【摘要】 目的 探討高原地區橈神經損傷的治療效果，并總結影響療效的因素。 方法 回顧性分析2005年6月-2010年6月收治的橈神經損傷并有完整隨訪資料的54例患者，其中男40例，女14例；年齡8～69歲，平均32.6歲。開放性損傷5例，閉合性損傷49例；左側26例，右側28例。受傷原因:刀傷5例，醫源性損傷（手術牽拉傷、被鋼板擠壓傷）10例，肱骨干骨折合并橈神經損傷39例。神經損傷類型:橈神經完全斷裂12例；大部分斷裂15例；挫傷27例，挫傷長度1.5~4.5 cm。所有患者均有典型的感覺及運動功能障。采用神經吻合修復27 例，神經松解減壓27例。骨折均用鋼板內固定。 結果 所有患者手術均順利，術后切口均I期愈合，無手術相關并發癥發生。54例均獲隨訪16~24個月，平均18個月。骨折于術后8～14個月達臨床愈合。末次隨訪時根據中華醫學會手外科上肢周圍神經功能評定標準，神經吻合的27例中，獲優14例，良8例，差5例；神經松解減壓術治療的27例均獲優。總優良率為91%。 結論 上臂橈神經損傷宜早期手術修復，神經吻合的療效較神經松解減壓術差。
【Abstract】 Objective To explore the therapeutic effect on radial nerve injuries in plateau area, and to analyze the influencing factors. Methods The clinical data of 54 patients with radial nerve injuries who were treated between June 2005 and June 2010 were retrospectively analyzed. The patients included 40 males and 14 females and aged 8-69 years (averaged 32.6 years old). Of these 54 patients, 5 were open injuries, 49 were closed injuries; 26 were on the left side, and 28 were on the right sides. Causes of injuries included: 5 direct cut injuries, 10 iatrogenic injuries (including traction injuries and crush injuries by steel plates), and 39 humeral shaft fracture and radial nerve injuries. Types of nerve injuries included: 12 complete radial neurotmesis, 15 partial radial neurotmesis, and 27 radial contusions (with contusion length ranged 1.5-4.5 cm). All patients had radial nerve injuries experienced significant motor dysfunctions. Among these patients, 27 underwent nerve anastomosis, the remaining 27 were treated by nerve decompression; all fractures were treated with internal fixation with steel plates. Results During the average follow-up of 18 months (16-24 months), all 54 patients completely recovered from radial nerve injuries without any complications. The time for fracture healing ranged 8-14 months. According to the evaluation standards for radial nerve functional recovery, developed by the Chinese Medical Association, among the 27 cases treated by nerve anastomosis, 14 were “optimal”, 8 were “fair”, and 5 were “bad”; and all 27 cases treated by nerve decompression were “optimal”. Conclusion It is suggested to have early surgical treatment for the upper arm radical nerve injuries. The nerve decompression had better curative effects than the nerve anastomosis does.
引用本文： 秦桂蘭,李平. 高原地區橈神經損傷54例療效分析. 華西醫學, 2011, 26(12): 1836-1838. doi: 復制