【摘要】　目的　 探討高原地區(qū)橈神經(jīng)損傷的治療效果，并總結(jié)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(jīng)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(kāi)放性損傷5例，閉合性損傷49例；左側(cè)26例，右側(cè)28例。受傷原因:刀傷5例，醫(yī)源性損傷（手術(shù)牽拉傷、被鋼板擠壓傷）10例，肱骨干骨折合并橈神經(jīng)損傷39例。神經(jīng)損傷類型:橈神經(jīng)完全斷裂12例；大部分?jǐn)嗔?5例；挫傷27例，挫傷長(zhǎng)度1.5~4.5 cm。所有患者均有典型的感覺(jué)及運(yùn)動(dòng)功能障。采用神經(jīng)吻合修復(fù)27 例，神經(jīng)松解減壓27例。骨折均用鋼板內(nèi)固定。　結(jié)果　 所有患者手術(shù)均順利，術(shù)后切口均I期愈合，無(wú)手術(shù)相關(guān)并發(fā)癥發(fā)生。54例均獲隨訪16~24個(gè)月，平均18個(gè)月。骨折于術(shù)后8～14個(gè)月達(dá)臨床愈合。末次隨訪時(shí)根據(jù)中華醫(yī)學(xué)會(huì)手外科上肢周圍神經(jīng)功能評(píng)定標(biāo)準(zhǔn)，神經(jīng)吻合的27例中，獲優(yōu)14例，良8例，差5例；神經(jīng)松解減壓術(shù)治療的27例均獲優(yōu)?？們?yōu)良率為91%。　結(jié)論　 上臂橈神經(jīng)損傷宜早期手術(shù)修復(fù)，神經(jīng)吻合的療效較神經(jīng)松解減壓術(shù)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(qū)橈神經(jīng)損傷54例療效分析. 華西醫(yī)學(xué), 2011, 26(12): 1836-1838. doi: 復(fù)制

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