【摘要】 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1.5~4.5 cm。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 To explore the therapeutic effect on radial nerve injuries in plateau area, and to analyze the influencing factors. Methods The clinical data of 54 patients with radial nerve injuries who were treated between June 2005 and June 2010 were retrospectively analyzed. The patients included 40 males and 14 females and aged 8-69 years (averaged 32.6 years old). Of these 54 patients, 5 were open injuries, 49 were closed injuries; 26 were on the left side, and 28 were on the right sides. Causes of injuries included: 5 direct cut injuries, 10 iatrogenic injuries (including traction injuries and crush injuries by steel plates), and 39 humeral shaft fracture and radial nerve injuries. Types of nerve injuries included: 12 complete radial neurotmesis, 15 partial radial neurotmesis, and 27 radial contusions (with contusion length ranged 1.5-4.5 cm). All patients had radial nerve injuries experienced significant motor dysfunctions. Among these patients, 27 underwent nerve anastomosis, the remaining 27 were treated by nerve decompression; all fractures were treated with internal fixation with steel plates. Results During the average follow-up of 18 months (16-24 months), all 54 patients completely recovered from radial nerve injuries without any complications. The time for fracture healing ranged 8-14 months. According to the evaluation standards for radial nerve functional recovery, developed by the Chinese Medical Association, among the 27 cases treated by nerve anastomosis, 14 were “optimal”, 8 were “fair”, and 5 were “bad”; and all 27 cases treated by nerve decompression were “optimal”. Conclusion It is suggested to have early surgical treatment for the upper arm radical nerve injuries. The nerve decompression had better curative effects than the nerve anastomosis does.
Objective To investigate the effectiveness and surgical skills of microsurgical repair of radial nerve deep branch injury. Methods Between March 2001 and February 2011, 49 cases of radial nerve deep branch injury were treated by microsurgical technique. There were 40 males and 9 females with an average age of 32 years (range, 19-58 years), including 13 cases of knife-cut injury, 9 cases of electric-saw injury, 7 cases of dagger-stab injury, 6 cases of glass-cut injury, 5 cases of iatrogenic injury, 4 cases of Monteggia fracture, 3 cases of nailgun injury, and 2 cases of crush injury of the forearm complicated by fracture of the proximal radius. The disease duration ranged from 3 hours to 3 years and 8 months (mean, 4.9 months). The sites of injury were at front of supinator tube in 15 cases, in the supinator tube in 23 cases, and at back of supinator tube in 11 cases. One-stage repair was performed by end-to-end suture in 21 cases, including 9 cases of epineurial neurorrhaphy and 12 cases of perineurial neurorrhaphy; two-stage repair was performed in 28 cases, including 26 cases of sural nerve graft and 2 cases of neurolysis. Results Postoperative wounds primarily healed. All patients were followed up 21.5 months on average (range, 12-39 months). At last follow-up, in 21 cases of one-stage repair, the muscle strength of the extensor pollicis longus was level 5 in 13 cases, and level 4 in 8 cases; in 28 cases of two-stage repair, the muscle strength of the extensor pollicis longus was level 5 in 2 cases, level 4 in 21 cases, level 3 in 4 cases, and level 2 in 1 case; and significant difference was found (Z= — 5.340, P=0.000). In 9 cases undergoing epineurial neurorrhaphy at one-stage repair, the muscle strength of the extensor pollicis longus was level 5 in 3 cases, and level 4 in 6 cases; in 12 cases undergoing perineurial neurorrhaphy at one-stage repair, the muscle strength of the extensor pollicis longus was level 5 in 10 cases, and level 4 in 2 cases; and significant difference was found (Z= — 2.279, P=0.023). In 26 cases undergoing nerve graft at two-stage repair, the muscle strength of the extensor pollicis longus was level 5 in 2 cases, level 4 in 20 cases, level 3 in 3 cases, and level 2 in 1 case; in 2 cases undergoing neurolysis at two-stage repair, the muscle strength of the extensor pollicis longus was level 4 in 1 case and level 3 in 1 case; and no significant difference was found (Z= — 1.117, P=0.264). According to the upper arm function assessment criterion issued by Hand Surgery Association of Chinese Medicine Association, the results were excellent in 18 cases, good in 3 cases in one-stage repair patients; excellent in 2 cases, good in 21 cases, fair in 4 cases, and poor in 1 case in two-stage repair patients; and there was significant difference (Z= — 5.340, P=0.000). Conclusion Microsurgical one-stage repair of radial nerve deep branch injury can obtain better effectiveness than two-stage repair by nerve graft, and perineurial neurorrhaphy is significantly better than epineurial neurorrhaphy.
To explore the possibil ity of treating mid-distal humeral shaft fractures associated with radial nerve palsies with minimal invasive plating osteosynthesis (MIPO) techniques. Methods From April 2003 to October 2006, 10 patients with mid-distal humeral shaft fractures associated with radial nerve palsies were treated. All patients were male, aged 19-58 years. According to AO/ASIF classification, there were 4 cases of B1 type, 2 cases of B3 type, 1 case of A2 type, 1 caseof B2 type, 1 case of C3 type and 1 case of A3 type. A straight 4.5 mm dynamic compression plate was placed on the anterior aspect of humerus through two small incisions located on the anterior side of proximal and distal part of the arm. The radial nerve exploration was performed through a lateral small incision made on the fracture site. The fractures were then reduced by manual manipulation and the plate was fixated to the main fragments with 3 screws in each end of the plate. The postoperative compl ications, the bone heal ing time, and the recovery time of the radial nerve functions were recorded. The functions of the affected shoulder and elbow were assessed with UCLA and Mayo elbow performance score system respectively. Results All incision healed by first intention. Ten patients were followed up 9-36 months with an average of 15.7 months. The X-ray films showed that the union of fractures was achieved 12-16 weeks (13.6 weeks on average). The function of the radial nerves recovered completely 12-36 weeks (17.8 weeks on average) in 9 patients. The abductions of the affected shoulder were 150-170° (165° on average). The ROM of the elbows were 130-140° (135.5° on average). According to the UCLA shoulder scoring system, 9 patients achieved the excellent result and 1 patient achieved the good result. All the patients had the excellent results according to Mayo elbow performance score system. Conclusion The mid-distal humeral shaft fractures associated with radial nervepalsies can be treated with MIPO technique and the good results can be obtained.
Objective To evaluate the effect of tendon transfer on reconstructing the extension of wrist, thumb and digit after irreversible radial nerve injury. Methods From January 1987 to February 2005, 25 cases of irreversible radial nerve injury were treated with Riordan tendon transfer. Among them there were 19 cases of central radial nerve injury with wrist ,thumb and digit extension dysfunction and 6 cases of deep branch of radial nerve injury with digit and thumbextension dysfunction. The muscle strength of wrist and digit extension ranged from grade 0 to grade Ⅰ. Tendon transfer was done 4 months to 8 years after their injuries. Results Twenty-three cases were followed up for3 to 60 months. According to the standard established by Chen Desong, 19 cases (82.6%) showed excellent and good results. Fair result was showed in 2 cases and poor result was showed in 2 cases. Conclusion Riordan tendon transfer should be the first choice of treating irreversible radial nerve injury.
OBJECTIVE: To investigate the reparative method and effect of radial nerve injury. METHODS: From 1990 to 2000, 50 cases with radial nerve injuries were adopted in this study. Among them, there were 38 males and 12 females, aged from 5 to 65 years. For the 50 cases, there were 28 cases with complete nerve rupture, 3 cases with incomplete nerve rupture, 10 cases with compressive injury, 5 cases with contusion injury and 4 cases with defect and irreversible injury. All the patients were treated with radial nerve exploration in 1 hour to 6 months after injury. 31 cases were treated with nerve anastomosis, 10 cases with nerve lytic operation, 4 cases with tendon transfer and 5 cases with palliative treatment. RESULTS: All the cases were followed up 3 months to 10 years. The curative effect was assessed according to Highest grade method. There were excellent and good results in 46 cases, moderate results in 4 cases. CONCLUSION: It is necessary to explore and repair the radial nerve injury immediately after the diagnosis being confirmed. If the function of radial nerve could not recover in 6 months, tendon transfer should be carried out to reconstruct the extension of elbow, thumb and fingers.
The reconstruction of the extension function of wrist and fingers in 35 patients with radial nerveinjury was reported, The indications of oporation and the main management during and after operationwere discussed.It was thought that the tendon transfer was an effective method to reconstructextension functions of wrist and fingers after the injury of radial nerves and could be served as asupplementary means after radial nerve repair.