桡神经损伤的神经电生理检测与医源性损伤预防

Electroneurophysiologic detection of radial nerve injury and the prevention of iatrogenic injury

目的：探讨桡神经损伤的神经电生理检测方法及其医源性桡神经损伤的预防。方法：测定40例桡神经损伤病人的桡神经运动神经传导速度（MCV）及感觉神经传导速度（SCV）。根据桡神经损伤定位诊断和鉴别诊断的需要，按不同阶段分布选择肌肉进行肌电图（EMG）检查。结果：40例患者桡神经肘以上完全性（或严重）损伤20例，不全性损伤9例；桡神经肘以下完全性（或严重）损伤7例，不全性损伤3例；桡神经腋部严重损伤1例。医源性桡神经损伤11例，占总病例的28％。结论：桡神经损伤诊断应用神经电生理检查很重要，EMG在桡神经损伤的定位诊断与鉴别诊断中有着重要价值，其中肱桡肌、肱三头肌、三角肌是重要的鉴别诊断及定位肌肉。医源性桡神经损伤难以回避且发生率较高，应用术中持续肌电监测可以提高手术的准确性与操作的精确性，减少神经损伤的发生。

Objective：To discuss detecting method of eleetroneurophysiology for radial nerve injuries（RNI） ,and the prevention of iatrogenic RNI. Methods： The radial nerve＇s motor conduction velocities （MCV）and sensory conduction velocity （SCV）were detected in 40 patients with RNL According to the localizational diagnosis of RNI and differential diagnosis,muscles were examined with eleetromyography （EMG）in different phases. Results：In 40 patients with different degree of radial nerve injury, 20 of them were completely injured （or severely） in the above elbow, 9 of them were in incompletely injured in the above elbow, 7 of them were completely injured （or severely）in the bebow elbow, 3 of them were incompletely injured. Only one was badly in the injured radial nerve＇axilla . Besides, there were 11 patients with iatrogenic RNI, taking up 28%. Conclusion： Electroneurophysiology detection method is very important for diagnosis of RNI, EMG contains significant value for localization and differential diagnosis of RNI, braehioradialis triceps and deltoid are the significant muscles which can afford the right localizational diagnosis. The iatrogenic radial nerve injury is too difficult to avoid and incident extremely, however, nerve injuries can be reduced by monitoring the myoeleetrieity continuously in the operation which may improve its veracity and accuracy.