儿童桡神经损伤78例分析

78 cases of radial nerve injuries in children

目的讨论儿童桡神经损伤的临床特点和治疗方法。方法对７８例儿童桡神经损伤的临床资料进行总结和分析。伤因：６６例为上肢骨折或脱位时合并神经损伤，其中肱骨下段骨折７例，肱骨髁上骨折３７例，孟氏骨折或单纯桡骨头脱位１８例，尺骨和／或桡骨骨折４例。１２例为单纯神经损伤。采用手法复位、石膏固定或牵引１８例，神经松解术３８例，神经吻合术２０例，肌腱转移功能重建术２例。结果４２例随访２个月～２６年，平均４年２个月。用Ｈｉｇｈｅｔ运动评定法评定，疗效为优者３４例，优良率达８１％。伤后３个月内治疗者优良率占９６．５％，明显优于伤后６个月处理者的５０％。结论儿童上肢骨折脱位易合并桡神经损伤，对开放性骨折合并桡神经损伤者应尽快手术治疗。

Objective To discuss the pathogenesis and treatment of radial nerve injuries in children. Methods Etiology and treatment of seventy eight radial nerve injuries in children were retrospectively analyzed. The nerve injuries were simplex in 12 cases, but were complicated by upper limb fractures or dislocation in sixty six patients (84.6%): 7 fractures of middle and distal thirds of the humeral shaft, 37 supracondylar fractures of humerus, 18 Monteggia fractures or radial head dislocation , 4 radius or ulna fractures. 18 patients underwent manipulative reduction and immobilization with plaster cast or traction. 38 neurolysis, 20 neurorrhaphy and 2 tendon transfer. 42 patients were followed up for 2 months to 26 years (averaged 4 years and 2 months). Results The overall excellent and good rate was 81%. The treatment outcome was much better in those managed within 3 months than those managed 6 months later. Conclusion Radial nerve injury is a common complication of upper limb fractures or dislocation in children and early treatment is recommended.