闭合性肱骨干骨折并桡神经损伤42例

42 Cases Closed Fracture of Humeral Shaft Complicated with Radial Nerve Injury

目的:分析肱骨干骨折并桡神经损伤原因及治疗效果。方法:采用骨折复位外固定,桡神经保守观察治疗27例及骨折端切开复位内固定并行桡神经探查术治疗15例。结果:27例保守治疗病人中16例三个月内骨折愈合,桡神经功能恢复优良,10例6个月内骨折愈合,桡神经功能恢复优良8例,良好2例,1例观察8周因桡神经功能无改善,改为手术探查,发现桡神经嵌压在骨折端,解除嵌压,桡神经外膜切开松解术后6个月桡神经功能恢复优良。15例手术治疗患者中,6例3个月内骨折端愈合,桡神经功能恢复优良,9例半年内骨折端愈合,桡神经功能恢复优良6例,良好3例。结论:肱骨中1/3段及中、下1/3交界处受直接暴力所致的粉碎,斜形、横形骨折和肱骨中、下1/3交界处受间接暴力所致的斜形,螺旋形骨折都易损伤桡神经,桡神经损伤以挫伤为主,经骨折小夹板外固定,桡神经保守观察治疗大部分能恢复,对复位不理想,稳定性差的斜形,螺旋形及粉碎形等骨折需手术行骨折内固定及桡神经探查治疗。

Objective： To explore the causes and treatment of fracture of humeral shaft complicated with radial nerve injury. Method： 27 cases reduction with external fixation, in the mean while, radial nerve were treated with conservative method. 15 cascs were internal fixed. Result： 16 cases of 27 cases were cured after three months conservative therapy, Radial nerve function were with good recovery, 10 cases were cured of fracture in 6 months. 8 cases with good recovery of radial nerve function, 2 cases were better, 1 case without changes of radial nerve function after 8 weeks, and then were operated for the radial nerve wedge pressure, The radial nerve function were recovered after radial epineurium rehbilitation 6 months. In all I5 cases, 6 cases were cured in three months, with good recovery of radial nerve. 9 cases were cured of fracture, 6 cases with good recovery of radial nerve in half a year. 3 cases were better. Conclusion： Most of radial nerve contusion occured in 1/3 middle, I/3 middle and distal humeral fracture, most of the fracture type was oblique and spiral. The radial nerve were with good reduction by external fixation with small splint except the oblique and spiral fracture needed internal fixation and radial nerve exploration.