避免上肢医源性桡神经损伤的体会.docVIP

避免上肢医源性梯神经损伤的体会 【摘要】目的：介绍避免上肢医源性橈神经损伤的体会。 方法：2006年5月-2012年10月，笔者所在医院收治上肢 医源性橈神经损伤7例，分析其损伤原因及功能恢复情况。 结果：本组7例患者均获得11?15个月随访，平均 (13.0±1.2)个月。探查见楼神经不完全性损伤2例，完 全性损伤5例；上臂中段橈神经沟处4例，上臂远段穿出外 侧肌间隔处1例，前臂上段旋后肌止点处2例；内固定物及 骨折端卡压5例，术中直接损伤2例；神经修复术后1年以 上功能完全恢复3例，部分恢复2例，无恢复2例。结论： 熟悉橈神经的走行，术中显露并保护橈神经可有效避免上肢 医源性橈神经损伤。 【关键词】上肢；医源性；橈神经损伤 中图分类号R683. 41文献标识码B文章编号 1674-6805 (2013) 33-0168-02 The Comprehend of Evading Iatrogenic Radial Nerve Injury of Upper Limb/ZOU Wen, ZOU Yong, LIU Rong-zhen, et al. //Chinese and Foreign Medical Research, 2013, 11 (33)： 168-169 [Abstract】 Objective： To introduce the comprehend of evading iatrogenic radial nerve injury of upper limb. Method: Between May 2006 to October 2012 , 7 patients of iatrogenic radial nerve injury of upper limb were treated in our hospital, to analyze the injury cause and functional recovery. Result： All patients were followed average (13. 0± 1.2) months (11-15 months) . 2 patients were immaturity radial nerve injury , 5 patients were complete radial nerve injury； 4 patients located groove for radial nerve, 1 patient located lateral muscle compartment，2 patients located forearm supinator insertion ； 5 patients were stamped by internal fixation or bone fracture, 2 patients were intraoperative coup injury； 3 patients were complete recovery, 2 patients were partial recovery, 2 patients were no recovery. Conclusion： The method of familiarity radial nerve anatomy and acting out to safeguard was a modus operandi to evade iatrogenic radial nerve injury of upper limb. [Key words] Upper limb； Iatrogenic； Radial nerve injury First-author，s address : The Second People s Hospital of Yibin, Yibin 644000, China 上肢外伤骨折多见，如肱骨中段骨折、肱骨远段骨折、 楼骨上段骨折等，多数需行手术内固定治疗，骨折愈合后取 除内固定物[1],在上述手术中均有橈神经损伤的案例报道, 即医源性橈神经损伤，术后患肢出现功能障碍，造成严重的 后果。因此，应采取相应的措施，避免上肢医源性橈神经损 伤。2006年5月-2012年10月，笔者收治从外院转院来的 上肢医源性橈神经损伤7例，报告如下。 1资料与方法 1. 1 一般资料 本组7例患者，男4例，女3例；年龄19?61岁，平 均(39. 0±15. 3)岁；左侧2例，右侧5例；损伤部位：上 臂中段4例，上臂远段1例，前臂上段2例；骨折内固定术 时损伤5例，取除内固定时损伤2例；全部患者术前均无橈 神经损伤症状和体征，术后才出现感觉障碍、垂指、垂腕等