Sundararaj G D, Mani K
J Bone Joint Surg Br. 1984 Mar;66(2):260-4. doi: 10.1302/0301-620X.66B2.6707065.
Simultaneous paralysis of the ulnar, median and radial nerves is seen in about 1% of hands with nerve involvement in Hansen's disease. Forty such cases were treated between 1955 and 1976; 35 of these have been followed up. In two hands there was a high radial, median and ulnar palsy and these left no scope for reconstruction. The other 33 cases which underwent two-stage reconstructive surgery are presented here. The first stage consisted of restoring active extension of the wrist, fingers and thumb: for this purpose the ideal muscles for transfer are pronator teres, flexor carpi radialis and palmaris longus respectively, and muscle power exceeding Grade 3 (on the MRC classification) was achieved in 89%, 96%, and 100% of these individual transfers. Arthrodesis of the wrist is not recommended when suitable muscles are available for transfer. The second stage of reconstruction attempts to restore intrinsic function of the fingers and opposition of the thumb; the sublimis is ideal for both purposes and satisfactory restoration of function was achieved in 89% and 85% of cases respectively. Ten of the 18 hands in which all five tendons were transferred had good or excellent results.
在麻风病累及神经的手部病例中,约1%会出现尺神经、正中神经和桡神经同时麻痹的情况。1955年至1976年间共治疗了40例此类病例;其中35例进行了随访。有两只手出现高位桡神经、正中神经和尺神经麻痹,无法进行重建手术。本文介绍了另外33例行两阶段重建手术的病例。第一阶段是恢复腕关节、手指和拇指的主动伸展:为此目的,理想的转移肌肉分别是旋前圆肌、桡侧腕屈肌和掌长肌,在这些个体转移中,肌肉力量超过3级(根据医学研究委员会分类)的分别占89%、96%和100%。当有合适的肌肉可供转移时,不建议进行腕关节固定术。重建的第二阶段试图恢复手指的内在功能和拇指的对掌功能;指浅屈肌对这两个目的都很理想,分别在89%和85%的病例中实现了功能的满意恢复。在18只转移了所有五条肌腱的手中,有10只取得了良好或极佳的效果。