示指尺侧指固有神经及其背侧支移位修复拇指两侧指固有神经撕脱离断伤  

Transferring the ulnaris proper digital nerve of index finger and its dorsal branch to repair the thumb nerve avulsion

作　　者：李启朝 刘章民 卢俊岳 邵文钗 冯小波 

机构地区：[1]任丘市人民医院手外科,河北任丘062550

出　　处：《中国修复重建外科杂志》2017年第8期992-995,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨应用示指尺侧指固有神经及其背侧支移位修复拇指两侧指固有神经撕脱离断伤的临床疗效。方法 2007年1月—2015年5月,采用示指尺侧指固有神经及其背侧支移位修复23例拇指两侧指固有神经撕脱离断伤患者。其中男17例,女6例;年龄16~63岁,平均32岁。致伤原因:机器绞伤10例,电锯伤8例,坚锐物品剐伤5例。拇指完全撕脱离断8例,拇指不完全离断2例,拇指掌侧裂伤13例(合并屈肌腱断裂7例)。受伤至手术时间为1.0~3.5 h,平均2.2 h。结果术后患者切口均Ⅰ期愈合,10例再植拇指全部成活。23例患者均获随访,随访时间5个月~2年8个月,平均1年4个月。患指指腹感觉恢复良好,末次随访时两点辨别觉为3~9 mm,平均6.8 mm。按照中华医学会手外科学会上肢部分功能评定试用标准评价,拇指指腹感觉达S418例、S3+5例,示指尺侧感觉为S3。结论应用示指尺侧指固有神经及其背侧支移位修复拇指指固有神经撕脱离断伤,能恢复拇指指腹良好感觉,手术操作简便,疗效确切。Objective To investigate the effectiveness of transferring the ulnaris proper digital nerve of index finger and its dorsal branch to repair the thumb nerve avulsion. Methods Between January 2007 and May 2015, 23 patients with thumb nerve avulsion were treated by transferring the ulnaris proper digital nerve of index finger and its dorsal branch. There were 17 males and 6 females with an average age of 32 years （range, 16-63 years）. The injuries were caused by machine twist in 10 cases, electric saw in 8 cases, and sharp article prick in 5 cases. And thumb rotational avulsion amputation happened in 8 cases, thumb incomplete amputation in 2 cases, laceration of thumb palmaris with the thumb nerve avulsion of both sides in 13 caese （7 cases with tendon rupture）. The time from injury to operation was 1.0- 3.5 hours （mean, 2.2 hours）. Results All incisions healed by first intention. Ten cases of thumb reimplantation were successful. All the patients were followed up for 5 months to 2 years and 8 months, with an average of 1 year and 4 months. Two-point discrimination was 3-9 mm （mean, 6.8 mm）. According to Society of Hand Surgery standard for the evaluation of upper part of the function, the sensory of the thumb was rated as S4 in 18 cases and S3 in 5 cases; the sensory at donor sites recovered to S3. Conclusion Transferring the ulnaris proper digital nerve of index finger and its dorsal branch to repair the thumb nerve avulsion is a simple and effective method to restore sensory function of the thumb pulp.

关 键 词：神经移位 指固有神经 神经撕脱离断 拇指损伤 

分 类 号：R658.2[医药卫生—外科学]