肱骨干骨折合并桡神经损伤一期桡神经探查与保守治疗的疗效比较

目的 比较肱骨干骨折合并桡神经损伤一期桡神经探查与保守治疗的疗效.方法 1995年3月至2005年10月共收治且有完整随访资料的86例肱骨干骨折合并桡神经损伤患者,男63例,女23例;年龄15～66岁,平均34.0岁.根据对桡神经损伤治疗方法的不同分为两组,其中一期桡神经探查（A组）52例,一期保守治疗（B组）34例,比较两组患者的神经功能恢复时间及恢复率.结果 86例患者术后获6～103个月（平均31.2个月）随访.A组52例中有4例（7.7%）需二次手术;最终50例（96.2%）神经功能完全恢复,1例（1.9%）部分恢复,1例（1.9%）无恢复.B组34例中30例（88.2%）神经功能自发性恢复,4例（11.8%）需二期神经探查;最终33例（97.1%）神经功能完全恢复,1例（2.9%）部分恢复.两组神经功能恢复率比较差异无统计学意义（x2=0.050,P=1.000）.A组神经功能开始恢复时间及完全恢复时间平均分别为（5.3±4.1）、（14.7±8.2）周,B组分别为（4.5±3.9）、（11.6±8.7）周,两组比较差异均无统计学意义（P〉0.05）.结论 肱骨干骨折合并桡神经损伤选择保守治疗与一期神经探查具有相当的神经功能恢复率,桡神经损伤不影响肱骨干骨折治疗方式的选择,对闭合性肱骨干骨折合并的桡神经损伤采取保守治疗是一种良好的选择.

Early nerve exploration vs. Conservative observation in clinical management of radial nerve palsy associated with humeral shaft fracture

Objective To compare early nerve exploration and conservative observation in the clinical management of the radial nerve palsy (RNP) associated with humeral shaft fracture. Methods From March 1995 to October 2005, 708 cases of humeral shaft fracture were treated in our department. Of them, 86 were complicated with RNP and fully followed up. Their average age was 34. 0 years old (range, 15to 66 years). Fifty-two patients (group A) were treated with early nerve exploration and 34 (group B) with conservative observation. Functional recovery of the radial nerve was compared between the 2 groups.Results In group A, 4 cases (7. 7% ) needed a secondary surgery, while 50(96. 2% ) obtained complete functional recovery, one ( 1.9% ) partial recovery and one ( 1.9% ) no recovery. In group B, 30 cases (88. 2% ) recovered spontaneously, 4 ( 11.8% ) required late surgical exploration, 33 (97. 1% ) obtained complete recovery and one (2. 9% ) partial recovery. There was no significant difference between group A and group B in functional recovery of the nerve (x2 =0. 050, P = 1. 000). The initial recovery time and full recovery time of nerve function were (5. 3 ± 4. 1 ) and ( 14. 7 ± 8.2) weeks in group A and (4. 5 ± 3.9) and ( 11.6 ± 8.7) weeks in group B, without any significant difference between the 2 groups ( P > 0. 05) .Conclusions Early nerve exploration and conservative observation may have similar neural recovery in management of RNP associated with humeral shaft fracture. We recommend conservative observation as a primary choice for RNP associated with closed humeral shaft fractures if no contraindications exist.