肱骨骨折术后合并桡神经损伤的高频超声诊断

Application of High-resolution Sonography before Reoperation of Injured Radial Nerve Associated with Humeral Fracture

目的:评价高频超声对肱骨骨折术后合并桡神经损伤的诊断价值。方法:对38例肱骨骨折术后合并桡神经损伤的患者,于再次手术前行高频超声检查,观察并记录超声声像图特征,并判断神经通路存在与否。以手术所见及术中肌电图为金标准,并计算超声诊断的灵敏度、特异度及符合率。统计学分析采用SPSS19.0软件Fisher确切概率法。结果:根据声像图特征将超声检查结果分为三型。Ⅰ型23例,Ⅱ型5例,Ⅲ型10例。超声诊断的灵敏度为85.19%,特异度为100%,符合率为89.47%;高频超声可以有效判断神经通路是否存在(P<0.01)。结论:肱骨骨折术后出现桡神经损伤,高频超声可为手术提供直观及较为准确的辅助诊断信息。

Purpose： To evaluate the diagnostic value of high-resolution sonography before reoperation of injured radial nerve associated with humeral fracture. Methods： High-resolution sonography was used to examine 38 injured radial nerves associated with humeral fracture before reoperation. The sonographic results were compared with intraoperative observations and intraoperative electromyography was treated as golden standards. Fisher＇s exact test was used to analyze the diagnostic value of high-resolution sonography. Results： Based on the characteristics of sonographic results, the radial nerve injuries were divided into 3 types （23 cases of Type Ⅰ, 5 cases of Type Ⅱ, and 10 cases of Type Ⅲ）. The sensitivity of high-resolution sonography was 85.19%, the specificity was 100%, and the accuracy was 89.47%. The results showed that high-resolution sonography had significant diagnostic value of injuried radial nerve associated with humeral fracture （p〈O.O1）. Conclusion： Radial nerve injury is observed after humeral fracture surgery in some cases. High-resolution sonography provides visual and accurate diagnostic information, which is valuable for doctors to select strategies in reoperation.