Yu Rebecca S, Catalano Louis W, Barron O Alton, Johnson Caryl, Glickel Steven Z
Department of Orthopaedics, St. Luke's-Roosevelt Hospital Center, 1000 Tenth Avenue, New York, NY 10019, USA.
J Hand Surg Am. 2004 Mar;29(2):302-6. doi: 10.1016/j.jhsa.2003.11.007.
Casting for 3 to 4 weeks has been the accepted protocol after primary repair of digital nerve lacerations. In contrast, combined digital nerve and flexor tendon repairs are rehabilitated with immediate postsurgical range of motion. The purpose of this study was to compare the results of primary nerve repair in isolated digital nerve lacerations immobilized after surgery with nerve repairs combined with flexor tendon repairs that are mobilized in a limited, protected fashion immediately after surgery.
We reviewed retrospectively patients who had had surgical repair of isolated digital nerve lacerations or combined digital nerve and flexor tendon lacerations. Demographics recorded included age, hand dominance, injured digit, and time to mobilization. Follow-up data included range of motion at the metacarpophalangeal, proximal interphalangeal, distal interphalangeal, and wrist joints; static 2-point discrimination; and Semmes-Weinstein monofilament testing. Between-group comparisons were based on t-tests for continuous measures and chi-square tests for categoric measures. Paired t-tests were used for within-group comparisons. All comparisons were based on 2-tailed.05-level tests.
Fourteen patients (16 digits) with isolated nerve repairs (group 1) and 12 patients (14 digits) with combined nerve and tendon repairs (group 2) were evaluated. The average age and duration at follow-up evaluation were similar in the 2 groups. The average time to mobilization, however, was 21 days in group 1 and 4 days in group 2. Injuries occurred equally in dominant and nondominant hands. Good range of motion returned in all digits. In addition there was no significant difference in final 2-point discrimination and Semmes-Weinstein testing between groups 1 and 2.
Our data showed a decrease in sensibility between the injured and uninjured digits in each of the 2 groups studied, as has been shown previously. The difference in sensibility between the 2 groups, however, was not statistically significant. These data challenge the long-held belief that digital nerve repairs should be completely immobilized after surgery.
手指神经撕裂伤一期修复后，采用3至4周的石膏固定一直是公认的方案。相比之下，手指神经和屈肌腱联合修复术后则立即进行活动度康复训练。本研究的目的是比较单纯手指神经撕裂伤术后固定的一期神经修复结果与手指神经和屈肌腱联合修复术后立即进行有限度、受保护活动的结果。
我们回顾性分析了接受单纯手指神经撕裂伤或手指神经与屈肌腱联合撕裂伤手术修复的患者。记录的人口统计学数据包括年龄、利手、受伤手指和开始活动的时间。随访数据包括掌指关节、近端指间关节、远端指间关节和腕关节的活动度；静态两点辨别觉；以及Semmes-Weinstein单丝试验。组间比较基于连续测量的t检验和分类测量的卡方检验。组内比较采用配对t检验。所有比较均基于双侧0.05水平检验。
评估了14例（16指）单纯神经修复患者（第1组）和12例（14指）神经与肌腱联合修复患者（第2组）。两组患者的平均年龄和随访时的病程相似。然而，第1组开始活动的平均时间为21天，第2组为4天。优势手和非优势手受伤情况相同。所有手指均恢复了良好的活动度。此外，第1组和第2组之间最终的两点辨别觉和Semmes-Weinstein试验没有显著差异。
我们的数据显示，在所研究的两组中，受伤手指和未受伤手指之间的感觉均有所下降，正如之前所显示的那样。然而，两组之间的感觉差异无统计学意义。这些数据挑战了长期以来认为手指神经修复术后应完全固定的观念。
