儿童桡神经损伤78例分析

目的讨论儿童桡神经损伤的临床特点和治疗方法。方法对７８例儿童桡神经损伤的临床资料进行总结和分析。伤因：６６例为上肢骨折或脱位时合并神经损伤，其中肱骨下段骨折７例，肱骨髁上骨折３７例，孟氏骨折或单纯桡骨头脱位１８例，尺骨和／或桡骨骨折４例。１２例为单纯神经损伤。采用手法复位、石膏固定或牵引１８例，神经松解术３８例，神经吻合术２０例，肌腱转移功能重建术２例。结果４２例随访２个月～２６年，平均４年２个月。用Ｈｉｇｈｅｔ运动评定法评定，疗效为优者３４例，优良率达８１％。伤后３个月内治疗者优良率占９６．５％，明显优于伤后６个月处理者的５０％。结论儿童上肢骨折脱位易合并桡神经损伤，对开放性骨折合并桡神经损伤者应尽快手术治疗。闭合性损伤在保守治疗１～３个月后功能无恢复时应考虑手术治疗     

The optimal treatment algorithm of radial nerve injuries

The results of rehabilitation of 52 patients with radial nerve injuries were comparatively analyzed: the traditional rehabilitation complex (massage, training, etc.) was compared with the method of functional biomanagement. The technical characteristics of the designed functional cast were thoroughly described. The study demonstrated that reinnervation and functional recovery of the denervated muscles without segmental influence were significantly slower.     

Severe injuries of the radial nerve treated by sural nerve grafting

We present six cases of severe injuries of the radial nerve in the arm. These were all treated by autogenous nerve grafting over distances of between 7 and 14 cm up to 26 months after the injury. We describe our results and discuss the place of nerve grafting in the management of these injuries.     

The electroneuromyography in diagnostics of the radial nerve injuries

Basic difficulties of the adequate and precise electrophysiological examination of radial nerve injuries are traditionally conditioned by the impossibility to separate the muscle, isolated from the muscles, innervated by the ulnar or medial nerves. The phenomenon of flexor motor units potentials propagation by the stimulating electroneuromyography and M-flow registration from extensor muscles has been described in literature. To prevent the false interpretation of the examination results, 98 patients with radial nerve injuries were examined using the original program of separate assessment of motor and sensor fibers.     

医源性桡神经损伤46例分析

目的阐述医源性桡神经损伤的伤因、治疗和预防措施。方法分析1991年～2003年间收治的46例医源性桡神经损伤的病例。结果伤因分为上肢手术误伤，肱骨干和桡骨上端闭合性骨折复位手法不当，头静脉穿刺致桡神经浅支损伤。本组21例保守治疗，22例手术治疗，3例行肌腱转位功能重建。结论手术误伤是医源性桡神经损伤的首要原因；临床医生丰富的解剖知识和细致、轻柔的操作是预防医源性桡神经损伤的关键。     

医源性桡神经损伤诊治的临床探讨

目的探讨医源性桡神经损伤的病因和手术时机。方法分析1998年5月-2003年1月间收治的16例医源性桡神经损伤病例。结果损伤病因有手术误伤12例，压迫伤2例，手法复位损伤2例。10俐显微手术治疗，疗效优者6例，良者2例，可1例，差1例，优良率达80％；6例保守治疗恢复功能。结论手术误伤是医源性桡神经损伤的主要原因，显微外科治疗是挽救医源性桡神经损伤的有效手段，手术时机的选择是影响疗效的重要因素。     

Splint satisfaction in the treatment of traumatic radial nerve injuries

Between the years 1986-2001, 135 patients who have had traumatic radial nerve injury, were supplied with dynamic wrist-hand orthoses (WHOs). The aim of this study is to examine the applied splints, considering aspects such as apperance, practicality of use, function, comfort and endurance. The author's assessments show that the biggest problem was due to the unaesthetic appearance of the finger extensor spring of the splints. For this reason, modification of these finger extensor outriggers has been attempted. Also, aspects of the splints such as the problems faced and regeneration of the nerve, have been considered and modifications made in order to eliminate any disfunction. This study reflects the reactions and satisfaction of 83 patients concerning the splints they have used. Conventional wire springs have been used in the splints of 71 patients, and 12 had modifications done on their outriggers. In terms of appearance, there were significant differences between modified outriggers and conventional outrigger (p < 0.05). Also, when the modified outriggers were compared in terms of appearance and durability, there was a statistically significant opinion in favour of them (p < 0.01).     

The ultrasound assessment of neuro-muscular apparatus by the radial nerve injuries

The use of ultrasound (US) scanning to assess the muscular function during the reinnervation is a new concept in medicine. The US signs of muscle denervation were thoroughly described in the article. The US muscle monitoring was performed by the complete and partial radial nerve injury in various follow-up periods. Absolute and relative indications for surgery were determined. The comparative characteristics of structural muscular changes, together with the US test for the assessment of the treatment efficacy and nerval and muscular recovery were suggested.     

Cross-chest radial nerve transfer in brachial plexus injuries. Experimental and anatomical basis

Brachial plexus avulsion injuries are devastating injuries to the upper limb, and nerve transfer remains the only option in reconstruction. Despite the encouraging results concerning recovery of shoulder and elbow function, no option is available for treatment of the paralytic hand. In rats, we sectioned the radial nerve in the elbow region and transferred it across the chest to reinnervate the lesioned contralateral medial cord of the brachial plexus. Rats were then evaluated for motor and sensory recovery, electrophysiologically, behaviorally and morphologically. Forepaw functional recovery was estimated to be 90%. In cadavers, the radial nerve and profunda brachii artery were dissected. It was observed that the radial nerve vascularized by the profunda brachii artery was able to reach the contralateral brachial plexus distal to the shoulder region without nerve grafts. After sectioning the radial nerve, sensory loss is minimal and motor palsy can be easily restored by tendon transfers. The results of tendon transfer for radial nerve palsy are better than for any other nerve. Cross-chest radial nerve transfer might be of clinical interest in the reconstruction of hand function in entire injury to the brachial plexus.     

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.     

桡神经浅支卡压征的治疗体会

本文报告用局封治疗１１例桡神经浅支卡压征。随访６个月-１年，疗效满意。其症状主要表现为：手背及前臂远段桡侧疼痛；手背桡测感觉减退；患手握力下降;Ｔｉｎｅｌ征阳性。桡神经浅支穿出点神经是固定的，进入浅部后有一定的滑动度，长期反复活动腕关节，使桡神经浅支反复牵拉、磨擦，以致水肿纤维化、结缔组织增生造成卡压是其发病的解剖因素。     

Tendon transfers for radial, median, and ulnar nerve injuries: current surgical techniques

Tendon transfers are performed predominantly to restore hand function or balance due to injuries of the radial, median, and ulnar nerves. Current surgical techniques for the most common tendon transfers for reconstruction of radial, median, and ulnar nerve palsies are demonstrated. These techniques can also be applied to restore flexion and extension of the fingers and thumb after injuries to the extrinsic flexor and extensor muscles and tendons of the forearm or intrinsic muscles of the hand.     

桡神经浅支卡压征的治疗体会

本文报告用局封治疗１１例桡神经浅支卡压征。随访６个月－１年，疗效满意。其症状主要表现为：手背及前臂远段桡侧疼痛；手背桡侧感觉减退；患手握力下降；Ｔｉｎｅｌ征阳性。桡神经浅支穿出点神经是固定的，进入浅部后有一定的滑动度，长期反复活动腕关节，使桡神经浅支反复牵拉、磨擦，以致水肿纤维化、结缔组织增生造成卡压是其发病的解剖因素。