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肱骨骨折合并桡神经损伤

[Humeral fractures complicated by radial nerve lesions].

作者信息

Vukadinović S, Mikić Z, Lartey J

出版信息

Acta Chir Iugosl. 1981;28(2):211-7.

PMID:7340350
Abstract

In the period of 1966-1975 the authors treated 228 patients with a fractures of diaphysis of humerus, 103 of whom underwent surgery; in 36 of them a paralysis of the radial nerve occurred. These 36 patients were divided into two groups: primary lesions (22 cases) which were discovered during hospitalization, and secondary lesions which occurred in postoperative course. The aim of clinical research with the primary lesion (respectively 22 patients) was to ascertain which method would have the best effect. In 77,2% of these patients, a radial nerve was not interrupted, while in 13.6% its continuity was partially preserved, and only in 9.09% a complete interruption occurred. Complete recovery of the nerve was in 50% of patients, 22.7% had a small conduction deficit, while its paralysis was further present in 18.8% of cases. Accordingly to this, the authors attained an excellent and very good results in 59% of patients, while in the remaining 41% of cases the results was satisfactory. It has been established that primary lesions of radial nerve has been occurring in 7.64% of cases (similar date do exist in reviewed reports), and in the majority of patients a spontaneously recovery will occur in the course of 2-3 months. Therefore the authors are not for a primary exploration of n.radialis if it is a question of closed fractures. In rare cases with interruption of the radial nerve with extensive contusions of both simultaneously interrupted nervous stumps a primary suture is not indicated. Therefore an eventual surgical exploration to establish whether an interruption of the nerve exists, does not contribute to attain recovery.

摘要

1966年至1975年期间,作者治疗了228例肱骨干骨折患者,其中103例接受了手术;其中36例发生了桡神经麻痹。这36例患者分为两组:原发性损伤(22例),在住院期间发现,以及继发性损伤,发生在术后过程中。对原发性损伤患者(共22例)进行临床研究的目的是确定哪种方法效果最佳。在这些患者中,77.2%的桡神经未被中断,13.6%的神经连续性部分保留,只有9.09%的神经完全中断。50%的患者神经完全恢复,22.7%有轻微传导缺陷,18.8%的病例仍存在神经麻痹。据此,作者在59%的患者中获得了优异和非常好的结果,而在其余41%的病例中结果令人满意。已经确定,桡神经原发性损伤发生在7.64%的病例中(综述报告中有类似数据),大多数患者在2至3个月内会自发恢复。因此,如果是闭合性骨折,作者不主张对桡神经进行一期探查。在罕见的桡神经中断且同时有广泛挫伤的情况下,不建议一期缝合两个同时中断的神经断端。因此,最终进行手术探查以确定神经是否中断,无助于实现恢复。

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1
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