Tackmann W, Kaeser H E, Nigst H, Pfeiffer P, Brennwald J, Gloor D
Fortschr Neurol Psychiatr. 1985 Apr;53(4):123-33. doi: 10.1055/s-2007-1001960.
A group of 37 patients (total 41 nerves) with a traumatic transection of median or ulnar nerves at the wrist were reinvestigated clinically and electrophysiologically 4-59 months after primary or secondary suture or grafting. Clinically there was no relation between the time after the operation, and sensory recovery determined according to the schedule of Nicholson and Seddon (1957), two-point discrimination, vibration threshold. There was also no relationship between the time after suture, and the motor latencies as well as amplitudes of evoked muscle action potentials from the abductor pollicis brevis or hypothenar muscles. In sensory nerve fibres there was a statistically significant increase of the maximum amplitude and of the cumulative amplitude during the period after operation, due to an increasing number of regenerated nerve fibres. Sensory nerve conduction velocities showed no relation to the time after suture. Cumulative amplitudes were significantly related to two-point discrimination and to restitution of sensibility. As indicated by the great scatter, however, this parameter is merely a moderate predictor for the degree of clinical recovery. Somatosensory evoked potentials can be helpful in some cases to indicate nerve regeneration when nerve action potentials in peripheral nerves cannot be recorded. However, latencies and amplitudes of the individual peaks did not reveal any relationship to either clinical findings or to period of time after operation. Needle electromyography also yielded highly variable findings. A constant finding was a persistent loss of motor units. Most of these were increased sin size, as indicated by prolonged duration of their action potentials during slight voluntary effort.
一组37例(共41条神经)手腕部正中神经或尺神经外伤性横断患者,在初次或二次缝合或移植术后4 - 59个月接受了临床和电生理复查。临床上,根据Nicholson和Seddon(1957年)的标准、两点辨别觉、振动觉阈值判断,手术时间与感觉恢复之间没有关联。缝合时间与拇短展肌或小鱼际肌诱发肌肉动作电位的运动潜伏期及波幅之间也没有关系。在感觉神经纤维中,由于再生神经纤维数量增加,术后期间最大波幅和累积波幅有统计学意义的增加。感觉神经传导速度与缝合时间无关。累积波幅与两点辨别觉及感觉恢复显著相关。然而,由于离散度大,该参数只是临床恢复程度的一个中等预测指标。当外周神经无法记录到神经动作电位时,体感诱发电位在某些情况下有助于提示神经再生。然而,各个波峰的潜伏期和波幅与临床发现或术后时间均无关系。针极肌电图检查结果也高度可变。一个持续存在的表现是运动单位持续缺失。其中大多数运动单位大小增加,轻微随意用力时动作电位持续时间延长即表明这一点。