Jardin E, Huard S, Chastel R, Uhring J, Obert L
EA 4268 innovation, imagerie, ingénierie et intervention en santé « I4S » - IFR 133 Inserm, pôle innovation et technique chirurgicale, service d'orthopédie, de traumatologie, de chirurgie plastique, reconstructrice et assistance main, CHU Jean-Minjoz, université de Franche-Comté, boulevard Fleming, Besançon, France.
Chir Main. 2011 Dec;30(6):393-9. doi: 10.1016/j.main.2011.09.004. Epub 2011 Oct 12.
Defects of the median, ulnar or radial nerves in the forearm, can be treated by conventional nerve grafts, or by interposing a synthetic guide such as nerve conduits. Wounds without nerve loss treated with simple suture may be supplemented by sleeving to prevent the nerve irritation symptoms using a nerve conduit or a vein sleeve. We studied the results of nerve conduits in both cases in a single-center retrospective study.
Four patients underwent surgery with placement of a nerve conduit in the forearm, between May 2007 and January 2011. All patients were reviewed by the same examiner. Pain, tenderness, motor (Medical Research Council classification, MRC), time to return to work and self-evaluation by the patient were measured. The averages of these data were calculated and compared with results of other studies in the literature, the nerve grafts for defects and the Socket joints for venous ulcers.
The decrease is on average 30 months (2 years). The defect never exceeds 40mm and is 22mm on average. According to the classification MRC, sensitivity found after inserting nerve conduits in the forearm after a defect is excellent (S4) for two of three patients and good (S3) for the third. Motor results were very good (M4 and M3 for one patient) andM2 for the other. As for the insertion of a nerve conduit as a sleeve, the result is good in terms of sensitivity (S3) and excellent in terms of motor (M5) for our case in the study. For our small group of patients with neuroma we obtained, results similar to those published in the literature with conventional techniques.
The nerve conduits seem to give results similar to conventional techniques, in situations of defects or neuromasin the forearm, with a diameter greater than 2mm, but defects of less than 30mm.
前臂正中神经、尺神经或桡神经的缺损，可通过传统神经移植或插入合成引导物（如神经导管）进行治疗。对于无神经损伤的伤口，单纯缝合治疗后，可使用神经导管或静脉套管进行套入，以预防神经刺激症状。我们在一项单中心回顾性研究中，对这两种情况使用神经导管的结果进行了研究。
2007年5月至2011年1月期间，4例患者在前臂接受了神经导管植入手术。所有患者均由同一名检查者进行评估。测量疼痛、压痛、运动功能（医学研究委员会分级，MRC）、恢复工作时间以及患者的自我评估。计算这些数据的平均值，并与文献中其他研究的结果、用于缺损的神经移植以及用于静脉溃疡的套接关节的结果进行比较。
平均下降时间为30个月（2年）。缺损从未超过40毫米，平均为22毫米。根据MRC分级，在前臂缺损后插入神经导管后，三名患者中有两名的感觉功能极佳（S4），第三名患者良好（S3）。运动功能结果中，一名患者非常好（M4和M3），另一名患者为M2。至于作为套管插入神经导管，在本研究中的病例中，感觉功能良好（S3），运动功能极佳（M5）。对于我们获得的一小群患有神经瘤的患者，其结果与文献中传统技术发表的结果相似。
在前臂直径大于2毫米但缺损小于30毫米的缺损或神经瘤情况下，神经导管似乎能给出与传统技术相似的结果。
