文献阅读｜肱骨干骨折致桡神经麻痹：是否有必要进行探查？
Approach to Radial Nerve Palsy Caused by Humerus Shaft Fracture: Is Primary Exploration Necessary?
PMID: 23352153 DOI: 10.1016/j.injury.2013.01.004
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Abstract
Introduction: While recommendations for early exploration and nerve repair in cases of open fractures of the humeral shaft associated with radial nerve palsy are clear, the therapeutic algorithm for the management of closed humeral shaft fractures complicated by radial nerve palsy is still uncertain. The purpose of this study was to determine whether patients with complete sensory and motor radial nerve palsy following a closed fracture of the humeral shaft should be surgically explored.
Patients and methods: Twenty-five patients with closed humeral shaft fractures complicated by complete radial nerve palsy were retrospectively reviewed during a 12-year period. Surgical intervention was indicated if functional recovery of the radial nerve was not present after 16 weeks of expectant management.
Results: Surgical exploration was performed in 12 patients (48%) after a mean period of expectant management of 16.8 weeks (range: 16-18 weeks). In 2 of them (10%) total nerve transection was found. In the rest 10 patients underwent surgical exploration the radial nerve was found to be macroscopically intact. All intact nerves were fully recovered after a mean time of 21.6 weeks (range: 20-24 weeks) post-injury. In 13 patients (52%) in whom surgical exploration was not performed the mean time to full nerve recovery was 12 weeks (range: 7-14 weeks) post-injury.
Conclusions: We proposed immediate exploration of the radial nerve in case of open fractures of the humeral shaft, irreducible fractures or unacceptable reduction, associated vascular injuries, radial nerve palsy after manipulation or intractable neurogenic pain. Due to high rate of spontaneous recovery of the radial nerve after closed humeral shaft fractures we recommend 16-18 weeks of expectant management followed by surgical intervention.
重点词汇汇总：
Radial Nerve 桡神经
Palsy /ˈpɔːlzi/n. 麻痹，麻痹状态；中风vt. 麻痹；使瘫痪
algorithm /ˈælɡərɪðəm/n. [计][数] 算法，运算法则
macroscopically宏观地;肉眼可见地
irreducible fractures 不能复位性骨折 /ˌɪrɪˈduːsəbl/adj. [数] 不可约的；不能削减的；不能复归的
intractable /ɪnˈtræktəbl/adj. 棘手的；难治的；倔强的；不听话的
neurogenic pain神经源性疼痛
百度翻译：
肱骨干骨折致桡神经麻痹的探讨：是否有必要进行初步探讨？
摘要
导言：虽然对于肱骨干开放性骨折合并桡神经麻痹的早期探查和神经修复的建议是明确的，但对于闭合性肱骨干骨折合并桡神经麻痹的治疗算法仍不确定。本研究的目的是确定肱骨干闭合性骨折后完全感觉和运动性桡神经麻痹的患者是否需要手术治疗。
方法：回顾性分析25例肱骨干闭合性骨折合并完全性桡神经麻痹患者12年的临床资料。如果预期治疗16周后桡神经功能没有恢复，则需要手术治疗。
结果：12例（48%）在平均16.8周（16-18周）的期待治疗后进行了手术探查。其中2例（10%）出现全神经切断。其余10例经手术探查，桡神经大体完整。伤后平均21.6周（20～24周）神经完全恢复。在13例（52%）未进行手术探查的患者中，神经完全恢复的平均时间为损伤后12周（范围：7-14周）。
结论：对于肱骨干开放性骨折、骨折不可复位或复位不可接受、合并血管损伤、术后桡神经麻痹或顽固性神经源性疼痛，建议立即探查桡神经。由于闭合性肱骨干骨折后桡神经的自发恢复率很高，我们建议16-18周的预期治疗，然后进行手术治疗。