Service d'orthopédie et de chirurgie du membre supérieur, Hôpital Saint-Antoine, 184 Rue du Faubourg Saint-Antoine, 75012 Paris, France.
Service de chirurgie de la main et du membre supérieur, chirurgie des nerfs périphériques Hôpital Lapeyronie, CHU Montpellier, CHU Montpellier, Avenue du doyen Gaston Giraud, 34295 Montpellier Cedex 5, France.
Hand Surg Rehabil. 2022 Feb;41S:S112-S117. doi: 10.1016/j.hansur.2020.10.021. Epub 2021 Jul 1.
Ulnar paralysis has multiple clinical presentations, which are due to partial recovery or to anatomical variations between the ulnar and median nerves. The main sequelae of ulnar nerve paralysis are the loss of hand strength with impairment of all intrinsic functions of the fingers and some of the thumb's functions. Weakness of the adductor pollicis and flexor pollicis brevis muscles may manifest as weak key pinch with automatic flexion of the thumb interphalangeal joint when gripping. Indications for palliative surgery have decreased due to advances in peripheral nerve surgery. However, palliative surgery still has a significant role to play when nerve repair techniques are not indicated or do not provide satisfactory results. The principle is to reinforce metacarpophalangeal flexion while stabilizing the thumb's interphalangeal joint, thus supplementing the action of the flexor pollicis brevis. This is generally done by transferring the flexor digitorum superficialis tendon of the fourth finger to the distal insertion of the superficial thenar muscles and the extensor pollicis longus. Restoration of the first dorsal interosseous is more rarely indicated.
尺神经麻痹有多种临床表现，这是由于尺神经和正中神经之间的部分恢复或解剖变异所致。尺神经麻痹的主要后遗症是手部力量丧失，手指的所有内在功能和拇指的一些功能受损。内收拇指肌和拇短屈肌的无力可能表现为在握持时，拇指指间关节自动弯曲导致弱的钥匙扣握。由于周围神经手术的进步，姑息性手术的适应证已经减少。然而，当神经修复技术不适用或不能提供满意的结果时，姑息性手术仍然有重要的作用。其原则是加强掌指关节的屈曲，同时稳定拇指指间关节，从而补充拇短屈肌的作用。这通常通过将第四指的指浅屈肌腱转移到大鱼际肌的远端插入点和拇长伸肌腱来完成。很少有指征重建第一背侧骨间肌。
