高频超声在肱骨骨折合并桡神经损伤诊断中的应用

目的 评价高频超声对肱骨骨折合并桡神经损伤的诊断价值.方法 对36例肱骨骨折术后并发桡神经完全损伤的患者,于神经损伤后1～3个月行神经电生理检查及高频超声诊断检查,28例患者进行了桡神经松解或桡神经修复手术治疗,8例保守治疗.结果 按照神经巢状结构、神经瘤以及外部组织压迫神经等三方面,将桡神经损伤分成4型:Ⅰ型4例,Ⅱ型9例,Ⅲa型12例,Ⅲb型7例,Ⅳ型4例.31例患者经神经手术或非手术治疗功能恢复良好;5例(Ⅲb型3例,Ⅳ型2例)患者接受二期功能重建手术,功能恢复良好.结论 肱骨骨折术后出现桡神经损伤,超声诊断可以提供早期、直观以及正确的辅助诊断方法,同时根据超声诊断的分型选择合适的治疗方法,对桡神经预后有一定的参考意义.

Application of high-resolution sonography for diagnosis of radial nerve injury combined with humeral fracture

Objective To evaluated the value of high-resolution ultrasonography in diagnosis of radial nerve injury combined with humeral fracture. Methods Thirty-six patients with complete radial nerve palsy following humeral fracture and surgery were included in the study. One to three months after the nerve injury electrophysiologic evaluation and high resolution ultrasonograghy of the radial nerve was conducted. Twenty-eight patients went on to have radial nerve neurolysis or repair, while 8 had conservative treatment. Results According to the ultrasonic image characteristics of the radial nerve, its nestle structure, existence of neuroma and extent of external compression from other structures, the radial nerve injuries were divided into 4 types: type Ⅰ in 4 cases, type Ⅱ in 9 cases, type Ⅲ a in 12 cases, type Ⅲ b in 7 cases, and type Ⅳ in 4 cases. Thirty-one patients achieved completely functional recovery after surgical or conservative treatment. Five cases ( Ⅲ b 3 cases, Ⅳ 2 cases) underwent secondary surgeries for functional reconstruction and achieved good results.Conclusion For radial nerve injuries caused by humeral fracture and surgery, high-resolution ultrasonography can provide early, direct and accurate diagnosis. At the same time, according to the characteristics of ultrasonic image radial nerve injury could be divided into 4 types which dictate the treatment options and prognosis.