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患者,男,5岁。因从高处摔伤,右手掌撑地伤后小时入院。查体:右肘部肿胀畸形压痛明显,肘外侧皮下可触及突出的骨折断,右手主动伸拇、伸指功能丧失,右腕下垂。X线片示:右肱骨髁上骨折,远断端向后内侧移位。诊断:右肱骨髁上伸直型骨折伴桡神经损伤。即在全麻下行切开复位桡神经探查术。采用肘外侧切口,见骨折近端锐利,位于皮下,桡神经在骨折平面断裂,整复骨折,交叉克氏针内固定后,在放大6倍手术显微镜下,采用9-0无创缝合线缝合神经外膜6针。术后石膏固定6周,拔除克氏针。3个月后复查见主动伸拇、伸指功能恢复。一年后随访肘部无畸形,活动自如。 体会 肱骨髁上骨折合并桡神经损伤,多为挫伤,神经功能可自行恢复。但神经断裂,则必须行手术吻合,手术愈早愈好,引起神经断离可见下面几种情况:(1)引起骨折暴力较大;(2)多为伸直型肱骨髁上骨折,移位较大、骨折近端锐利;(3)大多数损伤情况下可触及突出骨折断端;(4)主动伸拇指、伸指功能丧失,虎口区皮肤感觉消失。有以上情况时应尽早手术探查,及时修复断裂的神经,可获得良好效果。手术切口可采用肘外侧切口,具有创伤小,操作简便,可在同一切口内处理骨折和神经等特点。
Patient, male, 5 years old. Due to fall from a height, right hand palm injury to hospital after hours of admission. Physical examination: right elbow swelling tenderness tenderness, elbow lateral subcutaneous palpable prominent fracture, the right hand initiatively stretch the thumb, extensor function loss, right wrist drooping. X-ray showed: the right humerus supracondylar fracture, distal end to the posterior medial shift. Diagnosis: Right supracondylar humeral straight fracture with radial nerve injury. That underwent open reduction under general anesthesia radial nerve exploration. Using the lateral incision elbow, see the proximal fracture sharp, located subcutaneously, the radial nerve fractures in the fracture plane, the whole complex fracture, cross Kirschner wire fixation, under a magnification of 6 times the operating microscope, using 9-0 non-invasive suture suture nerve Outer membrane 6-pin. Postoperative gypsum fixed for 6 weeks, remove Kirschner wire. 3 months after the review found active thumb, stretch finger function recovery. A year after the elbow without deformity, mobility. Experience humeral fractures associated with radial nerve injury, mostly contusion, nerve function can be restored. However, the nerve fracture, you must line operation anastomosis, the sooner the better the surgery, causing nerve detachment seen the following conditions: (1) caused by a large fracture violence; (2) mostly straight humeral supracondylar fracture, displacement Large, proximal fracture sharp; (3) most cases of injury can reach out prominent fracture ends; (4) take the initiative to thumb, stretch finger loss of function, the skin feels disappear in the mouth area. The above situation should be as soon as possible surgical exploration, repair the nerve in time, get good results. Surgical incision elbow lateral incision can be used, with less trauma, easy to operate, can be treated in the same incision and nerve and other characteristics.