[桡神经深支损伤显微外科修复的疗效分析]

Li Jinyong, Hu Hongliang, Wang Huanxin, Cheng Xuefeng

Department of Orthopaedics, the Second People's Hospital of Zhengzhou, Zhengzhou Henan, 450006, P.R.China.

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2012 Nov;26(11):1344-7.

OBJECTIVE

To investigate the effectiveness and surgical skills of microsurgical repair of radial nerve deep branch injury.

METHODS

Between March 2001 and February 2011, 49 cases of radial nerve deep branch injury were treated by microsurgical technique. There were 40 males and 9 females with an average age of 32 years (range, 19-58 years), including 13 cases of knife-cut injury, 9 cases of electric-saw injury, 7 cases of dagger-stab injury, 6 cases of glass-cut injury, 5 cases of iatrogenic injury, 4 cases of Monteggia fracture, 3 cases of nailgun injury, and 2 cases of crush injury of the forearm complicated by fracture of the proximal radius. The disease duration ranged from 3 hours to 3 years and 8 months (mean, 4.9 months). The sites of injury were at front of supinator tube in 15 cases, in the supinator tube in 23 cases, and at back of supinator tube in 11 cases. One-stage repair was performed by end-to-end suture in 21 cases, including 9 cases of epineurial neurorrhaphy and 12 cases of perineurial neurorrhaphy; two-stage repair was performed in 28 cases, including 26 cases of sural nerve graft and 2 cases of neurolysis.

RESULTS

Postoperative wounds primarily healed. All patients were followed up 21.5 months on average (range, 12-39 months). At last follow-up, in 21 cases of one-stage repair, the muscle strength of the extensor pollicis longus was level 5 in 13 cases, and level 4 in 8 cases; in 28 cases of two-stage repair, the muscle strength of the extensor pollicis longus was level 5 in 2 cases, level 4 in 21 cases, level 3 in 4 cases, and level 2 in 1 case; and significant difference was found (Z=-5.340, P=0.000). In 9 cases undergoing epineurial neurorrhaphy at one-stage repair, the muscle strength of the extensor pollicis longus was level 5 in 3 cases, and level 4 in 6 cases; in 12 cases undergoing perineurial neurorrhaphy at one-stage repair, the muscle strength of the extensor pollicis longus was level 5 in 10 cases, and level 4 in 2 cases; and significant difference was found (Z=-2.279, P=0.023). In 26 cases undergoing nerve graft at two-stage repair, the muscle strength of the extensor pollicis longus was level 5 in 2 cases, level 4 in 20 cases, level 3 in 3 cases, and level 2 in 1 case; in 2 cases undergoing neurolysis at two-stage repair, the muscle strength of the extensor pollicis longus was level 4 in 1 case and level 3 in 1 case; and no significant difference was found (Z=-1.117, P=0.264). According to the upper arm function assessment criterion issued by Hand Surgery Association of Chinese Medicine Association, the results were excellent in 18 cases, good in 3 cases in one-stage repair patients; excellent in 2 cases, good in 21 cases, fair in 4 cases, and poor in 1 case in two-stage repair patients; and there was significant difference (Z=-5.340, P=0.000).

CONCLUSION

Microsurgical one-stage repair of radial nerve deep branch injury can obtain better effectiveness than two-stage repair by nerve graft, and perineurial neurorrhaphy is significantly better than epineurial neurorrhaphy.

目的

探讨桡神经深支损伤显微外科修复的疗效及手术技巧。

方法

2001年3月至2011年2月，采用显微外科技术治疗49例桡神经深支损伤患者。其中男40例，女9例，平均年龄32岁（19 - 58岁），包括刀割伤13例、电锯伤9例、匕首刺伤7例、玻璃割伤6例、医源性损伤5例、孟氏骨折4例、射钉枪伤3例、前臂挤压伤合并桡骨近端骨折2例。病程3小时至3年8个月（平均4.9个月）。损伤部位：旋后肌管前方15例，旋后肌管内23例，旋后肌管后方11例。一期修复21例，采用端端缝合，其中神经外膜缝合9例，神经束膜缝合12例；二期修复28例，其中腓肠神经移植26例，神经松解2例。

结果

术后伤口均一期愈合。所有患者平均随访21.5个月（12 - 39个月）。末次随访时，一期修复的21例中，拇长伸肌肌力5级13例，4级8例；二期修复的28例中，拇长伸肌肌力5级2例，4级21例，3级4例，2级1例；差异有统计学意义（Z = -5.340，P = 0.000）。一期修复行神经外膜缝合的9例中，拇长伸肌肌力5级3例，4级6例；行神经束膜缝合的12例中，拇长伸肌肌力5级10例，4级2例；差异有统计学意义（Z = -2.279，P = 0.023）。二期修复行神经移植的26例中，拇长伸肌肌力5级2例，4级20例，3级3例，2级1例；行神经松解的2例中，拇长伸肌肌力4级1例，3级1例；差异无统计学意义（Z = -1.117，P = 0.264）。参照中华医学会手外科学会制定的上肢功能评定标准，一期修复患者中优18例，良3例；二期修复患者中优2例，良21例，可4例，差1例；差异有统计学意义（Z = -5.340，P = 0.000）。