肱骨干骨折合并桡神经损伤不同治疗方法的临床分析

目的探讨不同疗法治疗肱骨干骨折合并桡神经损伤的临床效果。方法选取2012-01—2014-01间收治的60例肱骨干骨折合并桡神经损伤患者,依据不同治疗方法分为2组。A组35例实施早期桡神经探查治疗,B组25例实施保守治疗。观察2组的治疗效果。结果 A组优良率为88.6%,B组优良率为80.0%。A组术后随访时间为(12.2±2.3)个月,骨折愈合时间为(4.1±0.3)个月。B组术后随访时间为(12.1±2.4)个月,骨折愈合时间为(4.0±0.2)个月。2组患者术后无1例发生延迟愈合或者骨不连。2组差异均无统计学意义(P0.05)。结论对肱骨干骨折合并桡神经损伤患者给予早期桡神经探查或采取保守治疗均能够提高整体治疗效果,促进神经功能的恢复。     

儿童Ⅲ型肱骨髁上骨折伴桡神经损伤治疗分析

目的探讨一期手术治疗Ⅲ型儿童肱骨髁上骨折伴桡神经损伤的临床疗效。方法自2001年8月至2007年3月，对15例Ⅲ型肱骨髁上骨折伴桡神经损伤的患儿采用一期切开复位内固定并神经探查术。结果本组随访12～18个月，所有患儿桡神经功能均完全恢复，骨折于8～12周全部愈合，2例屈曲受限20°～30°，1例轻度肘内翻（小于5°）。结论采用一期切开复位内固定并神经探查术治疗儿童Ⅲ型肱骨髁上骨折伴桡神经损伤，神经离断或嵌压能得到及时处理，神经功能恢复好。骨折的解剖复位和克氏针的牢固固定，可有效地防止肘内翻畸形的发生。     

自锁髓内钉内固定治疗肱骨干骨折合并桡神经损伤

目的 探讨采用自锁髓内钉内固定治疗肱骨干骨折合并桡神经损伤的临床疗效及优越性。方法 回顾性地复习了8例肱骨干骨折合并桡神经损伤患者的治疗经过及疗效。结果 所有病例骨折愈合顺利，桡神经功能恢复满意。结论 肱骨干骨折合并桡神经损伤应尽早手术探查，自锁髓内钉内固定克服了传统钢板螺钉内固定的不足，能同时兼顾骨折愈合和损伤桡神经的功能恢复，有一定的优越性。     

逆行交锁髓内钉治疗合并桡神经损伤的肱骨干骨折

桡神经损伤是肱骨干中下段骨折最常见的并发症，能否得到及时合理的治疗，是神经功能恢复的关键。2003年10月至2006年12月，对13例合并桡神经损伤的肱骨干骨折患者，采用逆行交锁髓内钉固定治疗骨折，同时行桡神经探查修复，经临床观察，效果满意。     

脑外伤合并肱骨干骨折伴迟发性桡神经损伤1例报告

目的报告1例脑外伤合并肱骨干骨折伴迟发性挠神经损伤治疗体会。方法脑外伤合并肱骨干折出现迟发性桡神经损伤,术中彻底松解神经,去除神经周围骨痂,术后早期锻炼。结果早期内固定,神经松解,术后早期功能锻炼,神经功能恢复良好。结论脑外伤合并肱骨干骨折伴迟发性桡神经损伤需尽可能早期行内固定治疗,若无法早期内固定,需行外固定骨折端,然后择期选择合适内固定、彻底松解神经,早期功能锻炼促进神经功能恢复。     

联合固定治疗合并桡神经损伤的肱骨中下段粉碎性骨折

目的报道联合固定治疗合并桡神经损伤的肱骨中下段粉碎性骨折的临床效果。方法对13例合并桡神经损伤的肱骨中下段粉碎性骨折的患者采用接骨板或螺钉结合三维外固定支架进行治疗,术中给予一期植骨,并对桡神经探查和修复。结果所有患者术后3～5个月获得骨性愈合。其中5例桡神经为骨折端嵌压,1例为不全断裂,7例为挫伤。12例平均于术后6周恢复,1例术后4个月恢复。结论对于合并桡神经损伤的肱骨中下段粉碎性骨折患者采用联合固定、术后一期植骨及桡神经早期探查的方法可取得满意的疗效。     

肱骨干骨折合并桡神经损伤的早期手术治疗

桡神经损伤是肱骨中下段骨折最常见的并发症，能否及时、合理的治疗，是神经功能恢复的关键。1999～2001年，我院共收治肱骨干骨折合并桡神经损伤26例，均早期进行手术探查、修复。经6～24个月随访，效果良好。     

肱骨骨折致桡神经损伤治疗疗效分析

目的：对肱骨骨折引起桡神经损伤的治疗进行分析。方法：统计治疗肱骨骨折合并桡神经损伤43例,其中肱骨中下1／3骨折38例,其它部位肱骨干骨折5例,手术治疗29例,其中神经对端缝合13例,桡神经松解5例,神经部分缝合4周,神经减压3例,腓神经移植2例,肌腱移植2例。结果：功能完全恢复35例,不全恢复8例,结论：临床上肱骨骨折是造成桡神经损伤的主要原因,在桡神经缺损较多的情况下,尽可能采用桡神经近端内移和远端松解来克服缺损。对端缝合桡神经大多数病例可取得较理想的治疗效果。对桡神经无法恢复的病例,采用肌腱移位重建腕,指功能有一定的帮助。     

闭合复位带锁髓内钉适宜治疗合并桡神经损伤的肱骨干骨折吗?

目的探讨肱骨干骨折合并的桡神经损伤是否会因为带锁髓内钉置入时的闭合复位操作而导致神经损伤的加重。方法2002年1月～2005年1月手术治疗的353例肱骨干骨折患者中,63例术前合并桡神经损伤。对此63例患者的体检、手术记录、X线片及治疗结果进行回顾性分析。11例行闭合复位带锁髓内钉固定；52例行切开复位内固定术及桡神经探查术,应用PEMS 3．1版本的卡方检验对11例行闭合复位带锁髓内钉固定术的患者与19例可以采用带锁髓内钉固定但行切开复位内固定术及桡神经探查术的患者桡神经恢复情况进行统计学分析。结果52例行切开复位内固定术及桡神经探查术的患者中,9例(17．3%)桡神经被骨折端嵌压,其余43例均为桡神经挫伤。63例患者中,除2例外,桡神经损伤均于术后2～12周(平均8周)自行恢复。所有患者术后3～4个月获骨性愈合。闭合复位带锁髓内钉术与切开复位内固定及神经探查术对肱骨干骨折合并桡神经损伤患者的影响差异无显著性意义(P=0．3931)。结论闭合复位带锁髓内钉固定治疗合并桡神经损伤的肱骨干骨折患者是适宜的。     

创伤性浮肘并桡神经损伤一期手术治疗疗效分析

目的 探讨采用一期手术骨折内固定、神经探查松解或缝合治疗创伤性浮肘并桡神经损伤的疗效.方法 2005年3月至2009年11月,对17例患者一期行手术探查,骨折断端钢板内固定并桡神经松解或缝合治疗.所有患者均有桡神经损伤的体征,无明显血管损伤征象.术后观察骨折愈合时间,肘关节、前臂和桡神经功能恢复情况.结果 骨折平均愈合时间为5个月,无肘内外翻畸形,1例患者有肘关节僵硬,其余患者前臂旋转和肘关节伸屈功能良好.1例前臂毁损伤患者桡神经功能无恢复;3例桡神经完全断裂伤患者伸腕、伸拇功能恢复较慢,最长恢复时间达1年;余13例不全损伤者桡神经功能恢复较快,最长恢复时间为4个月.本组患者无较大的手术并发症.结论 在生命体征平稳的条件下,创伤性浮肘并桡神经损伤患者应积极一期行骨折内固定并神经探查松解或缝合治疗,能使骨折早期愈合,挽救肘关节伸屈和前臂旋转功能,较好地恢复桡神经的功能.     

肱骨干骨折后桡神经麻痹的系统评价

目的采用循证医学研究方法,系统评价肱骨干骨折后桡神经麻痹(radialnervepalsy,RNP)的不同处理方法,为临床治疗决策提供证据基础。方法采用PubMed、Datastar及CochraneDatabase等互联网公共搜索引擎作为检索工具,检索过去40年中发表的有关肱骨干骨折后桡神经麻痹的文献,再对入选文献的参考文献行手工检索,制定数据抽取问表,对入选文献进行数据抽取、汇总、归纳和荟萃分析。结果共检索到391篇原始文献,其中324篇得自电子检索,67篇得自手工检索。有35篇符合最终的入选标准,总计随访患者1045例。其中21篇文献共记录了发生于4517例肱骨干骨折中的532例桡神经麻痹,肱骨干骨折后桡神经麻痹的发生率为11.8%。肱骨干中1/5和中远1/5部位的桡神经麻痹发生率明显高于其他部位(P<0.05)。不同骨折类型中,横形和螺旋形骨折较斜形和粉碎性骨折更易于并发桡神经麻痹(P<0.0001)。肱骨干骨折后桡神经麻痹总的恢复率为88.1%,早期保守治疗的病例自发性恢复率为70.7%。观察等待组和早期手术探查组之间神经恢复的最终结果没有明显差别。结论对肱骨干骨折后桡神经麻痹采用早期保守治疗不会影响神经的最终恢复结果,可以避免许多不必要的手术。     

Postoperative radial nerve palsy in humeral shaft nonunion reconstruction: Can the lateral paratricipital approach prevent this common complication?

BackgroundPostoperative radial nerve palsy (RNP) is a well-known complication of nonunion reconstruction of the humerus. The purpose of the current study is to determine if the surgical approach for nonunion reconstruction of the humerus influences the rate of postoperative radial nerve palsy.MethodsA retrospective case-control study of all humeral shaft and extraarticular distal humerus nonunion reconstructions performed between January 1, 2004, and August 31, 2021, was conducted. Patients included were over 18 years of age, had a non-pathologic humerus fracture nonunion and had intact radial nerve function prior to nonunion reconstruction. Exclusion criteria consisted of nonunions involving the proximal humerus, intraarticular fractures, and reconstructive treatment procedures with either intramedullary nail or external fixation methods. Perioperative variables were recorded and analyzed in regard to the development of postoperative RNP. A subgroup analysis was performed to assess the interaction of significant variables on the development of postoperative RNP.ResultsThe overall rate of postoperative RNP in this series was 6/53 (11%). However, no cases of postoperative radial nerve palsy were observed in patients who underwent nonunion reconstruction with a lateral paratricipital approach. A new RNP was seen in 4/9 (44%) of those patients who underwent a triceps splitting approach, which was significantly higher than those utilizing either an anterolateral approach (2/28, 7%) or a lateral paratricipital approach (0/16, 0%, p = 0.007).Discussion and conclusionOur data suggests that the lateral paratricipital exposure decreases the risk of radial nerve injury with nonunion reconstruction of the humerus. The lateral paratricipital exposure offers the benefit of radial nerve exploration, decompression, neurolysis and protection prior to fracture manipulation and instrumentation. This study shows conventional approaches may predispose patients to a high rate of postoperative RNP, similar to that in the literature.     

微创旋入钉内固定技术治疗伴桡神经麻痹的肱骨干中下段骨折

目的：总结微创旋入钉内固定技术在治疗伴桡神经麻痹的肱骨干中、下段骨折的应用效果。方法：自2004年1月至2008年1月,收治36倒伴桡神经麻痹的肱骨干中、下段骨折患者。其中男28例,女8例;年龄20～58岁,平均36．5岁。致伤原因：机械伤18例,交通伤8例,意外伤10例,均为闭合性骨折。根据AO分型：A1型5例,A2型7例,B1型8例,B2型7例,B3型5例,C3型4例。于骨折部位外侧做小切口,探查桡神经后,复位骨折。经肩峰外侧做小切口,分开三角肌,于大结节后侧开槽,顺行用髓腔钻扩髓,挑选合适旋入钉旋入髓腔远端,沿槽口打入锁片完成固定。记录术后并发症、骨折愈合时间、桡神经功能恢复时间、肩关节和肘关节屈伸范围。采用ASES肩关节和HSS肘关节评分标准评价疗效.结果：36例患者切口均Ⅰ期愈合。获随访9-36周,平均18．5周。骨折愈合时间12～16周,平均为15．6周。桡神经功能术后12～36周完全恢复,平均17．8周。肩关节外展150°～170°,平均160°;肘关节活动范围130°～140°,平均135°。肩关节功能根据ASES评分标准,由术前的（43．85±8．90）分上升至术后的（91．27±7．66）分,差异有统计学意义（t=24．238,P=0．000）,其中优20例,良12例,可4例;肘关节根据HSS评分标准,由术前的（39．97±16．06）分上升至术后的（96．22±3．59）分,差异有统计学意义（t=20．512,P=0．000）,36例均为优。结论：采用微创旋入钉内固定技术治疗伴桡神经麻痹的肱骨干中、下段骨折可获得良好效果。     

Indications, dangers and results of surgical treatment of humeral shaft fractures

A series of 78 fractures of the humeral shaft is presented that were treated operatively between 1978 and 1987. Open fractures, fractures with primary palsy of the radial nerve, distal fractures with an intraarticular component, fractures in polytraumatized patients and non-unions were absolute indications for operative stabilization in this series. In 71 fractures, internal stabilization was performed and in 7 fractures external fixation. In 16 fractures (20.6%), primary palsy of the radial nerve was present. In 10 patients (12.8%), radial nerve palsy appeared postoperatively. Nonunions and deep infections did not occur. In two cases, a second osteosynthesis was necessary after loosening of the implants. The humeral shaft fracture shows normal bony consolidation after conservative treatment as well as appropriate plate osteosynthesis. Nine of the 16 patients with primary radial nerve palsy (56.2%) and 6 of the 10 patients with secondary radial nerve palsy (60%) had total functional recovery. In our series, intraoperative palsy of the radial nerve was the most frequent complication after dissection of spiroid fractures in the middle or lower third of the humeral shaft. In this fracture form, a more unstable osteosynthesis, such as intramedullary pinning in accordance to Hackethal, should be chosen.     

The management of humeral shaft fractures with associated radial nerve palsy: a review of 117 cases

Patients and methods  

This single center retrospective study reviews the management and outcomes of 117 consecutive patients with humeral shaft fractures and associated radial nerve palsy (RNP) treated over a 20-year period (1986–2006). A total of 101 fractures were managed conservatively and 16 fractures underwent external fixation for poor bony alignment. Sixteen grade 1 and 2 open fractures underwent wound toileting alone. No patients underwent initial radial nerve exploration or opening of the fracture sites.     

Radial nerve lesions associated with fractures of the humeral shaft

Radial nerve palsy associated with a fracture of the shaft of the humerus is a relatively common injury. Out of 91 radial nerve injuries, operated upon in the Neurosurgical University Clinic in Belgrade from 1979 to 1988, 37 were associated with fractures of the humeral shaft or their surgical treatment. These fractures were previously treated in other medical units. In all cases a microsurgical reconstruction of the radial nerve was done: an interfascicular neurolysis in 24 cases and interfascicular grafting in 13 cases. A useful functional recovery was obtained in 91.9 per cent of the cases. Timing of nerve exploration and repair, as a main problem, is discussed.     

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.     

Radial nerve transection after ballistic humeral shaft fractures: A retrospective cohort study

IntroductionRadial nerve palsy following fracture of the humeral shaft is common. However, the incidence of nerve transection in the setting of ballistic trauma is unknown. The purpose of this study was to estimate the incidence of radial nerve transection after ballistic fracture of the humerus.MethodsPatients presenting to an urban, level-1 trauma center with a ballistic fracture of the humeral shaft were retrospectively reviewed. Patient demographics, clinical exam on presentation, and operative data were reviewed to determine the incidence of radial nerve palsy on initial examination, the incidence of operative treatment, the incidence of how frequently the nerve was directly visualized, and the incidence of radial nerve transection.ResultsOne-hundred and thirteen ballistic humeral shaft fractures were identified. Of these, 30 (26.5%) patients had a complete radial nerve palsy on exam. Of patients with a radial nerve palsy, on exam 20 were taken to the operating room and the nerve was visualized in 17 of those cases. There 2 were partially lacerated nerves and 12 nerves were completely transected. Thus, in patients with a complete nerve deficit on examination who underwent operative treatment with nerve exploration, the rate of nerve transection was 70.6%. The lower bound rate of nerve transection for all patients with radial nerve palsy (assuming all unexplored nerves were intact) was 40.0%.ConclusionThe rate of nerve transection in patients with humerus shaft fractures with associated radial nerve palsies is likely higher than the rate of nerve transection in similar injuries caused by blunt mechanisms. The authors recommend early exploration and fixation of these injuries.