Dumontier C, Mériaux J L, Mitz V, Lenoble E, Lemerle J P, Vilain R
Service de Chirurgie orthopédique et réparatrice (SOS MAINS), Hôpital Boucicaut, Paris.
Rev Chir Orthop Reparatrice Appar Mot. 1990;76(2):95-101.
77 patients with an isolated traumatic ulnar nerve lesion were operated on between 1972 and 1982. 40 patients with more than 18 months of follow-up were reviewed with a new clinical quoting. 37.5 p. cent of satisfactory results were achieved with nerve sutures done in emergency, 56.3 p. cent with secondary nerve grafting. Factors influencing the results were age, level of the lesion and use of the microscope. 80 p. cent of the patients recovered a protective sensibility, but only one third discrimination. Patients considered sensory deficit as little cumbersome. Wartenberg's sign was noticed in 60 p. cent of our patients and a claw hand in 46 p. cent. Power grip was only 70 p. cent of the contralateral hand due to poor interosseous muscle recovery. The main disability was an instable thumb metacarpophalangeal joint in 70 p. cent. Subterminal pinch grip was weak and was improved by the transfer of the flexor digitorum superficialis of the ring finger. Cold hypersensitivity was noticed in 73 p. cent of our patients, but its frequency diminished with sensory recovery. Motor deficiencies were the most important and required early tendon transfers in older patients.
1972年至1982年间,对77例单纯性创伤性尺神经损伤患者进行了手术。对40例随访超过18个月的患者采用新的临床评分标准进行了评估。急诊行神经缝合术的患者中,37.5%取得了满意的结果,二期行神经移植术的患者中,56.3%取得了满意的结果。影响结果的因素有年龄、损伤部位和显微镜的使用。80%的患者恢复了保护性感觉,但只有三分之一恢复了辨别觉。患者认为感觉障碍带来的不便较小。60%的患者出现了瓦滕伯格征,46%的患者出现了爪形手。由于骨间肌恢复较差,强力握力仅为对侧手的70%。主要残疾是70%的患者拇指掌指关节不稳定。指尖捏力较弱,通过环指浅屈肌转移得以改善。73%的患者出现冷过敏,但随着感觉恢复,其发生率降低。运动功能障碍最为重要,老年患者需要早期进行肌腱转移。