肱骨干骨折合并桡神经损伤的治疗策略  

Treatment strategies of humeral shaft fractures associated with radial nerve injuries

作　　者：朱晓中[1] 付凯[1] 郑宪友[1] 柴益民[1] 曾炳芳[1] 

机构地区：[1]上海市第六人民医院骨科,200233

出　　处：《中华手外科杂志》2015年第1期24-26,共3页Chinese Journal of Hand Surgery

基　　金：国家自然科学基金（81371965）;上海科委项目（12DZ1940404）

摘　　要：目的 分析肱骨干骨折后合并桡神经损伤的原因及治疗效果.方法 回顾性总结自2008年10月至2012年12月我院收治的32例肱骨干骨折后合并桡神经损伤患者,骨折采用切开复位钢板内固定;桡神经采用探查修复术,其中单纯探查18例,直接神经端端缝合修复11例,3例陈旧性骨折采用腓肠神经游离移植修复.分析致伤原因、骨折部位、骨折类型及桡神经损伤的关系.结果 32例患者平均随访（12.6±1.8）个月.骨折愈合时间为2.5-6.0个月,平均4.2个月.桡神经功能恢复情况根据中华医学会手外科学会上肢周围神经功能评定标准评定：优20例,良6例,差6例;优良率为81.25％.6例桡神经功能恢复差者行肌腱转位重建术.结论 肱骨中段骨折易损伤桡神经;伴发神经症状的肱骨干骨折均需桡神经探查修复,具体修复措施因神经损伤时间、损伤程度而异.Objective To analyze the etiology,treatment options and treatment outcomes of radial nerve injmy associated with humeral shaft fractures.Methods From October 2008 to December 2012,32 patients with humeral shaft fractures accompanied with radial nerve injuries were treated.All the fractures were treated with open reduction and internal fixation with plate and screws.The radial nerve was explored in all the cases.Simple exploration and neurolysis was carried out in 18 cases.Direct end-to-end repair of the ruptured nerve was done in 11 cases,while sural nerve graft was used to repair the radial nerve in 3 cases of old fractures.The relationships of the cause of injury,fracture site and fracture type to the radial nerve injury were analyzed.Results All 32 patients were follow-up for an average of （12.6 ± 1.8） months.Fracture union was achieved 2.5 to 6.0 months （4.2 months on average） postoperatively.According to the upper hmb peripheral nerve functional evaluation criteria issued by the Hand Surgery Society of Chinese Medical Association,radial nerve functional recovery was rated as excellent in 20 cases,good in 6 cases and poor in 6 cases.The overall excellent and good rate was 81.25%.The rest 6 cases had poor radial nerve functions and were treated with tendon transfers.Conclusion Humeral shaft fractures,bone may easily cause radial nerve injury.Radial nerve exploration should be considered in humeral shaft fracture cases when neurologic symptoms are present.Treatment options for radial nerve repair depend on the duration and extent of nerve injury.

关 键 词：桡神经 骨折 肱骨干 

分 类 号：R683.41[医药卫生—骨科学]