Jerome J Terrence Jose
Department of Orthopedics, Hand and Reconstructive Microsurgery, Olympia Hospital & Research Centre, Puthur, Trichy, Tamil Nadu, India.
JBJS Case Connect. 2023 Mar 16;13(1). doi: e22.00704. eCollection 2023 Jan 1.
The author reports a 4-month-old high median nerve palsy in a 19-year-old man with right forearm fractures, stabilized with dynamic compression plates and screws. Surgical exploration revealed a large median nerve neuroma in the midarm that was excised, and the gap was bridged with sural nerve cable grafts. The extensor carpi radialis nerve was transferred to the anterior interosseous nerve in the forearm. The adductor branch of terminal divisions of the ulnar nerve was transferred to the thenar branch of the median nerve in the hand.
The adductor branch of ulnar nerve transfer to the thenar motor branch in high median nerve palsy efficiently restored thumb opposition in 10 months of follow-up. In addition, the patient's grasp and pinch improved, preserving thumb adduction.
作者报告了一名19岁男性，因右前臂骨折采用动力加压钢板和螺钉固定后出现4个月的高位正中神经麻痹。手术探查发现上臂中部有一个巨大的正中神经神经瘤，将其切除，并用腓肠神经电缆移植修复神经缺损。桡侧腕伸肌神经在前臂被转移至骨间前神经。尺神经终末分支的内收肌支在手部被转移至正中神经的鱼际支。
在高位正中神经麻痹中，尺神经内收肌支转移至鱼际运动支在10个月的随访中有效恢复了拇指对掌功能。此外，患者的抓握和捏力有所改善，同时保留了拇指内收功能。
