Athlani L, De Almeida Y-K, Maschino H, Dap F, Dautel G
Service de chirurgie de la main, chirurgie plastique et reconstructrice de l'appareil locomoteur, centre chirurgical Émile-Gallé, CHU de Nancy, 49, rue Hermite, 54000 Nancy, France.
Hand Surg Rehabil. 2018 Oct;37(5):316-319. doi: 10.1016/j.hansur.2018.07.001. Epub 2018 Jul 21.
Hypothenar hammer syndrome is a rare condition secondary to ulnar artery damage in Guyon's canal, affecting mainly those exposed to repeated palm trauma. Surgery is discussed in cases of severe symptoms that are resistant to conservative treatment, and/or when anatomical lesions with high embolism potential are discovered during imaging exams. Resection of the pathological zone with revascularization by autologous vein graft is the best option. We report the case of a 60-year-old patient who had a recurrence of symptoms more than 10 years after this type of surgical treatment was performed. There was an aneurysmal thrombosed vein graft with extensive thrombus from the ulnar artery upstream to Guyon's canal to the superficial palmar arch. Finger revascularization was provided by the superficial branch of the radial artery and the presence of a collateral vascular supply. This late complication was responsible for compression of the ulnar nerve in Guyon's canal. A new surgery was performed to resect the thrombosed zone, including the vein graft, without vascular reconstruction due to the good vascularization of all the fingers, and to release the ulnar nerve at the wrist. The postoperative course was uneventful with the disappearance of pain and sensory-motor deficits. Good finger vascularization was confirmed by imaging at 3 months postoperative; nerve conduction was normal at 6 months on electroneuromyography.
小鱼际锤状指综合征是一种罕见的疾病，继发于Guyon管内尺动脉损伤，主要影响那些反复遭受手掌创伤的人。对于保守治疗无效的严重症状病例，和/或在影像学检查中发现具有高栓塞风险的解剖学病变时，会讨论手术治疗。切除病变区域并采用自体静脉移植进行血管重建是最佳选择。我们报告了一例60岁患者的病例，该患者在进行此类手术治疗10多年后症状复发。存在一个动脉瘤样血栓形成的静脉移植物，血栓广泛，从尺动脉上游至Guyon管直至掌浅弓。通过桡动脉浅支实现了手指再血管化，且存在侧支血管供应。这种晚期并发症导致了Guyon管内尺神经受压。由于所有手指的血管化良好，因此进行了一次新的手术，切除包括静脉移植物在内的血栓形成区域，未进行血管重建，并在腕部松解尺神经。术后过程顺利，疼痛和感觉运动障碍消失。术后3个月的影像学检查证实手指血管化良好；术后6个月的神经电生理检查显示神经传导正常。
