- 期刊
外傷性橈神經麻痺
Traumatic Radial Nerve Palsy
摘要
從1984年至1989年止，共有39位病人因為橈神經麻痺到台大醫院治療，致病因為肱骨骨折、刀傷、鈍器傷等。4人失去聯絡、年紀最大的62歲，最小的12歲，平均年齡32歲。男26人、女9人，一共35人接受分析。這裏面不包括糖連病人、嚴重頭部外傷病人，臂神經叢傷害者。共有26人是轉診病人，但無法得知橈神經麻痺發生於術前或術後，可能是因為剛受傷時已接受石膏固定及因為傷口疼痛，沒有注意到伸指，伸腕動作之缺失。我們治療原則為臨床評估、肌電圖(EMG)，神經傳導速率(NCV)檢查，區分為叉關節以上(高位)，及肘關節以下(低位傷害)，配合手部支架使用來保持伸腕狀態及手指關節柔軟，經過觀察一段合理等待時間，而後決定要不要進一步做神經探查術。有10位病人因為神經功能恢復不理想而接受橈神經探查術，其中4人(40%)證實橈神經完全斷掉。有8位病人開刀適應症是因為肱骨骨折需要做骨內固定術，因同時合併有橈神經麻痺、所以在做內固定術，順便探查橈神經。我們發現若神經聯接完好，將來橈神經的功能完全恢復的機率很好，對於超過一年之橈神經麻痺、因為肌內肉萎縮，則直接做肌腱轉移術。
並列摘要
Radial nerve palsy causes great damage to the hand functions of patients. The palsy may be caused by fracture, blunt injury or cutting injury. If severance of radial nerve is quite evident, early exploration and repair is indicated. However in blunt injury there is still controversies in explorations of the nerve. Because if opration is done late, the motor recovery cannot be good due to hypotrophy of the muscle, However if it is done too early, recovery may be on the way. This was a retrospective syudy of the patients with radial nerve palsy treated in Natinal Taiwan University Hopsital. We advised that realistic waiting time is a good policy to follow. Internal Splinting of early tendon transfer was indicated in certain cases.