Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, People's Republic of China.
Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, People's Republic of China.
J Neurol Surg A Cent Eur Neurosurg. 2024 Nov;85(6):594-601. doi: 10.1055/a-1842-4343. Epub 2022 May 3.
We explore a minimally invasive method (combined ultrasound detection, electrode placement and electrophysiologic nerve examination) to evaluate the early-stage quality of a nerve suture site.
Ten patients with median and/or ulnar nerve injuries who had undergone nerve suture were recruited. Postoperative ultrasound examination found that the nerve injury was sutured. Then, a stimulating electrode and recording electrode were located beside the nerve proximal and distal to the suture site guided by ultrasound. Measurement of nerve action potentials (NAP) were performed with these electrodes, followed by surgical exploration. The pre- and intraoperative electrophysiologic findings were compared, together with amplitude, latency, and wave shape of NAP.
Of the 10 patients, 3 patients were diagnosed with median nerve injury, 2 with ulnar nerve injury, and 5 with the median nerve and ulnar nerve injury. NAP could not be detected pre- and intraoperatively in three median nerves from three patients and in two ulnar nerves from two patients. NAP was detected in 10 nerves from the remaining 5 patients. The pre- and intraoperative NAP results showed consistent results concerning the status of the nerve suture. Wilcoxon's signed-rank test indicated no significant difference in the amplitude and latency detected via sonographically placed electrodes and during surgical exploration. The number of negative-phase waves were equally distributed.
Ultrasound-guided electrode placement and NAP detection can substitute surgery and serve as a minimally invasive approach to evaluate the regeneration of a sutured nerve.
我们探索了一种微创方法（结合超声检测、电极放置和电生理神经检查），以评估神经缝合部位的早期质量。
招募了 10 名接受正中神经和/或尺神经损伤神经缝合的患者。术后超声检查发现神经损伤已缝合。然后，在超声引导下，将刺激电极和记录电极放置在缝合部位的神经近端和远端。使用这些电极进行神经动作电位（NAP）测量，然后进行手术探查。比较术前和术中的电生理发现，以及 NAP 的幅度、潜伏期和波形。
10 名患者中，3 名诊断为正中神经损伤，2 名诊断为尺神经损伤，5 名同时存在正中神经和尺神经损伤。3 名患者的 3 根正中神经和 2 名患者的 2 根尺神经在术前和术中均无法检测到 NAP。其余 5 名患者的 10 根神经检测到 NAP。术前和术中的 NAP 结果均显示神经缝合状态一致。Wilcoxon 符号秩检验表明，超声引导下放置的电极和手术探查时检测到的振幅和潜伏期无显著差异。负相波的数量分布均匀。
超声引导电极放置和 NAP 检测可以替代手术，作为一种微创方法来评估缝合神经的再生。
