医源性桡神经损伤36例报告

Latrogenic injuries of radial nerve:A report of 36 cases

目的 :探讨医源性桡神经损伤的原因及防治措施。方法 :从 1987年 3月到 2 0 0 0年 3月共收治医源性桡神经损伤 36例 ,其中 33例是手术致伤 ,3例是多次手法复位致伤。手术治疗 32例 ,非手术治疗 4例 ,行神经外膜缝合或外膜一束膜缝合修复 8例 ,神经松解 19例 ,肌腱转位 8例 ,自行恢复 3例。结果 :2 7例病例随访 1～ 6年 ,按张咸中标准评价 ,优 2 0例 ,良 4例 ,差 3例。结论 :加强医生的责任心 ,熟悉桡神经的有关局部解剖和细致的手术操作 ,医源性桡神经损伤是完全可以避免的。一旦发生 ,早期诊治可以取得满意的效果。

Objective:To investigate the causes, the prevention and the treatment of iatrogenic radial nerve injuries.Methods: From March 1987 to March 2000 ,the authors treated 36 cases of iatrogenic radial nerve injuries .Of the 36 cases ,33 cases occurred after the orthopaedic operation ,3 cases occurred after the manipulative reduction. 32 cases were treated surgically, and the other 4 cases were treated non-surgically. 8 cases were repaired by epineurial suturing or by epi-fascicular suturing to connect the severed ends of the nerves. 19 cases were treated with neurolysis operation, 8 cases with tendon transfer and 3 cases with palliative treatment. Results: 27 cases were followed up for 1 year to 6 years. The curative effect was assessed according to Zhang Xianzhong's norm. The recovery of 20 cases were excellent, 4 cases were good, 3 cases were poor.Conclusion:The iatrogenic radial nerve injury can be avoided if the surgeon take a high responsibility and grasp a precise knowledge of pertinent anatomy. At the same time more attention should be paid in operation. Once incurred, the damage can be minimized if it is recognised and treated earlier.