医源性骨间背侧神经损伤15例

Iatrogenic interosseous posterior nerve injuries:a report of 15 patients

目的:探讨医源性骨间背侧神经损伤的原因、治疗和预防措施.方法:本组15例,手术误切伤10例,术中误结扎伤2例,牵拉伤2例,内固定钢板压迫神经1例.骨间背侧神经根据解剖学特点可分为3个区域,各区损伤机制和临床表现不同,本组Ⅰ区为11例,Ⅱ区4例,Ⅲ区0例.13例采用神经松解、神经吻合、神经移植等治疗;2例经保守治疗.结果:15例经7～62个月随访,神经功能恢复按Clawson和Seddon分级:运动功能M4及M5为优,M3为良,M2为可,M0及M1为差.结果:本组评价优8例,良4例,可3例,优良率80%.结论:骨间背侧神经由于其解剖学特殊性容易发生医源性损伤,而医务人员高度责任心、严谨的工作作风和细致的操作技术是预防的关键.

Objective： To explore causes, treatment methods and prevention of iatrogenic interosseous posterior nerve injuries. Methods：Among fifteen patients（male 10 and female 5）with interosseous posterior nerve injuries, 10 were caused by mis-ineision during operation, 2 by mis-deligation during operation, 2 by traction injuries and 1 by compression during internal fixation with steel plate. Based on anatomical characteristics, the interosseous posterior nerve can be divided into three segments, with different mechanism and clinical manifestations of the nerve injuries are different. In all 15 patients in the present study, there were 11 patients suffering from nerve injuries in Ⅰ segment,4 in Ⅱ segment and no patient in Ⅲ segment. Thirteen patients undergone neurolysis, anastomosis or nerve grafting and 2 were treated with conservative methods. Results： All the patients were followed up from 7 to 62 months; Functional recover of the nervous function was graded according to Clawson and Seddon standaM： the motor function reached to M4 or M5 can be regarded as excellent, M3 as good, M2 as poor,M0 or MI as bad. In our study,8 patients obtained excellent results,4 good,poor and no bad. The excellent-and-good rate was 80 %. Conclusion： The interosseous posterior nerve injury is often caused by iatrogenie factors, and high responsibility of doctors combined with careful manipulation is the way to prevent from its occurrence.