尺神经松解原位放置在肱骨远端骨折术中的临床应用  

Clinical application of ulnar nerve release in situ placement in distal humerus fracture

作　　者：刘洋[1] 赵彦瑞[1] 周君琳[1] Liu Yang;Zhao Yanrui;Zhou Junlin(Department of Orthopedics,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院骨科,100020

出　　处：《中华肩肘外科电子杂志》2024年第3期223-229,共7页Chinese Journal of Shoulder and Elbow(Electronic Edition)

基　　金：北京市临床重点专科项目经费资助(2022创伤科)。

摘　　要：目的探究肱骨远端骨折切开复位内固定术中使用尺神经前置处理的临床功效。方法本研究自2014年1月至2020年12月,连续纳入就诊于首都医科大学附属北京朝阳医院骨科需接受切开复位内固定手术的肱骨远端骨折(AO/OTA分型为13-C)患者76例,根据术中是否使用前臂筋膜覆盖下尺神经前置处理分为以下两组:前置组17例,对照组59例。收集患者一般资料及手术资料信息,包括性别、年龄、骨折分型、手术时间,本研究还记录了随访信息,包括患肢骨愈合时间和术后并发症。截取统一的随访节点(术后1年),门诊医生会对患者的肘关节活动度(肘屈伸角度和前臂旋转角度)进行测量,为客观、全面的量化患者的肘关节术后表现,本研究选用Mayo肘关节功能评分系统(Mayo elbow performance score,MEPS)。对于患肢的尺神经存在症状或异常者,及时记录,选用经改良的McGowan预后评级以量化展示术后患者的尺神经的临床情况。结果共76例肱骨远端骨折患者接受至少1年的随访,其中尺神经前置组17例,平均年龄为54.3(31~71)岁;尺神经不前置组59例,平均年龄为56.7(28~73)岁,两组患者在骨折分型、骨折愈合时间的差异均无统计学意义。尺神经前置组中,肘关节平均屈伸活动度为(130.4±12.7)°和(25.6±3.0)°,平均前臂旋前、旋后活动度为(60.8±5.5)°和(61.8±5.4)°;尺神经非前置组,肘关节平均屈伸活动度为(128.6±9.3)°和(24.1±3.4)°,平均前臂旋前、旋后活动度为(59.7±4.3)°和(61.2±5.2)°。尺神经前置/非前置的两组病例在患侧肘-前臂活动范围差异无统计学意义(P>0.05)。经筋膜覆盖下尺神经前置的患者随访结果提示存在尺神经损伤状况的有9例,后续的复查发现仍旧存在4例残留尺神经恢复不佳的不良事件,这些患者的改良McGowan评级系统提示1级7例、2级2例,采用组内相关系数(intraclass correlation coefficient,ICC)评价该评分系统�Background Statistics show that elbow fractures account for about 4%of fracture types in adults,and distal humerus fractures account for 30%of all elbow fractures.Due to the complex neurovascular structure of the distal humerus,it is often difficult to treat such fractures,and surgeons face many challenges.Accurate movement of the ulnar nerve and its protection throughout open reduction and internal fixation(ORIF)operation is crucial,as it can significantly reduce the risk of iatrogenic nerve injury.Nevertheless,ulnar neuropathy is a relatively common complication after ORIF surgery for distal humeral fractures,with an incidence of up to 38%.A variety of potential causes can cause ulnar nerve dysfunction.Among them,ulnar nerve preposition is a technical method often considered in the surgical intervention of elbow fractures.Fascia covering adequately protects the ulnar nerve during the preposition process from subsequent damage to the ulnar nerve by surrounding tissues(scar,ectopic ossification,healed bone tissue)and internal fixation devices.On the other hand,the method used by the surgeon to peel the ulnar nerve during the preposition process will extensively separate the soft tissue,and there is a risk of iatrogenic damage to the ulnar nerve.At present,in the field of orthopedic trauma,whether or not ulnar nerve preposition is used by surgeons in open reduction and internal fixation of elbow fractures,especially distal humerus fractures,and how this operation affects the function of ulnar nerve after surgery is still a controversial issue.According to the study of Ruan et al.,ulnar nerve preposition is significantly effective in improving ulnar nerve dysfunction during open reduction and internal fixation.However,other studies have suggested that ulnar preposition has no additional benefit and may even increase the risk of ulnar nerve dysfunction.Objective To investigate the clinical efficacy of ulnar nerve preprocessing in open reduction and internal fixation of distal humerus fracture.Methods From January 20

关 键 词：肱骨远端骨折 尺神经前置 旋前圆肌 并发症 

分 类 号：R687.3[医药卫生—骨科学]