Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, United States.
Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, United States.
Injury. 2022 Oct;53(10):3339-3343. doi: 10.1016/j.injury.2022.07.024. Epub 2022 Jul 16.
Postoperative radial nerve palsy (RNP) is a well-known complication of nonunion reconstruction of the humerus. The purpose of the current study is to determine if the surgical approach for nonunion reconstruction of the humerus influences the rate of postoperative radial nerve palsy.
A retrospective case-control study of all humeral shaft and extraarticular distal humerus nonunion reconstructions performed between January 1, 2004, and August 31, 2021, was conducted. Patients included were over 18 years of age, had a non-pathologic humerus fracture nonunion and had intact radial nerve function prior to nonunion reconstruction. Exclusion criteria consisted of nonunions involving the proximal humerus, intraarticular fractures, and reconstructive treatment procedures with either intramedullary nail or external fixation methods. Perioperative variables were recorded and analyzed in regard to the development of postoperative RNP. A subgroup analysis was performed to assess the interaction of significant variables on the development of postoperative RNP.
The overall rate of postoperative RNP in this series was 6/53 (11%). However, no cases of postoperative radial nerve palsy were observed in patients who underwent nonunion reconstruction with a lateral paratricipital approach. A new RNP was seen in 4/9 (44%) of those patients who underwent a triceps splitting approach, which was significantly higher than those utilizing either an anterolateral approach (2/28, 7%) or a lateral paratricipital approach (0/16, 0%, p = 0.007).
Our data suggests that the lateral paratricipital exposure decreases the risk of radial nerve injury with nonunion reconstruction of the humerus. The lateral paratricipital exposure offers the benefit of radial nerve exploration, decompression, neurolysis and protection prior to fracture manipulation and instrumentation. This study shows conventional approaches may predispose patients to a high rate of postoperative RNP, similar to that in the literature.
术后桡神经麻痹（RNP）是肱骨非愈合重建的一种众所周知的并发症。本研究的目的是确定肱骨非愈合重建的手术入路是否会影响术后桡神经麻痹的发生率。
对 2004 年 1 月 1 日至 2021 年 8 月 31 日期间进行的所有肱骨干和关节外肱骨远端非愈合重建的病例进行回顾性病例对照研究。纳入标准为年龄大于 18 岁，存在非病理性肱骨干骨折非愈合且在非愈合重建前桡神经功能完整。排除标准包括肱骨近端非愈合、关节内骨折以及使用髓内钉或外固定方法的重建治疗程序。记录并分析围手术期变量与术后 RNP 的发生情况。进行亚组分析以评估显著变量对术后 RNP 发生的相互作用。
本系列中术后 RNP 的总体发生率为 6/53（11%）。然而，在采用外侧肌间隔入路进行非愈合重建的患者中，未观察到术后桡神经麻痹病例。采用三头肌劈开入路的患者中有 4/9（44%）出现新发 RNP，明显高于采用前外侧入路（2/28，7%）或外侧肌间隔入路（0/16，0%，p=0.007）的患者。
我们的数据表明，外侧肌间隔显露降低了肱骨非愈合重建时桡神经损伤的风险。外侧肌间隔显露在骨折操作和器械固定之前提供了桡神经探查、减压、神经松解和保护的益处。本研究表明，传统入路可能使患者术后 RNP 发生率较高，与文献报道相似。
