骨间背神经损伤11例的诊疗体会

Diagnosis and treatment experience of 11 cases with interosseous dorsal nerve injury

目的探讨骨间背神经损伤的手术治疗方法及术后疗效,为临床合理选择治疗方案提供依据。方法对2005年7月-2016年8月收治的11例骨间背神经损伤病例进行回顾性分析,3例行神经接合术,2例行神经接合术+肌腱缝合术,3例单纯行神经松解术,2例行肿瘤摘除术+神经松解术,1例行神经移植术,术后4个月行肌腱移位术。运用Barthel指数评价日常生活能力,运动功能恢复情况参考英国医学研究院外伤学会关于神经损伤后运动功能恢复的评价标准。结果术后随访8~24个月,运动功能恢复情况评价:M5的8例,M4的2例;1例行肌腱移位术后肌力4级。与治疗前对比,治疗后患者的Barthel指数明显增高,日常生活能力较术前提高。结论外伤所致骨间背神经损伤,临床诊断成立,应积极进行神经接合术或神经移植术,桡神经深支卡压,要彻底探查神经进行松解,同时注意桡神经多处卡压,必要时行肌腱移位术,术后临床效果满意。

Objective To investigate the operation method and postoperative efficacy of posterior interosseous nerve injury and provide a foundation for reasonable therapy.Methods Between July 2005 and August 2016,in a retrospective analysis of 11 cases of posterior interosseous nerve injury.Neurorrhappy was performed in 3 patients.Two cases underwent neurorrhappy and tendon suture.Neurolysis alone in 3 cases.Two cases of tumor resection and neurolysis.One patient underwent nerve transplantation and tendon transfer 4 months after operation.Using Barthel index to evaluate the ability of daily life.Evaluation criteria consulted the trauma society of the british medical research institute for the recovery of motor function after nerve injury of motor function recovery.Results Postoperative followup was from 8 to 12 months,Evaluation of motor function recovery:function recovery was 8 cases of grade M5,2 cases of grade M4,1 case of grade M4 After tendon transposition.The Barthel index of patients before treatment was higher than that of patients after treatment.The ability of daily living was better than that before operation.Conclusion If clinical diagnosis of injury of posterior interosseous nerve caused by trauma is established,Neurorrhaphy or nerve transplantation should be carried out actively.When the deep branch of the radial nerve is jammed,the nerve should be thoroughly explored for release,and attention should be paid to the multiple entrapment of the radial nerve,tendon transposition if necessary.It has Satisfactory clinical effect after operation.