肱骨干骨折不愈合伴发桡神经麻痹的最终转归。
Final outcomes of radial nerve palsy associated with humeral shaft fracture and nonunion.
机构信息
NYU Hospital for Joint Diseases, 301 East 17th Street, New York, NY, 10003, USA.
Jamaica Hospital Medical Center, Jamaica, NY, USA.
出版信息
J Orthop Traumatol. 2019 Mar 28;20(1):18. doi: 10.1186/s10195-019-0526-2.
BACKGROUND
Little evidence regarding the extent of recovery of radial nerve lesions with associated humerus trauma exists. The aim of this study is to examine the incidence and resolution of types of radial nerve palsy (RNP) in operative and nonoperative humeral shaft fracture populations.
MATERIALS AND METHODS
Radial nerve lesions were identified as complete (RNPc), which included motor and sensory loss, and incomplete (RNPi), which included sensory-only lesions. Charts were reviewed for treatment type, radial nerve status, RNP resolution time, and follow-up time. Descriptive statistics were used to document incidence of RNP and time to resolution. Independent-samples t-test was used to determine significant differences between RNP resolution time in operative and nonoperative cohorts.
RESULTS
A total of 175 patients (77 operative, 98 nonoperative) with diaphyseal humeral shaft injury between 2007 and 2016 were identified and treated. Seventeen out of 77 (22.1%) patients treated operatively were diagnosed preoperatively with a radial nerve lesion. Two (2.6%) patients developed secondary RNPc postoperatively. Eight out of 98 (8.2%) patients presented with RNP postinjury for nonoperatively treated humeral shaft fracture. All patients who presented with either RNPc, RNPi, or iatrogenic RNP had complete resolution of their RNP. No statistically significant difference was found in recovery time when comparing the operative versus nonoperative RNPc, operative versus nonoperative RNPi, or RNPc versus RNPi patient groups.
CONCLUSIONS
All 27 (100%) patients presenting with or developing radial nerve palsy in our study recovered. No patient required further surgery for radial nerve palsy. Radial nerve exploration in conjunction with open reduction and internal fixation (ORIF) appears to facilitate speedier resolution of RNP when directly compared with observation in nonoperative cases, although not statistically significantly so. These findings provide surgeons valuable information they can share with patients who sustain radial nerve injury with associated humerus shaft fracture or nonunion.
LEVEL OF EVIDENCE
Level III treatment study.
背景
有关伴有肱骨创伤的桡神经损伤恢复程度的证据很少。本研究旨在检查手术和非手术肱骨干骨折患者中桡神经麻痹（RNP）的类型发生率和消退情况。
材料与方法
桡神经病变被确定为完全性（RNPc），包括运动和感觉丧失，以及不完全性（RNPi），包括仅感觉病变。对治疗类型、桡神经状态、RNP 消退时间和随访时间进行了图表回顾。使用描述性统计数据记录 RNP 的发生率和消退时间。使用独立样本 t 检验确定手术和非手术队列中 RNP 消退时间的显著差异。
结果
共确定并治疗了 2007 年至 2016 年间 175 例肱骨干骨折患者（77 例手术，98 例非手术）。77 例手术治疗的患者中，术前诊断出 17 例桡神经病变。2 例（2.6%）患者术后发生继发性 RNPc。8 例（8.2%）非手术治疗肱骨干骨折患者受伤后出现 RNP。所有出现 RNPc、RNPi 或医源性 RNP 的患者均完全恢复其 RNP。在比较手术与非手术 RNPc、手术与非手术 RNPi 或 RNPc 与 RNPi 患者组的恢复时间时，未发现统计学差异。
结论
我们研究中所有出现或发生桡神经麻痹的 27 例（100%）患者均恢复。没有患者因桡神经麻痹需要进一步手术。与非手术病例相比，桡神经探查联合切开复位内固定（ORIF）似乎可以更快地解决 RNP，但差异无统计学意义。这些发现为外科医生提供了有价值的信息，他们可以与伴有肱骨骨干骨折或不愈合的桡神经损伤患者分享。
证据水平
III 级治疗研究。
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