桡神经内置在肱骨中下段骨折钢板内固定术中的应用

Medial transposition of the radial nerve in steel plate internal fixation of lower segment fracture of humerus

目的 ：探讨在肱骨中下段骨折钢板内固定术中将桡神经内置的方法及疗效。方法 ：自2010年1月至2013年12月采用桡神经内置钢板内固定术治疗31例肱骨中下段骨折患者,男18例,女13例;年龄26~58岁,平均37岁;受伤至手术时间1~8 d,平均4.5 d。按AO骨折分型：A1型7例,A2型3例,A3型6例,B1型2例,B2型4例,B3型2例,C1例4例,C2型3例。患者术前均无桡神经损伤征象。采用美国骨科协会提出的DASH量表进行疗效评定,0表示上肢功能正常,1~100表示上肢功能有不同程度的损伤。结果：31例患者术后未发生与手术相关并发症,无神经损伤与伤口感染。31例患者术后获随访,时间8~15个月,平均11个月。上肢功能按DASH上肢功能量表评定,患者伤后评分76.2±11.8,末次随访评分8.2±7.4,术后随访评分与伤后评分比较差异有统计学意义（t=9.717,P〈0.01）,上肢功能恢复满意。结论：在肱骨中下段骨折钢板内固定术中将桡神经内置可有效避免医源性桡神经损伤。

Objective：To investigate the method of medial transposition of the radial nerve in plate fixation of lower seg-ment fracture of humerus. Methods：From January 2010 to December 2013,31 patients with medial transposition of the radi-al nerve in plate fixation of lower segment fracture of humerus,including 18 males and 13 females ranging in age from 26 to 58 years old with a mean of 37 years old. The time between injury and operation was 1 to 8 days with an average of 4.5 days. According to AO classification,7 fractures were type A1,3 fractures were type A2,6 fractures were type A3,2 fractures were type B1,4 fractures were type B2,2 fractures were type B3,4 fractures were type C1,3 fractures were type C2. No patients had any signs of radial nerve injury. The results were evaluated with DASH（disability of arm shoulder hand）Questionnaire by the American Academy of Orthopedic Surgeons（AAOS）,which 0 indicated normal upper extremity function,and 1 to 100 indicated varying degrees of damage to the function of the upper extremties. Results：There was no neurologic complication or postoperative wound infection in this series. The followed up period ranged form 8 to 15 months（means 11 months）postopera-tively. The clinical outcomes were evaluated with DASH Questionnaire,the score before operation was 76.2±11.8,the final fol-low up score was 8.2±7.4,the final follow up score was significant higher than before operation（P〈0.01）. The function of the upper extremities recovered satisfactorily. Conslusion：The method of medial transposition of the radial nerve in plate fixa-tion of lower segment fracture of humerus can avoid iatrogenic radial nerve injury effectively.