Korompilias Anastasios V, Lykissas Marios G, Kostas-Agnantis Ioannis P, Vekris Marios D, Soucacos Panayiotis N, Beris Alexandros E
Department of Orthopaedic Surgery, University of Ioannina School of Medicine, Ioannina, PC 45110, Greece.
Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY 10021, USA.
Injury. 2013 Mar;44(3):323-6. doi: 10.1016/j.injury.2013.01.004. Epub 2013 Jan 23.
While recommendations for early exploration and nerve repair in cases of open fractures of the humeral shaft associated with radial nerve palsy are clear, the therapeutic algorithm for the management of closed humeral shaft fractures complicated by radial nerve palsy is still uncertain. The purpose of this study was to determine whether patients with complete sensory and motor radial nerve palsy following a closed fracture of the humeral shaft should be surgically explored.
Twenty-five patients with closed humeral shaft fractures complicated by complete radial nerve palsy were retrospectively reviewed during a 12-year period. Surgical intervention was indicated if functional recovery of the radial nerve was not present after 16 weeks of expectant management.
Surgical exploration was performed in 12 patients (48%) after a mean period of expectant management of 16.8 weeks (range: 16-18 weeks). In 2 of them (10%) total nerve transection was found. In the rest 10 patients underwent surgical exploration the radial nerve was found to be macroscopically intact. All intact nerves were fully recovered after a mean time of 21.6 weeks (range: 20-24 weeks) post-injury. In 13 patients (52%) in whom surgical exploration was not performed the mean time to full nerve recovery was 12 weeks (range: 7-14 weeks) post-injury.
We proposed immediate exploration of the radial nerve in case of open fractures of the humeral shaft, irreducible fractures or unacceptable reduction, associated vascular injuries, radial nerve palsy after manipulation or intractable neurogenic pain. Due to high rate of spontaneous recovery of the radial nerve after closed humeral shaft fractures we recommend 16-18 weeks of expectant management followed by surgical intervention.
虽然对于肱骨干开放性骨折合并桡神经麻痹病例的早期探查和神经修复建议很明确，但肱骨干闭合性骨折并发桡神经麻痹的治疗方案仍不明确。本研究的目的是确定肱骨干闭合性骨折后出现完全感觉和运动桡神经麻痹的患者是否应进行手术探查。
回顾性分析了12年间25例肱骨干闭合性骨折并发完全性桡神经麻痹的患者。如果在16周的观察治疗后桡神经仍未恢复功能，则进行手术干预。
平均观察治疗16.8周（范围：16 - 18周）后，12例患者（48%）进行了手术探查。其中2例（10%）发现神经完全横断。其余10例接受手术探查的患者，桡神经肉眼观完整。所有完整的神经在受伤后平均21.6周（范围：20 - 24周）完全恢复。13例（52%）未进行手术探查的患者，神经完全恢复的平均时间为受伤后12周（范围：7 - 14周）。
我们建议，对于肱骨干开放性骨折、无法复位的骨折或复位不佳、合并血管损伤、手法复位后桡神经麻痹或顽固性神经性疼痛的病例，应立即探查桡神经。由于肱骨干闭合性骨折后桡神经自发恢复率较高，我们建议进行16 - 18周的观察治疗，然后再进行手术干预。
