Chaise F, Friol J P, Gaisne E
Département de chirurgie de la main et des nerfs périphériques, Clinique Mutualiste de Loire Atlantique, Nantes.
Rev Chir Orthop Reparatrice Appar Mot. 1993;79(5):393-7.
A group of 107 patients with 110 injured digital nerves was studied one year after microsurgical nerve suture. Return of sensibility was tested within the autonomous zones for the nerve. Four tests were used to appreciate the results: pain, Tinel sign, Weber two point discrimination test, the return of the sensibility appreciated by the patient himself. At follow-up, 86 per cent of the patients were found without pain, 75 per cent without Tinel sign, 68 per cent achieved a two point discrimination test of < or = 7 mm, 18 per cent were found with a discrimination test value of 9 mm or more. 93 per cent were satisfied or very satisfied. Of the factors studied, the patient's age at the time of nerve suture was found to be directly related to the return of sensibility as tested by two point discrimination test. Although the return of sensibility following nerve suture in adults is not as good as in children, primary suture of the nerve is worthwhile, a protective sensation is better than an anesthetic digit, and the incidence of painful neuroma is very minimal. The findings in the present study indicate that the nerve suture gives better results that the nerve graft.
一组107例有110条指神经损伤的患者在显微外科神经缝合术后一年接受了研究。在神经的自主区内测试感觉恢复情况。采用四项测试来评估结果:疼痛、Tinel征、Weber两点辨别试验、患者自身感觉到的感觉恢复情况。随访时发现,86%的患者无疼痛,75%的患者无Tinel征,68%的患者两点辨别试验结果≤7mm,18%的患者两点辨别试验值≥9mm。93%的患者满意或非常满意。在所研究的因素中,发现神经缝合时患者的年龄与两点辨别试验所测试的感觉恢复直接相关。虽然成人神经缝合后的感觉恢复不如儿童,但神经一期缝合是值得的,有保护性感觉总比手指麻醉要好,而且疼痛性神经瘤的发生率非常低。本研究结果表明,神经缝合比神经移植效果更好。