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[手部刺伤导致尺神经内在运动支孤立性离断:三例报告]

[Isolated severance of the intrinsic motor branch of the ulnar nerve caused by stab injuries to the hand: A report of three cases].

作者信息

Ozaksar Kemal, Toros Tulgar, Kayalar Murat, Ademoğlu Yalçin

机构信息

El Mikrocerrahi ve Ortopedi Travmatoloji Hastanesi.

出版信息

Acta Orthop Traumatol Turc. 2007;41(3):249-52.

Abstract

Laceration of the deep intrinsic motor branch of the ulnar nerve below the Guyon canal is rarely seen in penetrating injuries of the hand. We report three patients (1 woman, 2 men) who underwent microsurgical repair for isolated injuries to the motor nerve branch of the ulnar nerve due to penetrating injuries to the hypothenar area of the hand. Two patients had normal sensation. All the patients had intrinsic muscle paralysis and claw deformity of some fingers, with significantly weakened grip and pinch strengths. Exploration showed isolated severance of the deep intrinsic motor branch of the ulnar nerve. One patient underwent end-to-end repair with epiperineural suture technique. Two patients required bridging with a sural nerve graft from the leg for 2-cm and 4-cm gaps, respectively, that occurred following nerve excision. During the follow-up period, grip and pinch strengths of all the patients approximated to the values of the normal side. Intrinsic muscle function and abduction and adduction of fingers recovered in two patients, whereas in one patient finger adduction was not reversible and claw deformity persisted in one finger even after two years.

摘要

尺神经深支在Guyon管以下的撕裂伤在手部穿透伤中很少见。我们报告了3例患者(1名女性,2名男性),他们因手部小鱼际区域的穿透伤导致尺神经运动神经支孤立损伤而接受了显微外科修复。2例患者感觉正常。所有患者均有内在肌麻痹和部分手指的爪形畸形,握力和捏力明显减弱。探查显示尺神经深支孤立断裂。1例患者采用神经外膜缝合技术进行端端修复。2例患者因神经切除后分别出现2厘米和4厘米的间隙,需要用来自腿部的腓肠神经移植进行桥接。在随访期间,所有患者的握力和捏力接近正常侧的值。2例患者的内在肌功能以及手指的外展和内收功能恢复,而1例患者的手指内收功能不可逆,即使在两年后仍有1根手指存在爪形畸形。

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