Rajan P, Premkumar R, Rajkumar P, Richard J
Schieffelin Leprosy Research and Training Centre, Karigiri, India.
J Hand Ther. 2005 Jan-Mar;18(1):40-5. doi: 10.1197/j.jht.2004.10.011.
The authors sought to determine the impact of hand dominance and its relation to function among ulnar alone and combined ulnar and median nerve lesions in leprosy patients. The study sample consisted of 62 persons affected with leprosy (mean age 36.1 years) who were either suffering from ulnar nerve lesions alone (34 patients) or combined ulnar and median lesions (28 patients). The data from the earlier work of this institution with normal hands in the adjacent rural uninvolved population were taken as controls. Grip, pulp-to-pulp, lateral, and three-jaw-chuck pinch strengths were measured using a hydraulic hand dynamometer and a pinch gauge. Basic daily activities were assessed using the battery developed at Karigiri. Means, standard errors, correlations, and t-tests were used in the analyses. The overall difference between grip and pinch strength measurements in both dominant and nondominant hands was 40% less than those in normal hands if the ulnar nerve alone was involved. If impairment of this nerve was combined with that of the median nerve, the overall difference in strength measurements increased to 51%. The hand strength of the dominant side was statistically significant between single and two nerves for pulp-to-pulp pinch (p = 0.019). No other strength tests produced statistically significantly results related to hand dominance (grip strength, lateral, chuck pinch) with either one or two nerve involvement. To observe differences in basic daily activities, scores were compared to Karigiri norms. The bilateral basic daily activities score was impaired by 45% compared with norms with only ulnar nerve involvement and by 59% with ulnar and median nerve involvement. The different pinch strengths related to basic daily activities was not significantly affected in nondominant hands, whether it was ulnar alone or combined ulnar and median nerve lesions. In this population diagnosed with leprosy, ulnar nerve impairment at the level of the elbow reduced the grip and pinch strengths and performance in basic daily activities by 40% and 45%, respectively. If combined with median nerve lesion at wrist level, the strengths and daily activity losses increased to 50% and 60%, respectively. There is no effect on grip strength either in ulnar or ulnar and median nerve injuries, irrespective of whether dominant or nondominant hands were involved. Different pinch strengths related to basic daily activities were significantly affected only in the dominant hand with involvement of these nerves.
作者试图确定利手的影响及其与麻风病患者单纯尺神经损伤以及尺神经和正中神经联合损伤后功能的关系。研究样本包括62名麻风病患者(平均年龄36.1岁),他们要么仅患有尺神经损伤(34例患者),要么患有尺神经和正中神经联合损伤(28例患者)。该机构早期对相邻未受影响农村地区正常手部人群的研究数据用作对照。使用液压式握力计和捏力计测量握力、指腹对指腹捏力、侧捏力和三爪夹捏力。使用在卡里吉里开发的量表评估基本日常活动。分析中使用了均值、标准误差、相关性和t检验。如果仅涉及尺神经,优势手和非优势手的握力和捏力测量的总体差异比正常手小40%。如果该神经损伤与正中神经损伤合并,力量测量的总体差异增加到51%。对于指腹对指腹捏力,单神经损伤和双神经损伤时优势侧的手部力量在统计学上有显著差异(p = 0.019)。对于握力、侧捏力、夹捏力,无论单神经还是双神经损伤,没有其他力量测试产生与利手相关的统计学显著结果。为了观察基本日常活动的差异,将得分与卡里吉里标准进行比较。仅尺神经损伤时,双侧基本日常活动得分比标准降低45%,尺神经和正中神经联合损伤时降低59%。无论仅为尺神经损伤还是尺神经和正中神经联合损伤,非优势手与基本日常活动相关的不同捏力均未受到显著影响。在这个麻风病确诊人群中,肘部水平的尺神经损伤使握力和捏力以及基本日常活动表现分别降低40%和45%。如果与腕部水平的正中神经损伤合并,力量和日常活动能力损失分别增加到50%和60%。无论是尺神经损伤还是尺神经和正中神经联合损伤,无论涉及优势手还是非优势手,对握力均无影响。与基本日常活动相关的不同捏力仅在这些神经受累的优势手中受到显著影响。