Casscells C D, Lindsey R W, Ebersole J, Li B
Department of Orthopaedic Surgery, Yale University School of Medicine, New Haven, Connecticut.
Clin Orthop Relat Res. 1993 Jun(291):259-65.
Ulnar neuropathy is a known complication of median sternotomy surgery, and its precise cause is not clear. The authors hypothesize that a "double-crush" phenomenon caused by intraoperative compression of the brachial plexus occurs in a patient with preexisting, previously undiagnosed slowing of ulnar nerve conduction. Eighty-four arms in 42 patients scheduled for cardiac surgery were studied. Pre- and postoperative history and physical examinations were performed by separate blinded examiners; however, the nerve conduction studies were performed by a single examiner. Fifteen arms (18%) in 11 patients (26%) clinically demonstrated postoperative neuropathy. After surgery, all symptomatic patients had considerable slowing of their preoperative conduction studies. A direct correlation appears to exist between preoperative slowing of ulnar nerve conduction and postmedian sternotomy neuropathy. A careful preoperative evaluation including nerve conduction studies may detect the predisposed patient; the surgeon attempting postoperative cubital tunnel decompression is cautioned that the lesion may not be an isolated one.
尺神经病变是正中胸骨切开术已知的并发症，其确切病因尚不清楚。作者推测，在术前存在未被诊断出的尺神经传导减慢的患者中，术中臂丛神经受压会导致“双重压迫”现象。对42例计划进行心脏手术患者的84条手臂进行了研究。术前和术后的病史及体格检查由不同的盲法检查者进行；然而，神经传导研究由一名检查者进行。11例患者（26%）的15条手臂（18%）临床上表现出术后神经病变。手术后，所有有症状的患者术前传导研究均有明显减慢。尺神经传导术前减慢与正中胸骨切开术后神经病变之间似乎存在直接关联。包括神经传导研究在内的仔细术前评估可能会发现易患患者；对于试图进行术后肘管减压的外科医生，需提醒其病变可能并非孤立存在。
