Chassard M, Pham E, Comtet J J
Department of Hand Surgery, Hôpital E. Herriot, Centre d'Informatique Médicale Alexis Carrel, Lyon, France.
J Hand Surg Br. 1993 Dec;18(6):790-6. doi: 10.1016/0266-7681(93)90247-d.
Transection of both median and ulnar nerves provides an objective model to compare sensory and functional recovery. 22 patients were evaluated after nerve repair. The mean age was 30 years and the mean time since surgery 80 months. Primary direct suture was performed in 15 patients and six grafts were necessary. Median nerve suture and ulnar nerve graft were combined in one case. Both sensory and functional evaluation were completed. Statistical evaluation analyzed the relationship between age, injury location, mechanism, type of rehabilitation and the result, and the relationship between two-point discrimination distance (2-PD) and the functional score. According to the S0 to S4 grading, only 26.5% (ulnar) and 31% (median) of direct suture cases achieved S3+ or more. All nerve grafts in adults were poor. A strong relationship was found between two-point discrimination distance (moving and static) and the functional result, even after multivariate analysis. A modification of the Medical Research Council's classification is suggested.
正中神经和尺神经横断提供了一个用于比较感觉和功能恢复的客观模型。对22例接受神经修复的患者进行了评估。平均年龄为30岁,距手术的平均时间为80个月。15例患者进行了一期直接缝合,6例需要移植。1例患者同时进行了正中神经缝合和尺神经移植。完成了感觉和功能评估。统计评估分析了年龄、损伤部位、机制、康复类型与结果之间的关系,以及两点辨别距离(2-PD)与功能评分之间的关系。根据S0至S4分级,直接缝合病例中只有26.5%(尺神经)和31%(正中神经)达到S3+或更高。所有成人神经移植效果均较差。即使经过多变量分析,也发现两点辨别距离(动态和静态)与功能结果之间存在密切关系。建议对医学研究委员会的分类进行修改。