Verdecchia Nicole, Johnson Julie, Baratz Mark, Orebaugh Steven
Department of Anesthesiology.
Department or Orthopedic Surgery, University of Pittsburgh Medical Center, PA, USA.
Orthop Rev (Pavia). 2018 Mar 29;10(1):7355. doi: 10.4081/or.2018.7355.
Nerve dysfunction after upper extremity orthopedic surgery is a recognized complication, and may result from a variety of different causes. Hand and wrist surgery require incisions and retraction that necessarily border on small peripheral nerves, which may be difficult to identify and protect with absolute certainty. This article reviews the rates and ranges of reported nerve dysfunction with respect to common surgical interventions for the distal upper extremity, including wrist arthroplasty, wrist arthrodesis, wrist arthroscopy, distal radius open reduction and internal fixation, carpal tunnel release, and thumb carpometacarpal surgery. A relatively large range of neurologic complications is reported, however many of the studies cited involve relatively small numbers of patients, and only rarely are neurologic complications included as primary outcome measures. Knowledge of these neurologic outcomes should help the surgeon to better counsel patients with regard to perioperative risk, as well as provide insight into workup and management of any adverse neurologic outcomes that may arise.
上肢骨科手术后的神经功能障碍是一种公认的并发症，可能由多种不同原因引起。手部和腕部手术需要进行切口和牵开操作，这些操作必然会靠近周围的小神经，而这些神经可能难以确切识别和保护。本文回顾了关于上肢远端常见手术干预（包括腕关节置换术、腕关节融合术、腕关节镜检查、桡骨远端切开复位内固定术、腕管松解术和拇指腕掌关节手术）后报告的神经功能障碍发生率和范围。报告的神经并发症范围相对较大，然而许多引用的研究涉及的患者数量相对较少，并且神经并发症很少被作为主要结局指标。了解这些神经学结果应有助于外科医生更好地向患者提供围手术期风险咨询，同时也有助于深入了解可能出现的任何不良神经学结果的检查和处理。
