机器挤轧致桡神经损伤39例的治疗  

Treatment of radial nerve injury caused by machinery crush in 39 cases

作　　者：缪玉龙 朱文华 刘敏峰 邵志恩 邓智明 朱振兴 

机构地区：[1]扬州大学附属常熟市第二人民医院手足外科,江苏常熟215500

出　　处：《实用手外科杂志》2017年第1期22-23,35,共3页Journal of Practical Hand Surgery

摘　　要：目的探讨机器挤轧所致桡神经损伤的治疗方法和疗效。方法对2010年8月-2015年10月机器挤轧所致的39例桡神经损伤患者，予保守治疗8例，其中干部损伤6例，前臂深支损伤2例；手术治疗31例，干部损伤11例，前臂深支损伤20例。其中桡神经松解术26例。神经接合术5例。术后支具托外固定及常规治疗。结果39例随访3-36个月。保守治疗8例功能和感觉均恢复。手术治疗31例．功能恢复29例，2例因合并前臂骨筋膜综合征，术后出现伸拇伸指功能障碍；虎口区感觉恢复28例，3例术后3年仍有虎口区感觉迟钝。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34例，良3例，可2例，总优良率94．9％。结论外伤性桡神经损伤，修复成功率较高。外伤后应采取积极的态度，把握手术时机，并采用恰当的方法．可获得良好的预后。Objective To analyze the treatment options and treatment outcomes of radial nerve injury caused by machinery crush. Methods 39 patients with radial nerve injury were treated. 8 patients were treated by conservative treatment, including 6 cases of nerve stem injury and 2 cases of the deep branch of radial nerve injury. 31 patients were treated by operative treatment, including 11 cases of nerve stem injury and 20 cases of the deep branch of radial nerve injury. The operations were performed with radial nerve release in 26 cases, teminal to teminal repair for 5 cases. They were treated in time by external fixation and regular way after operation. Results All 39 patients were followed-up for 3 months to 3 years. The 8 patients＂ function and feeling were restored by conservative treatment. All 31 patients with operative treatment, 29 cases function were restored, 2 cases turned up dysfunction because of osteofascial compartment syndrome. 28 patients＂ thumb-index web feeling were restored, 3 patients＂ thumb-index web were insensitive after operation; according to the upper limb peripheral nerve functional evaluation criteria issued by the Hand Surgery Society of Chinese Medical Association, radial nerve functional recovery was excellent in 34 cases, good in 3 cases and poor in 2 cases. The overall excellent and good rate was 94.9%. Conclusion Satisfactory outcome can be obtained in the radial nerve injury, so we shoud have a positive attitude and treat in time by combined and regular way.

关 键 词：挤轧 桡神经 损伤 显微外科 

分 类 号：R651.3[医药卫生—外科学]