桡神经深支损伤治疗.docVIP

桡神经深支损伤治疗 桡神经深支损伤的治疗 2010-02-25 吴梅英 　　【摘要】　目的　探讨桡神经深支损伤的手术治疗方法和疗效。方法　58例桡神经损伤患者,33例采用显微外科吻合和移植,19例神经松解,2例神经残端植入,4例肌腱转位。结果　神经吻合和移植优良率93.9%,神经松解优良率89.5%,4例肌腱转位疗效均满意,2例神经残端植入者疗效均差。结论　对已明确的桡神经深支应尽早手术探查修复;对于鱼尾平面的桡神经深支损伤宜采用肌腱转位。 　　【关键词】　桡神经深支　吻合　移植　损伤 Therapy for Posterior Interosseous Nerve Injury　　WU Mei-ying. Dept. of Orthopaedics, Southwestern Hospital, Third Military Medical University, Chongqing 400038 　　【Abstract】　Aim　To explore the therapeutic methods and their effects on posterior interosseous nerve injury. Methods　We analysed retrospectively the clinical data of 58 patients with posterior interosseous nerve injury treated in our hospital during the year of 1984 and 1994. Among them, there were 33 cases done with microsurgical anastomosis or transplantation, 19 with neurolysis, 2 with nerve end embedment and 4 with tendon transposition. 姟迹祝裕怠保龋凇絉esults　The following-up showed that 93.9% of the patients were excellent and good in anastomosis or transplantation group, and 89.5% in neurolysis group. Four cases with tendon transposition were satisfactory, but 2 cases with nerve ends embedment were poor. Conclusions　If the posterior interosseous nerve injury is surely diagnosed, the repairment should be carried out as quickly as possible, and tendon transposition should be performed with regard to the posterior interosseous nerve injury at the level of “fish-tail”. 　　【Key words】　Posterior interosseous nerve　Anastomosis　Transplant　Injury 　　桡神经深支损伤在临床上并非罕见,但伤后往往没有典型的垂腕畸形,易被忽略而漏诊。我院1984～1994年共收治各种原因所致桡神经深支损伤58例,根据不同原因所造成的损伤采用不同手术方法治疗,取得了较好效果。 临　床　资　料 　　1.一般资料:58例桡神经深支损伤患者中,男42例,女16例;年龄16～64岁。10岁以下儿童6例,60岁以上4例,余为青壮年。新鲜伤14例(4例为孟氏骨折所致,余为锐器伤所致),陈旧性损伤44例(锐器伤24例,8例为陈旧性桡骨小头脱位所致,在初期治疗时24例未发现桡神经深支损伤,其漏诊率达54.5%。12例为桡神经深支卡压综合征)。 　　2.治疗方法:新鲜损伤14例中,10例为开放性损伤,清创时同时扩大伤口,找出断裂神经,用8-0带针尼龙线Ⅰ期修复神经,4例神经嵌压及挫伤予以松解,孟氏骨折同时行切开复位。 陈旧性损伤44例根据术中探查情况采用不同手术方法治疗。其中23例神经断裂者中有19例行神经直接吻合,4例神经缺损在2～3cm者行游离神经移植;15例粘连行神经松解;另6例因神经断裂在鱼尾分支处无法修复,2例行神经植入,4例行肌腱转位重建伸拇、伸指功能(1例神经植入患者因神经无恢复,2年后再次行肌腱转位术)。陈旧