Martini A, Zellner P R
Chirurg. 1976 Dec;47(12):682-6.
This paper concerns the clinical results of microsurgical repair to nerve injuries on the upper extremities of 66 patients, who had sustained a total of 126 nerve injuries. The majority of these cases involved lesions of the sensory nerves, occurring in the area of the palmar surface of the hand and flexor surface of the fingers (102 nerves and 24 injuries involving the nerve trunks of the median and ulnar nerves). -- Fifty-five percent of the cases were treated primarily, 25% secondarily, and the remaining 20% required nerve transplants. Forty percent involved crush injuries and 87% had sustained associated injuries. -- Tests for tactile gnosis were performed by means of "blindfold" tests. The analysis of the results was carried out according to accepted methods; the "Sedon" method was adapted in order to be able to judge the sensibility from a more functional aspect. -- The repair to sensory nerves is more successful than that carried out on the motor nerves. The degree of success is dependent upon the age of the patient, the nature of the wounds, and the associated injuries. -- Results of primary nerve suture are considerably better than those resulting from nerve transplants even in cases of unfavorable soft issue conditions. Thus, our opinion is that an experienced hand surgeon trained in the field of microsurgery should not be afraid of undertaking primary repair procedures as long as the technical and administrative requirements are adequate.
本文涉及66例上肢神经损伤患者显微外科修复的临床结果，这些患者共有126处神经损伤。其中大多数病例为感觉神经损伤，发生在手掌面和手指屈面区域（102条神经，24处损伤累及正中神经和尺神经干）。——55%的病例为一期治疗，25%为二期治疗，其余20%需要进行神经移植。40%的病例为挤压伤，87%伴有其他相关损伤。——通过“蒙眼”测试进行触觉识别测试。结果分析按照公认的方法进行；采用“塞登”方法以便能够从更功能化的角度判断感觉。——感觉神经的修复比运动神经的修复更成功。成功程度取决于患者年龄、伤口性质和相关损伤。——即使在软组织条件不利的情况下，一期神经缝合的结果也比神经移植的结果好得多。因此，我们认为，只要技术和管理要求具备，在显微外科领域接受过培训的经验丰富的手外科医生不应惧怕进行一期修复手术。
