肱骨髁上骨折需要手术探查神经的临床观察

Clinical observation of supracondylar fracture of humerus requiring surgical nerve exploration

目的探讨微创治疗伴有神经损伤的肱骨髁上骨折的临床效果及需要手术探查神经的初步研究。方法选取2017年8月至2020年9月期间就诊于山西省儿童医院骨科的34例肱骨髁上骨折伴有神经损伤的儿童患者,进行病例回顾性分析,闭合复位克氏针固定及小切口手术探查损伤神经,进行6个月~3年的随访,随访时间(2.15±0.49)年,根据中华医学会手外科学会上肢周围神经功能评定试用标准评定肘关节功能、桡神经、正中神经、尺神经功能。结果儿童肘关节功能评定:优31例,良2例,可1例,差0例;优良33例。3例未能早期功能康复锻炼,2例经专业骨科康复治疗师治疗及配合理疗后,2.5个月功能恢复,其中1例极不配合功能康复训练,经骨科康复师治疗,经3.5个月肘关节、手指功能不受影响。神经损伤后两周:桡神经功能评定:优15例,良3例,可4例,差0例。正中神经功能评定:优5例,良2例,可6例,差0例。尺神经功能评定:优5例,良0例,可1例,差0例。伤后3个月:桡神经、正中神经、尺神经功能评定优良率均为100%。结论伴有神经损伤的肱骨髁上骨折经微创手术治疗,需要手术探查神经仍属少数,术后骨折神经损伤恢复顺利,临床效果良好。

Objective To investigate the clinical effect of minimally invasive treatment of supracondylar fracture of humerus with nerve injury and the need for surgical exploration of nerve.Methods From August 2017 to September 2020,34 cases of children with supracondylar fracture of humerus with nerve injury in the Department of orthopedics of Shanxi Children′s Hospital were selected for retrospective analysis.Closed reduction,Kirschner wire fixation and small incision surgery were used to explore the injured nerve.The follow-up period ranged from 6 months to 3 years,with a follow-up time of(2.15±0.49)years.The elbow function,radial nerve,median nerve and ulnar nerve function were evaluated according to the trial standard of upper limb peripheral nerve function evaluation of Hand Surgery Society of Chinese Medical Association.Results The elbow function of children in this group:excellent 31 cases,good 2 cases,fair 1 cases,poor 0 cases,excellent 33 cases.Three patients failed to take early functional rehabilitation exercise.Two patients recovered after 2.5 months of treatment by professional orthopedic rehabilitation therapists and physical therapy.One of them did not cooperate with functional rehabilitation training.After 3.5 months of treatment by orthopedic rehabilitation therapists,elbow and finger functions were not affected.Two weeks after nerve injury:radial nerve function evaluation:excellent in 15 cases,good in 3 cases,fair in 4 cases,poor in 0 cases,excellent in 18 cases.Median nerve function evaluation:excellent in 5 cases,good in 2 cases,fair in 6 cases,poor in 0 cases,excellent in 7 cases.Ulnar nerve function evaluation:excellent 5 cases,good 0 cases,fair 1 cases,poor 0 cases,excellent 5 cases.At 3 months after injury,the excellent and good rate of radial nerve,median nerve and ulnar nerve was 100%.Conclusion The supracondylar fracture of humerus with nerve injury is treated by minimally invasive surgery,and the nerve exploration is still a few.The recovery of nerve injury after surgery is smooth,and the clinical effect is good.