Andelkovic Sladana Z, Lesic Aleksandar R, Bumbasirevic Marko Z, Rasulic Lukas G
Clinical Center of Serbia, Orthopedic and Traumatology Clinic, Belgrade, Serbia.
Turk Neurosurg. 2017;27(2):289-293. doi: 10.5137/1019-5149.JTN.15106-15.0.
The surgical management of injured digital nerves is a common part of hand trauma surgery. Despite improvements in the surgical techniques and suture material, the final outcomes of peripheral nerve repair can still be disappointing. This study investigates the outcomes following the surgical treatment of traumatic digital nerve lesions of the hand.
150 consecutive patients with acutely digital nerve injuries were treated through by primary repair in our Unit between January 2005 and December 2009. 126 were male, 24 female (male/female ratio of 5.25:1), with an age range of 16-70 years, and a mean follow-up of 30 months. All 150 patients underwent primary epineural suture within 48 hours of their injury. Sensory recovery was assessed using the Medical Research Council scale (MRC). Sensibility testing was performed after a minimum of 12 months. Disabilities of the Arm, Shoulder and Hand scores (DASH) were used to evaluate the functional outcomes.
Eighteen patients (9.33%) had excellent sensibility with two-point discrimination test (S2PD) of ≤ 7 mm (S4). Forty-one patients (21.24%) achieved good sensibility (S2PD ≤ 15 mm, S3+), 76 (39.38%) achieved S3, 55 (28.50%) had poor sensibility (S2 and S1), and two patients had no sensibility (S0). The mean functional DASH score was 9.0 in our group of patients.
There was a significant correlation between patient age, mechanism of injury and nerve recovery, with younger patients and patients with narrow zone of injury achieving better sensory recoveries.
手指神经损伤的外科治疗是手部创伤手术的常见组成部分。尽管手术技术和缝合材料有所改进，但周围神经修复的最终效果仍可能不尽人意。本研究调查手部创伤性指神经损伤手术治疗后的结果。
2005年1月至2009年12月期间，我们科室对150例急性指神经损伤患者进行了一期修复治疗。其中男性126例，女性24例（男女比例为5.25:1），年龄范围为16至70岁，平均随访30个月。所有150例患者均在受伤后48小时内进行了一期神经外膜缝合。使用医学研究委员会量表（MRC）评估感觉恢复情况。至少在12个月后进行感觉测试。采用手臂、肩部和手部功能障碍评分（DASH）来评估功能结果。
18例患者（9.33%）两点辨别试验（S2PD）≤7mm，感觉恢复优秀（S4）。41例患者（21.24%）感觉恢复良好（S2PD≤15mm，S3+），76例（39.38%）达到S3，55例（28.50%）感觉恢复差（S2和S1），2例患者无感觉（S0）。我们这组患者的平均功能DASH评分为9.0。
患者年龄、损伤机制与神经恢复之间存在显著相关性，年龄较小的患者和损伤区域较窄的患者感觉恢复较好。
