儿童肱骨骨折合并桡神经损伤44例处理报告

本文报告了44例儿童肱骨不同部位骨折合并桡神经损伤的临床资料并讨论了损伤机理和治疗问题．全组肱骨中下段骨折7例，肱骨髁上骨折35例，肱骨外髁骨折2例．采用手法复位、石膏固定或牵引治疗14例，行神经松解术21例．神经吻合术8例，肌腱转移术1例．24例随访2月至26年（平均4年7个月），优良率为的95.8％，伤后6月内得到处理者功能恢复比较满意．桡神经走行与肱骨关系密切，故肱骨骨折易合并桡神经损伤．对开放性损伤或肱骨干中下段骨折明显移位合并的桡神经损伤应尽快手术治疗，非手术治疗观察1月－3月神经功能无恢复者应考虑手术．如系粘连、压迫所致，行神经松解术，如已完全离断，行对端外膜缝合术．

Report of 44 Cases of Radial Nerve Injury Complicated with Humeral Fracturen in Children

Forty-four cases of radial nerve injuries compliocated with humeral fracture and themechanism of injury and treatment are discussed. The patients of fracture of middle and lower thirds ofthe humeral shaft fractures, supracondylar fracture of humeral and external condylar fracture were seven,thiry-five, two, respectively. Fourteen patientsunder went manipulative reduce, immobilizaion of plastercast ortraction, twenty-five underwent neurolysis, eight neurorrhaphy, one tendontranfer. Twenty-fourpatients were followed up 2 months to 26 years (averaged 4 years and 7 months). The overall excellentand good rate was 95.89%. Those managed in 6 months have a good results. The anatomylocation ofradial nerve are close contact with bone and joint,sohumeral fracture were complicated with radial nerveinjury frepuently. For those cases of open wound or displaced fracture of middle and lower thirds ofhumeral shaft, operation should be done as quickly as possible. If there is no signs of recovery in thenonoperative cases within 1-3 months, operate should be considered. Neurolysis is the choice of theinjury caused by compression oradhesion. If the nerve was divided, then end-to-endepineurialneurorrhaphy is an appropriate method.