Hunter J M
Department of Orthopaedic Surgery, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Hand Clin. 1996 May;12(2):365-78.
Two clinical and four surgical steps can be taken to return gliding and nutritional balance to the median nerve after revision surgery for a recurrent median nerve neuropathy: Step One (Clinical): An accurate diagnosis of the median nerve traction neuropathy. Consider brachial plexopathy and terminal neuropathies. Step Two (Surgical): Comprehensive exploration and meso-epineurolysis of the median nerve from the radial remnants of the divided TCL and fibrosed radial and ulnar bursae by resection of the bursae and flexor tenosynovectomy. Step Three (Surgical): Fasciotomy of the volar carpal ligament to lengthen the ulnar leaf of the TCL; permits visualization of the ulnar artery and neurolysis of the ulnar motor nerve. Step Four (Surgical): Mobilize the previously released radical leaf TCL and motor median nerve from the origin of the thenar muscles. Step Five (Surgical): Restore the inner gliding surface and strength of the flexor retinaculum of the hand and wrist by reconstruction of the TCL and the forearm antebrachial fascia. Step Six (Clinical): An immediate postoperative hand therapy program to restore gliding to the median nerve and flexor tendons. Protocols for upper extremity nerve gliding should be carried out under supervision at selected daily intervals. A prevailing brachial plexopathy requires positive supervised therapy for nerve gliding and posture control.
对于复发性正中神经病变进行翻修手术后，可采取两个临床步骤和四个手术步骤来恢复正中神经的滑动和营养平衡：第一步（临床）：准确诊断正中神经牵拉伤性神经病变。考虑臂丛神经病变和终末神经病变。第二步（手术）：通过切除滑囊和屈肌腱滑膜切除术，对正中神经进行全面探查，并对正中神经进行中-神经外膜松解，该正中神经来自已切断的腕横韧带的桡侧残余部分以及纤维化的桡侧和尺侧滑囊。第三步（手术）：切开掌侧腕横韧带以延长腕横韧带的尺侧叶；以便观察尺动脉并对尺侧运动神经进行神经松解。第四步（手术）：从大鱼际肌起点处游离先前已松解的桡侧叶腕横韧带和正中运动神经。第五步（手术）：通过重建腕横韧带和前臂前臂筋膜，恢复手和腕部屈肌支持带的内部滑动表面和强度。第六步（临床）：术后立即进行手部治疗计划，以恢复正中神经和屈肌腱的滑动。上肢神经滑动方案应在选定的每日间隔时间内，在监督下进行。存在臂丛神经病变时，需要对神经滑动和姿势控制进行积极的监督治疗。
