急诊神经移植修复手掌指神经缺损的评估：一项回顾性单中心研究

Evaluation of emergency nerve grafting for proper palmar digital nerve defects: a retrospective single centre study.

作者信息

Chevrollier J, Pedeutour B, Dap F, Dautel G

机构信息

SOS main, Service de chirurgie plastique et reconstructrice de l'appareil locomoteur, Centre chirurgical Emile-Gallé, 5400 Nancy, France.

出版信息

Orthop Traumatol Surg Res. 2014 Oct;100(6):605-10. doi: 10.1016/j.otsr.2014.05.018. Epub 2014 Aug 23.

DOI:10.1016/j.otsr.2014.05.018

PMID:25155205

Abstract

HYPOTHESIS

Finger trauma often results in discontinuity of the proper palmar digital nerves. The goal of this study was to retrospectively evaluate the clinical outcomes of emergency nerve grafting and the resulting donor site morbidity.

MATERIAL AND METHOD

Three women and 13 men who had been operated between 2008 and 2012 were reviewed. The average patient age was 39 years (range 18-78). All were operated on an emergency basis. The average defect was 38 mm long (range 15-60). The nerves were harvested from four sites: lateral antebrachial cutaneous nerve (12 cases), banked finger (2 cases), terminal portion of posterior interosseous nerve (1 case) and anterior interosseous nerve (1 case). The evaluation consisted of patient questioning and clinical examination of the treated finger and donor site. An objective sensory exam was also performed. The results were expressed according to the British Medical Research Council (MRC) classification.

RESULTS

There was little donor site morbidity (2 cases of symptomatic hypoesthesia, 1 case of scar hypersensitivity). Sixty-nine percent of patients stated that their grafted finger did not cause them any trouble during activities of daily living. Three patients required job retraining. Pain in the grafted finger was 0.6 (range 0-5) on the VAS. Normal sensation was restored in 31% of cases based on the monofilament sensory test; 25% had a slight decrease in touch sensitivity and 25% had reduced protective sensations. Weber's two-point discrimination test found 50% normal sensibility (threshold<6mm) and 6% with mediocre sensibility (threshold of 6-10mm). On the MRC grading scale, 50% of patients were at S4, 6% at S3+, 19% at S3, 12% at S2 and 12% at S1.

CONCLUSION

There were 56% good results in this patient series (S3+/S4) and no patients at S0. Donor site morbidity was rare. Thus use of nerve grafting is still a relevant option in an emergency setting.

LEVEL OF EVIDENCE

Level IV.

摘要

假设

手指创伤常导致指掌侧固有神经连续性中断。本研究的目的是回顾性评估急诊神经移植的临床结果以及供区并发症。

材料与方法

回顾了2008年至2012年间接受手术的3名女性和13名男性患者。患者平均年龄为39岁（范围18 - 78岁）。所有患者均接受急诊手术。平均缺损长度为38毫米（范围15 - 60毫米）。神经取自四个部位：前臂外侧皮神经（12例）、冷藏手指（2例）、骨间后神经终末部（1例）和骨间前神经（1例）。评估包括患者询问以及对治疗手指和供区的临床检查。还进行了客观的感觉检查。结果根据英国医学研究委员会（MRC）分类表示。

结果

供区并发症很少（2例有症状性感觉减退，1例瘢痕过敏）。69%的患者表示移植手指在日常生活活动中未给他们带来任何困扰。3名患者需要重新进行工作培训。移植手指的疼痛在视觉模拟评分（VAS）上为0.6（范围0 - 5）。根据单丝感觉测试，31%的病例恢复了正常感觉；25%的患者触觉敏感性略有下降，25%的患者保护性感觉减退。韦氏两点辨别试验发现50%的患者感觉正常（阈值<6毫米），6%的患者感觉中等（阈值为6 - 10毫米）。在MRC分级量表上，50%的患者为S4级，6%为S3 +级，19%为S3级，12%为S2级，12%为S1级。