高原地区桡神经损伤54例疗效分析

【】　目的　探讨高原地区桡神经损伤的治疗效果，并总结影响疗效的因素。　方法　回顾性分析2005年6月-2010年6月收治的桡神经损伤并有完整随访资料的54例患者，其中男40例，女14例；年龄8～69岁，平均32.6岁。开放性损伤5例，闭合性损伤49例；左侧26例，右侧28例。受伤原因刀伤5例，医源性损伤（手术牵拉伤、被钢板挤压伤）10例，肱骨干骨折合并桡神经损伤39例。神经损伤类型桡神经完全断裂12例；大部分断裂15例；挫伤27例，挫伤长度1.5~4.5cm。所有患者均有典型的感觉及运动功能障。采用神经吻合修复27例，神经松解减压27例。骨折均用钢板内固定。　结果　所有患者手术均顺利，术后切口均I期愈合，无手术相关并发症发生。54例均获随访16~24个月，平均18个月。骨折于术后8～14个月达临床愈合。末次随访时根据中华医学会手外科上肢周围神经功能评定标准，神经吻合的27例中，获优14例，良8例，差5例；神经松解减压术治疗的27例均获优。总优良率为91%。　结论　上臂桡神经损伤宜早期手术修复，神经吻合的疗效较神经松解减压术差。【Abstract】　Objective　Toexplorethetherapeuticeffectonradialnerveinjuriesinplateauarea,andtoanalyzetheinfluencingfactors.　Methods　Theclinicaldataof54patientswithradialnerveinjurieswhoweretreatedbetweenJune2005andJune2010wereretrospectivelyanalyzed.Thepatientsincluded40malesand14femalesandaged8-69years(averaged32.6yearsold).Ofthese54patients,5wereopeninjuries,49wereclosedinjuries;26wereontheleftside,and28wereontherightsides.Causesofinjuriesincluded5directcutinjuries,10iatrogenicinjuries(includingtractioninjuriesandcrushinjuriesbysteelplates),and39humeralshaftfractureandradialnerveinjuries.Typesofnerveinjuriesincluded12completeradialneurotmesis,15partialradialneurotmesis,and27radialcontusions(withcontusionlengthranged1.5-4.5cm).Allpatientshadradialnerveinjuriesexperiencedsignificantmotordysfunctions.Amongthesepatients,27underwentnerveanastomosis,theremaining27weretreatedbynervedecompression;allfracturesweretreatedwithinternalfixationwithsteelplates.　Results　Duringtheaveragefollow-upof18months(16-24months),all54patientscompletelyrecoveredfromradialnerveinjurieswithoutanycomplications.Thetimeforfracturehealingranged8-14months.Accordingtotheevaluationstandardsforradialnervefunctionalrecovery,developedbytheChineseMedicalAssociation,amongthe27casestreatedbynerveanastomosis,14were“optimal”,8were“fair”,and5were“bad”;andall27casestreatedbynervedecompressionwere“optimal”.　Conclusion　Itissuggestedtohaveearlysurgicaltreatmentfortheupperarmradicalnerveinjuries.Thenervedecompressionhadbettercurativeeffectsthanthenerveanastomosisdoes.