Amillo S, Barrios R H, Martínez-Peric R, Losada J I
Department of Orthopedic Surgery and Traumatology, University Clinic, School of Medicine, University of Navarra, Pamplona, Spain.
J Orthop Trauma. 1993;7(3):211-5. doi: 10.1097/00005131-199306000-00002.
Twelve patients who were surgically treated for radical nerve injuries associated with fractures of the humerus are reviewed. The average follow-up was 6 years (range 1-10). The mean time to full recovery was 19 months (range 12-40). Three fractures were open, and nine were closed. Seven of the fractures were located in the distal third of the humerus; two were in the middle third; two were segmental, involving both the middle and the distal thirds of the shaft; and one was supracondylar. All patients received initial treatment of the fracture in other medical units. The mean interval between the lesion and surgical treatment of the nerve injury was 6 months (range 25 days to 15 months). Perineural fibrosis at the lesion site was observed in four patients. Three nerves were found entrapped in the callus. In two cases the nerve was found to be partially divided, and in three cases a total section was observed. The techniques employed were microsurgical reconstruction with interfascicular grafting using sural nerve in six patients, neurolysis in five cases, and tendon transfers in one case. Excellent and good results were obtained in 91% of cases. In the case with a poor result, tendon transfers were made, with an acceptable functional result.
回顾了12例因肱骨骨折伴发桡神经损伤而接受手术治疗的患者。平均随访时间为6年（范围1 - 10年）。完全恢复的平均时间为19个月（范围12 - 40个月）。3例骨折为开放性，9例为闭合性。7例骨折位于肱骨远端三分之一处；2例位于中段三分之一处；2例为节段性骨折，累及骨干中段和远端三分之一处；1例为髁上骨折。所有患者均在其他医疗单位接受了骨折的初始治疗。神经损伤与手术治疗之间的平均间隔时间为6个月（范围25天至15个月）。4例患者在损伤部位观察到神经周围纤维化。3条神经被发现卡压于骨痂中。2例神经被发现部分断裂，3例观察到完全横断。所采用的技术包括6例患者采用腓肠神经束间移植进行显微外科重建，5例进行神经松解，1例进行肌腱转位。91%的病例获得了优良结果。结果不佳的病例进行了肌腱转位，功能结果尚可。
