摘要
目的：对８１例８４条儿童正中神经损伤进行回顾性研究，讨论其诊断和处理问题。方法：伤于腋部３条，上臂１０条，肘部３０条，前臂１４条，腕部２４条，掌部３条；完全离断５３条，部分断裂４条，挫伤或压迫变性２７条；开放伤５６条，闭合伤２８条。采用神经外膜对端吻合术５１条，自体神经移植术４条，神经外松解术１５条，因毁损未处理３条，骨折复位外固定观察１１条。结果：随访５０条，１～２８（平均７．８）年，优良率为８８％。结论：本组有１４例漏诊，为避免漏诊应详细问病史、反复检查。神经开放伤（火器伤等除外）应一期手术探查修复神经，骨折合并伤观察１～３个月，晚期神经伤也要力争手术修复神经。神经断裂以外膜缝合为主，神经受压或变性以神经外松解术为主，拇指对掌功能恢复不佳时用小指外展肌重建拇指对掌功能。
Objective: To discuss the diagnosis and treatment for median nerve injury in children. Methods : 84 cases of median nerve injury were treated from 1959 to 1996. The median nerve was affected at the site of axilla in 3 cases, arm in 10, elbow in 30, forearm in 14, wrist in 24 and palm in 3. In this series, there were 53 cases of complete neurotmesis, 4 incomplete one, and 27 cases of nerve entrappment. 56 cases of open lesion and 28 cases of close one were managed. Operations included: epineurial anastomosis in 51 cases, neural autotransplantation in 4, and epineurial neurolysis in 15. Besides, the other 3 cases were untreated due to local collapse and 11 cases were left for observation after reduction of fractures. Results: 50 patients were followedup for 1～28 years (mean 7.8 years). Among the 50 cases, 88% of them achieved excellent and good results. Conclusions: Immediate exploration and surgical repair should be performed on open injury except firearm injury. Nerve entrappment associated with fracture would be better observed for 1～3 months. Surgical repair of the nerve should also be tried for delayed injury. Neurotmesis requires epineurial anastomosis and nerve compressive lesion needs epineurial neurolysis. Dysfunction of opposition of the thumb suggests transfer of abductor digiti quint.
出处
《中华小儿外科杂志》
CSCD
1998年第2期70-72,共3页
Chinese Journal of Pediatric Surgery
