Engrav L H, Gottlieb J R, Walkinshaw M D, Heimbach D M, Trumble T E, Grube B J
Division of Plastic Surgery, University of Washington, Seattle 98195.
Ann Plast Surg. 1990 Sep;25(3):166-8. doi: 10.1097/00000637-199009000-00002.
Electrical injury to the upper extremity with immediate median and ulnar nerve palsy at the wrist is uncommon but devastating. When it does occur, the immediate clinical questions are (1) will the nerves recover, and (2) should the carpal tunnel and Guyon's canal be released? Our review of the literature did not answer these two questions. Therefore, we reviewed our experience with such patients and surveyed approximately 10% of the physician members of the American Burn Association. We reviewed approximately 80 patients with electrical injuries treated between January 1983 and September 1988, and found 5 patients (8 extremities) who did not require amputation and who manifested immediate palsy of the median and ulnar nerves at the wrist. The questionnaire was returned by 83% of those contacted. We concluded that such nerve palsies can recover to a significant degree and that a majority of surgeons would release the carpal tunnel and Guyon's canal, expecting improved recovery. Although it is still not proven whether decompression is beneficial, we will continue to decompress the carpal tunnel and Guyon's canal in such circumstances.
上肢电损伤伴腕部正中神经和尺神经即刻麻痹虽不常见但后果严重。一旦发生，临床面临的紧迫问题是：（1）神经能否恢复？（2）是否应切开腕管和Guyon管？我们查阅文献未能找到这两个问题的答案。因此，我们回顾了此类患者的治疗经验，并对约10%的美国烧伤协会医师会员进行了调查。我们回顾了1983年1月至1988年9月间接受治疗的约80例电损伤患者，发现5例（8处上肢）无需截肢且表现为腕部正中神经和尺神经即刻麻痹。83%的被调查者回复了问卷。我们得出结论，此类神经麻痹可在很大程度上恢复，且大多数外科医生会切开腕管和Guyon管，期望促进恢复。尽管减压是否有益仍未得到证实，但在此类情况下我们仍将继续切开腕管和Guyon管。
