Ruijs Aleid C J, Niehof Sjoerd P, Hovius Steven E R, Selles Ruud W
Department of Plastic, and the Department of Anesthesiology, Pain Treatment Centre, Erasmus MC, Rotterdam, The Netherlands.
J Hand Surg Am. 2011 Jun;36(6):986-93. doi: 10.1016/j.jhsa.2011.02.009. Epub 2011 Apr 22.
Peripheral nerve injury of the upper extremity frequently causes changes in the thermoregulatory system of the hands and fingers and leads to reports of cold intolerance. In this study, we aimed to measure the influence of median or ulnar nerve injury on cold-induced vasodilatation (CIVD) during prolonged cooling at low temperatures.
We tested 12 patients with a median (n = 6) or ulnar (n = 6) injury 4 to 76 months after nerve repair. The palmar sides of both hands were cooled continuously using a cold plate at 5°C. We measured the skin temperature of the fingers using videothermography and plotted graphs of the temperature changes of the nailbed. The presence of a CIVD reaction was defined as a minimum increase in temperature of 2.5°C starting at the distal phalanx. Furthermore, we measured self-reported symptoms of cold intolerance using the Cold Intolerance Severity Scale questionnaire.
A CIVD reaction was absent in the affected digits of 4 patients (follow-up, 6-37 mo), whereas the CIVD reaction in the uninjured hand was present. The CIVD was present in 6 patients after 50 months' follow-up (range, 24-76 mo). Two patients had no CIVD reaction in the injured or uninjured fingers. All patients with a CIVD response had at least diminished protective sensation. Presence of the CIVD reaction did not exclude self-reported symptoms of cold intolerance.
After peripheral nerve injury, it is possible to recover the CIVD reaction. This might be an indication of nerve recovery. However, a positive CIVD reaction does not exclude subjective symptoms of posttraumatic cold intolerance.
TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic III.
上肢周围神经损伤常导致手部和手指温度调节系统发生变化，并引发对寒冷不耐受的报告。在本研究中，我们旨在测量正中神经或尺神经损伤对低温长时间冷却期间冷诱导血管舒张（CIVD）的影响。
我们测试了12例在神经修复后4至76个月的正中神经（n = 6）或尺神经（n = 6）损伤患者。使用5°C的冷板持续冷却双手的手掌面。我们使用视频热成像测量手指的皮肤温度，并绘制甲床温度变化图。CIVD反应的存在定义为从远端指骨开始温度至少升高2.5°C。此外，我们使用寒冷不耐受严重程度量表问卷测量自我报告的寒冷不耐受症状。
4例患者（随访6 - 37个月）受影响手指未出现CIVD反应，而未受伤手部出现了CIVD反应。6例患者在随访50个月（范围24 - 76个月）后出现了CIVD。2例患者受伤或未受伤手指均未出现CIVD反应。所有有CIVD反应的患者至少保护性感觉减退。CIVD反应的存在并不能排除自我报告的寒冷不耐受症状。
周围神经损伤后，CIVD反应有可能恢复。这可能是神经恢复的一个迹象。然而，CIVD反应阳性并不能排除创伤后寒冷不耐受的主观症状。
研究类型/证据水平：诊断性III级。
