CAJ | 학술논문

目的评价严重自体压迫性上臂桡神经损伤的手术疗效.方法对2005年3月至2009年8月收治的8例自体压迫性桡神经损伤患者进行回顾性总结.8例中有5例是由于醉酒后致腕指下垂畸形,3例由外伤昏迷所致.发病距手术时间为2～6个月,平均3.6个月.手术探查发现上臂桡神经主干及深支上有受压病变,5例出现腊肠样改变,其中3例有2处呈腊肠样改变.3例行神经外膜松解术；5例将病变段神经切除,其中2例直接缝合,3例取腓肠神经移植修复.结果术后随访9个月至3年,6例伸腕、伸指、伸拇肌力恢复至M3～M4,2例效果较差.根据中华医学会手外科学会上肢功能评定试用标准评定:优4例,良2例,可2例.结论严重自体压迫性桡神经损伤手术治疗大部分患者可取得良好的疗效.
목적 평개엄중자체압박성상비뇨신경손상적수술료효.방법 대2005년3월지2009년8월수치적8례자체압박성뇨신경손상환자진행회고성총결.8례중유5례시유우취주후치완지하수기형,3례유외상혼미소치.발병거수술시간위2～6개월,평균3.6개월.수술탐사발현상비뇨신경주간급심지상유수압병변,5례출현석장양개변,기중3례유2처정석장양개변.3례행신경외막송해술；5례장병변단신경절제,기중2례직접봉합,3례취비장신경이식수복.결과 술후수방9개월지3년,6례신완、신지、신무기력회복지M3～M4,2례효과교차.근거중화의학회수외과학회상지공능평정시용표준평정:우4례,량2례,가2례.결론 엄중자체압박성뇨신경손상수술치료대부분환자가취득량호적료효.
Objective To assess the surgical outcomes of severe radial nerve injury caused by compression in the upper arm.Methods Eight patients of severe radial nerve injury caused by compression in the upper arm who received surgery in our department from March 2005 to August 2009 were analyzed retrospectively.Wrist drop happened after being drunk in 5 patients and after traumatic coma in 3 patients.The interval from paralysis to surgery was 2 to 6 months(mean 3.6 months).All patients were treated surgically.The radial nerve was exposed to reveal compression constrictions at the main trunk of the radial nerve and the posterior interosseous nerve.Sausage-like changes were seen in 5 cases.There were two-part sausage-like changes in 3 cases.External neurolysis was carried out in 3 cases,while resection of the constricted portions of the nerves was done in the other 5 patients.Direct nerve coaptation was achieved in 2 cases whereas nerve-grafting had to be done in 3 cases.Results The patients were follow-up from 9 months to 3 years after the operation.Six patients regained at least grade-4 muscle power in the involved muscles.The other two patients who had been treated by nerve-grafting had poor results.According to the upper limb functional evaluation criteria issued by the Hand Surgery Society of the Chinese Medical Association the treatment outcomes were good in 4 cases,fair in 2 cases and poor in 2 cases.Conclusion Surgical treatment is effective for most of the severe compressive radial nerve injury patients.