得以恢复,平均(3.50±1.73)个月。骨折愈合时间为10～24周,平均(15.45±3.73)周。末次随访时骨折均愈合,无钢板断裂、移位,无骨折成角及旋转畸形。按照Mayo肘关节功能评分:优46例,良18例,优良率100.00%。[结论]术前彩超定位有助于准确显露桡神经,有利于降低医源性桡神经麻痹的发生率,设备简单,可重复性高,安全有效。[Objective] To evaluate the clinic outcomes of the ultrasound guided radial nerve exposure during surgical treatment of humeral diaphyseal fractures. [Methods] A retrospective study was conducted on 64 patients who underwent surgical treatment for humeral diaphyseal fractures, including 42 males and 22 females aged from 18 to 65 years with a mean of(41.38±13.45) years, from January 2013 to December 2016. Of them, 4 patients had radial never palsy before operation. Ultrasound-guided radial nerve localization was preoperatively done to determine the nerve diameter and extent of injuries. Subsequently, open reduction and internal fixation(ORIF) with locking plates were performed through a dorsal midline incision with the nerve explored and protected. After operation, the sensory and motion functions of the radial nerve, as well as fracture healing were observed. At the latest follow-up, the elbow function was evaluated using Mayo elbow grading. [Results] The ultrasound examination revealed that the anteroposterior diameter of radial nerve ranged from 1.28 to 1.82 mm with a mean of(1.59±0.15) mm, one of the 4 patients with radial nerve palsy had the nerve squeezed by the fracture ends before operation. The radial nerve was explored form 2 to 15 min with an average of(7.52±3.14) min during operation. All the 64 patients were followed up for 12 to 36 months with a mean of(18.63±6.37) months. The patients who had no the nerve injuries preoperatively kept normal sensory and motion function postoperatively, whereas the 4 patients who had radial nerve palsy preoperatively got complete functional recovery in(3.50±1.73) months on average postoperatively. Then all the patients achieved bony healing of the fractures from 10 to 24 weeks with a mean of(15.45±3.73) weeks. At the latest follow up, no implant loosening and breaking, as well as malunion of fracture were found in anyone of the patients.The clinical outcomes were graded as excellent in 46 and good in 18 cases with an excellent and good rate of 100%.[Conclusion]

关 键 词：超声检查 桡神经显露 肱骨中下段骨折 治疗效果 

分 类 号：R683.42[医药卫生—骨科学]