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.

Outcome assessment of one stage surgical treatment of floating elbow and radial nerve injuries

Objective To evaluate the clinical outcomes of one stage surgical fracture fixation and neurolvsis or neurorraphy in patients who suffered floating elbow and radial nerve injuries. Methods There were a total of 17 patients that were treated between March 2005 and November 2009 with one stage surgical ma nagement of floating elbow and radial nerve injury. All patients had symptoms of radial nerve injuries. There was no symptom for vascular injuries. Open reduction and plate fixation of elbow fractures, and neurolysis or n eurorraphy of the radial nerve were done. Postoperative evaluations included fracture union time, elbow and forearm function, and radial nerve functional recovery. Results The average fracture union time was 5 months. No cubitus varus or valgus was observed. Elbow stiffness was seen in one patient. Other patients achieved excellent recovery of forearm rotation and elbow flexion and extension. No radial nerve recovery occurred in one patient with forearm mutilated injury. Slow recovery of wrist and thumb extension was observed in 3 patients with complete radial nerve rupture, the longest recovery time being one year. Fast functional recovery was observed in 13 patients with incomplete radial nerve injury, the longest recovery time being 4 months. There were no serious complications. Conclusion When the patient' s vital signs are stable, one stage surgery should be carried out for fracture internal fixation and neurolysis or nerve repair. This will lead to early fracture union, preserve forearm rotation and elbow flexion and extension, and facilitate better radial nerve functional recovery.