桡神经损伤的治疗和经验教训

Causes and treatment in radial nerve injury

[目的]剖析桡神经损伤的原因,总结其经验教训。[方法]采用非手术疗法(给予抗炎、消肿、营养神经药物,辅以针灸理疗)和手术疗法(骨折复位内固定术、肌腱断裂修复术后,手术探查施行神经外膜缝合、神经松解术)治疗桡神经损伤29例。[结果]平均神经愈合时间为4个月;优19例,良8例,可2例。[结论]本组桡神经损伤的恢复效果满意,有的患者在恢复过程中的电生理显示与体征、症状不符;临床工作中,能及时正确判断神经损伤的性质和程度,对指导临床治疗极其重要;肱骨骨折内固定之际,必须仔细分离出桡神经并予以保护,其后整复骨折施行内固定;取出内固定物时,应先从远近端解剖出正常的桡神经,再逐渐暴露被瘢痕组织黏连的桡神经段,保护好桡神经,其后取出内固定物。骨外科医师只有谨慎地操作,方可减少桡神经的损伤。

[ Objective]To probe into the causes and treatments in the radial nerve injury. [ Method] Twenty-nine patients with radial nerve injury were treated. Conservative measures were anti-inflammatory, repercussion, nervous pharmacotherapy, acupuncture and physiotherapy. Surgical interventions included open reduction and internal fixation, tenorrhapy, neurorrhaphy and decompression of nerve. [ Result ] The outcome of treatment was evaluated with the result of 19 excellent, 8 good and 2 fair, in which nerve healing period was at an average of 4 months. [ Conclusion ] The overall effect was satisfactory in this series, among which, electro-neurogram were inconsistent with their symptoms and signs. It is important to asses the quality and degree in injury to the nerve for guiding the treatment. During internal fixation of the fractures of humerus, the exclusion and protection of the radial nerve should be carefully done. when removig the fixation the radial nerve would be protected by first dissecting normal radial nerve in distal and proximal segments ,then ,exposing gradually adherent segment within the scar tissue. In brief, the opportunity of injury to the radial nerve may be reduced by careful operation.