肱骨骨折合并上肢神经损伤的治疗

Treatment of humeral fracture complicated with nerve injury

目的 总结肱骨骨折合并上肢神经损伤的治疗方法和效果。方法 32 例闭合性骨折,稳定型骨折行手法复位、石膏夹板外固定;不稳定型骨折行切开复位内固定,同时松解或吻合受损伤的神经。23 例开放性骨折及经8 周以上观察神经功能未恢复的9 例闭合性骨折,应用显微外科技术修复损伤的神经。结果 47 例获随访,随访时间6 个月～2 年,骨折均愈合,按神经感觉和运动功能恢复情况综合评定疗效(BMRC 法) :优23 例,良15 例,可7 例,差2 例,优良率80-86 % 。结论 肱骨骨折合并桡神经损伤是常见损伤,同时必须注意正中神经及尺神经的损伤,应用显微外科技术对损伤的神经及时进行修复,并采取适当的康复措施,是提高疗效的有效方法。

Objective To sum up treatment methods and effect for humeral fracture with nerve injury. Methods Manual reduction plaster and splint external fixation was used for patients with closed and stable fracture and others with unstable closed fracture were managed with excision reduction internal fixation while relaxing or suturing injuried nerve among 32 patients, 23 patients with open fracture and cases with closed fracture without recovering nerve functions over 8 weeks were selected for repairing injuried nerve by microsurgical technique. Results 47 cases were followed up from 6 months to 2 years, and all fractures were cured. According to sense and movement function recovering condition, the therapeutic result was synthetically evaluated(BMRC method), 23 cases were excellent, 15 cases better, 7 cases good, and 2 cases bad, and the excellent rate was 80 86%. Conclusion Humeral fracture combined with upper limbs nerve injuried is common, meanwhile the injury of median and ulnar nerve must be carefully managed, applying microsurgical technology to repair peripheral nerve injury promptly and taking measures of proper recovery should be the effective methods to achieve excellent rate.