Wachter N, Mentzel M, Krischak G, Häderer C, Gülke J
Klinik für Hand-, Plastische und Mikrochirurgie, Klinikum Stuttgart Katharinenhospital, Kriegsbergstraße 60, 70174, Stuttgart, Deutschland.
Klinik für Unfall-, Hand-, Plastische und Wiederherstellungschirurgie, Universität Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland.
Unfallchirurg. 2018 Mar;121(3):230-238. doi: 10.1007/s00113-017-0323-4.
Peripheral lesions of the median nerve cause characteristic changes of the grip function of the hand. For evaluating grip force changes, measurement by dynamometers (JAMAR dynamometer and pinch dynamometer) is of high relevance. In this study the ability of grip force measurements of different grip forms was evaluated to discriminate between a simulated median nerve lesion and healthy subjects.
In 21 healthy subjects, the grip force of power grip was measured by the JAMAR dynamometer at the second stage including measurement of force at the fingertips and the thenar by a sensor glove. With a pinch dynamometer the power of palmar abduction, precision grip, pincer grip and pinch grip was determined. Measurements were performed with and without median nerve block at the wrist.
In power grip of the JAMAR dynamometer at the second stage a significant reduction of the grip force of 13.4% was found (p < 0.03). The power distribution between the fingers D2-D5 did not change with median nerve block. The most relevant reduction of grip force in median nerve block compared with the healthy control was measured in palmar abduction (72.1%, p < 0.0002), followed by precision grip 31.0% (p < 0.0001), pincer grip 23.6% (p < 0.0004) and pinch grip 18.8% (p < 0.0002).
For the discrimination between healthy subjects and subjects with a median nerve block there was a limited relevance of the measurement of the power grip and force distribution at the fingers by the JAMAR dynamometer. However, the best distinction was observed by dynamometric measurement of other grips than power grip, such as palmar abduction, precision grip, pincer grip and pinch grip. The results could be relevant for the clinical diagnostics and rehabilitation of median nerve lesion, complementing the widespread measurement of the power grip by other grip forms.
正中神经的周围性病变会导致手部抓握功能出现特征性变化。为评估握力变化，使用测力计（JAMAR测力计和捏力计）进行测量具有高度相关性。在本研究中，评估了不同抓握形式的握力测量能力，以区分模拟正中神经损伤与健康受试者。
对21名健康受试者，在第二阶段使用JAMAR测力计测量强力抓握的握力，包括通过传感器手套测量指尖和大鱼际的力量。使用捏力计测定掌侧外展、精确抓握、镊子抓握和捏握的力量。在手腕处进行正中神经阻滞和不进行阻滞的情况下分别进行测量。
在第二阶段JAMAR测力计的强力抓握中，发现握力显著降低了13.4%（p < 0.03）。手指D2 - D5之间的力量分布在正中神经阻滞后没有变化。与健康对照组相比，正中神经阻滞时握力下降最显著的是掌侧外展（72.1%，p < 0.0002），其次是精确抓握31.0%（p < 0.0001）、镊子抓握23.6%（p < 0.0004）和捏握18.8%（p < 0.0002）。
对于区分健康受试者和正中神经阻滞受试者，JAMAR测力计测量的强力抓握力量及手指力量分布的相关性有限。然而，通过测量除强力抓握之外的其他抓握形式（如掌侧外展、精确抓握、镊子抓握和捏握）的测力计测量，能观察到最佳区分效果。这些结果可能与正中神经损伤的临床诊断和康复相关，可通过其他抓握形式补充广泛使用的强力抓握测量。
