汶川地震转运部分伤员闭合性周围神经损伤的早期治疗.DOCVIP

临床医学论文-汶川地震转运部分伤员闭合性周围神经损伤的早期治疗 【摘要】? 　　目的 总结汶川地震转运我院的合并闭合性周围神经损伤患者的早期治疗方法与初期疗效。方法 收集21例汶川地震所致闭合性周围神经损伤的临床资料，分析其受伤机制，总结早期治疗方法及初步疗效。结果 所有患者均于伤后2月随访，桡神经、尺神经、闭孔神经损伤恢复较好，腓总神经、股神经、坐骨神经次之，腰骶丛、部分臂丛、正中神经损伤恢复较差，1例股神经和1例腓总神经损伤因保守治疗无效采取手术探查松解。结论 地震致闭合性周围神经损伤多为挤压或压迫时间过长所致，早期及时进行正规的综合治疗，预后一般较好；对部分压迫伤较重、压迫时间较长、神经损伤较重者，应积极进行手术松解。 【关键词】? 地震伤 周围神经损伤 治疗??? 　　　　Abstract：? Objective? To summarize and review the early stage treatment and the initial curative effects of the closed peripheral nerve injury suffered by some patients transported from the Wenchuan earthquqke stricken area.Methods?A total of 21 cases suffering from closed peripheral nerve injury caused by Wenchuan earthquake were admitted to our hospital.The clinical data were collected,the injury mechanism was analyzed and the early stage treatment and the initial curative effects were summarized retrospectively.Results?All the patients were followed up 2 months after injury.Patients suffering radial nerve,ulnar nerve and obturator nerve injury recovered well,that of femoral nerve and sciatic nerve injury was fair,lumbosacral plexus,partial brachial plexus and median nerve injury was poor.The conservative therapy did not work on 2 patients(one with femoral nerve injury and the other sciatic nerve injury) ,which led to operative exploration.Conclusion? The closed peripheral nerve injury results from earthquake,which is regularly caused by crushing and longtime compression,recovere well if it is treated in time by combined and regular way.Those who suffer a longtime compression or a severe nerve injury should be explored operatively in time.??? 　　Key words:earthquake injury;peripheral nerve injury;therapeutics??? 　　闭合性周围神经损伤是现代创伤外科的常见疾病，其原因很多，可为外力压迫、牵拉，碾挫，骨折压迫等，造成神经不同程度损害，致使所支配肌肉肌力下降，甚至残疾。地震所致闭合性周围神经损伤多为挤压、压迫时间过长或骨折所致，且因压迫程度、部位、时间不同造成神经伤害与预后差异较大。我院自2008年5月18日～30日收治四川地震灾区转运来的合并周围神经损伤患者21例，经初步治疗，疗效较为满意，现报告如下。 　　临床资料 　　1? 一般资料??? 　　本组共21例、26条周围神经损伤，其中男性6例，女性15例；年龄7～63岁，平均33岁。损伤原因：掩埋挤压9例，骨折压迫7例，重物冲击压砸4例，牵拉1例。被掩埋及重物压砸时间