Hirasawa Y, Katsumi Y, Tokioka T
J Bone Joint Surg Br. 1985 Nov;67(5):814-9. doi: 10.1302/0301-620X.67B5.4055885.
We have studied the restoration of sensation in 24 patients after operations involving the digital nerves of the thumb. These comprised 10 neurorrhaphies, two nerve graftings, five replantations, one toe-to-thumb transfer and six neurovascular island flaps. The average follow-up period was 46 months. Greater sensitivity was found in the moving two-point discrimination (2PD) test than in the static 2PD test. The results of the Semmes-Weinstein test showed good correlation with the static 2PD test. Porter's letter test showed correlations with both 2PD tests, and the pulp-writing test showed good correlation with the moving 2PD test. The neurorrhaphy cases had the best results using the static 2PD and Semmes-Weinstein test, and had good restoration of sensation; the replantation cases were next best. After neurovascular island flaps, patients exhibited hypersensitivity, double sensation and distorted images on the pulp-writing test. Using this same test the nerve grafting cases had distorted touch perception and perceived a straight line as a curve. The pulp-writing test, using moving touch, is one method of examining mechanoreceptors and shows to what extent the patient perceives what touches the finger pulp; it gives a better indication of higher functions than the 2PD test.
我们研究了24例涉及拇指指神经手术患者的感觉恢复情况。这些手术包括10例神经缝合术、2例神经移植术、5例再植术、1例足趾-拇指移植术和6例神经血管岛状皮瓣手术。平均随访期为46个月。动态两点辨别觉（2PD）测试的敏感性高于静态2PD测试。Semmes-Weinstein测试结果与静态2PD测试显示出良好的相关性。波特字母测试与两种2PD测试均显示出相关性，而指腹书写测试与动态2PD测试显示出良好的相关性。在静态2PD和Semmes-Weinstein测试中，神经缝合术病例的结果最佳，感觉恢复良好；再植术病例次之。神经血管岛状皮瓣手术后，患者在指腹书写测试中表现出感觉过敏、双重感觉和图像扭曲。在同样的测试中，神经移植术病例的触觉感知扭曲，将直线感知为曲线。使用动态触摸的指腹书写测试是检查机械感受器的一种方法，它能显示患者在多大程度上感知到接触指腹的物体；与2PD测试相比，它能更好地反映高级功能。
