异位支配对正中神经尺神经损伤诊断影响的研究

目的 了解正中神经和尺神经之间交通支的存在对前臂这两条神经损伤诊断的影响,前臂正中神经至尺神经的交通支(Martin-Gruber anastomosis,MGA)、前臂尺神经至正中神经的交通支(reversed Martin-Gruber anastomosis,RMGA)和手部尺神经至正中神经的交通支(Riche-Cannieu anastomosis,RCA).方法 将160例正中神经或尺神经损伤合并存在异常交通支的患者分为三组:尺神经损伤并MGA组65例;正中神经损伤并RMGA组8例;正中神经损伤并RCA组87例.就其解剖基础、临床表现、电生理表现以及诊断进行讨论.结果 正中神经或尺神经损伤时,受损神经所支配肌肉的功能由于异常交通支的存在而得以代偿,导致其临床表现与神经损伤情况及其电生理表现不符.结论 充分了解正中神经和尺神经之间三种异常交通支的特点,对正中神经或尺神经损伤的临床诊断和治疗有重要意义,同时也可以避免错误地解释相关神经电生理检测的结果.     

Recurrent Ulnar Nerve Dislocation at the Elbow: Report of a Non-Traumatic Case with Ulnar Entrapment Neuropathy

An unusual case of habitual recurrent ulnar nerve dislocation at the elbow is described. The case was complicated by non-traumatic ulnar entrapment neuropathy interfering with the patient's profession as a musician (cello).     

Ulnar nerve palsy after open carpal tunnel decompression: Case report and review of the literature

Open carpal tunnel release is the commonest surgical treatment of median nerve compression at the wrist. Although successful in most cases, there are well described complications. We report a case of laceration of the deep motor branch of the ulnar nerve at the level of the hook of hamate following a complicated carpal tunnel decompression. Good surgical technique and knowledge of wrist anatomy are essential for performing this apparently simple procedure safely.     

Evaluation of Tension at Median and Ulnar Nerve Repairs at the Wrist in a Cadaveric Model

Background: Median and ulnar nerve lacerations at the wrist are often combined with zone 5 tendon injury. The inability to provide early range of motion leads to increased adhesions. Current therapy protocols recommend the wrist be held in 30° of flexion post operatively to protect the nerve repair. However, if tension and elongation across the nerve repair stay under a critical level in less wrist flexion, postoperative splinting in more extension could allow for better tendon excursion and less adhesions. Methods: Six cadaveric specimens were used. After appropriate dissection, the median and ulnar nerves were transected and repaired with a single 10-0 nylon suture. The wrist was ranged from 30° flexion to 45° extension to see if the repair would fail. Next, an epineural repair was accomplished with 9-0 nylon suture. The percent elongation along the nerve repair was measured at set increments from 30° flexion to 45° extension. Results: In all 6 specimens, median and ulnar nerve repairs with a single 10-0 nylon suture did not fail with wrist range of motion from 30° flexion to 45° extension. Mean percent elongation stayed under critical levels in up to 30° of extension. Conclusions: Both median and ulnar nerve repairs stayed under critical levels of tension and elongation in up to 30° of wrist extension. We believe it is possible to be more aggressive with wrist positioning in wrist level median and ulnar nerve repairs.     

Compression of the Deep Palmar Branch of the Ulnar Nerve by a Ganglion

A ganglion originating from the pisotriquetral joint is the most common cause of distal ulnar nerve compression. Midpalmar ganglions causing ulnar nerve compression are rare. This case describes a ganglion arising from the third carpometacarpal joint causing compression of the deep motor branch of the ulnar nerve.Investigation performed at the Toronto Western Hospital, University Health Network Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada     

肘部尺神经卡压与尺神经半脱位的诊疗进展

肘部尺神经卡压也称为肘管综合征,可造成手部一系列功能障碍,是最常见的上肢神经卡压症之一。尺神经脱位及半脱位为尺神经卡压的影响因素。尺神经卡压按McGowan分级分为Ⅰ、Ⅱ、Ⅲ级。Ⅰ级首选保守治疗 Ⅱ、Ⅲ级保守治疗效果欠佳,多需要手术治疗。手术方式主要有尺神经原位松解术（包括肱骨内髁切除术）、粘膜下尺神经前置术、肌下尺神经前置术及肌内尺神经前置术等,其中原位松解手术操作相对简单,但对于尺神经卡压伴有尺神经脱位者多属禁忌,应首选尺神经前置术。     

Ulnar Nerve Palsy Following Closed Fracture of the Distal Radius: A Report of 2 Cases

Ulnar nerve palsy subsequent to a fracture of the distal radius is extremely rare compared to a median nerve injury. The lesion tends to occur in younger patents with a high-energy mechanism of injury and a severe injury pattern consisting of wide displacement, comminution, combined distal ulnar fracture and open fracture. The mechanism of injury can contribute to a direct contusion and traction, compression secondary to prolonged edema and tissue fibrosis, intraneural fibrosis and laceration. We report 2 cases of progressive ulnar nerve palsy subsequent to closed fractures of the distal radius. The neurological symptoms recovered in all cases who underwent nerve decompression and neurolysis at 2 or 3 months after the trauma. It is recommended that cases with high-energy, widely displaced or comminuted fractures of the distal radius be evaluated carefully for ulnar nerve as well as median nerve injury.     

Meaningful power grip recovery after salvage reconstruction of a median nerve avulsion injury with a pedicled vascularized ulnar nerve

In cases of median nerve injury alongside an unsalvageable ulnar nerve, a vascularized ulnar nerve graft to reconstruct the median nerve is a viable option. While restoration of median nerve sensation is consistently reported, recovery of significant motor function is less frequently observed. The authors report a case involving a previously healthy man who sustained upper arm segmental median and ulnar nerve injuries and, after failure of sural nerve grafts, was treated with a pedicled vascularized ulnar nerve graft to restore median nerve function. Long-term follow-up showed near full fist, with 12 kg of grip strength, key pinch with 1.5 kg of strength and protective sensation in the median nerve distribution. The present case demonstrates that pedicled ulnar vascularized nerve grafts can provide significant improvements to median nerve sensory and motor function in a heavily scarred environment.     

Median Nerve Mistaken for Palmaris Longus Tendon: Restoration of Function with Sensory Nerve Transfers

Intraoperative iatrogenic nerve injuries occur despite vigilance in the operating room. Most of these injuries occur as a result of patient positioning, traction or pressure injury, hematoma, or technical error. The median nerve is especially susceptible to injury during carpal tunnel release. A rare but devastating injury of the median nerve is complete transection. The number of devastating injuries is not well known, as few of the injuries are documented or publicized. We report a case where the median nerve was harvested instead of the palmaris longus tendon. We present a review of the literature and suggest an alternative treatment to median nerve grafting using sensory nerve transfers in the hand.     

Nerve blocks at the wrist for carpal tunnel release revisited: the use of sensory-nerve and motor-nerve stimulation techniques

BACKGROUND AND OBJECTIVES: Because the median nerve at the wrist has mainly sensory endings, the aim of this study was to assess the response of the median nerve to nerve stimulation at the wrist and to evaluate the quality of median nerve block. A control group of patients who received blinded injections was analyzed and compared post hoc. METHODS: One hundred and eleven patients scheduled for ambulatory endoscopic carpal-tunnel release performed under median and ulnar nerve blocks at the wrist were prospectively studied. The blocks were performed with a nerve stimulator. Nerve-stimulation techniques were explained to the patient before the block was performed. The patient was trained to inform the anesthetist of their perception of an electrical paresthesia that was synchronized to the nerve stimulator. The anesthetist recorded the first response of the patient to nerve stimulation: sensory (S), sensory-motor (SM), or motor response (M). When the minimal stimulating current was obtained, an equal volume of 4 mL of 1.5% mepivacaine was injected on median and ulnar nerves. If necessary, a lateral subcutaneous injection of 2 mL of 1.5% mepivacaine was administered at the wrist crease in the musculocutaneous nerve area. Thirty-five patients who received blinded local anesthetics injections were included post hoc. Quality of anesthesia was compared between groups. RESULTS: Responses included 89 S (80.2%), 18 SM (16.2%), and 4 M (3.71%). No differences occurred in time to perform the block, minimal current intensity, and efficacy. More punctures were necessary in the M group compared with the S group and the control group (P < .05). The onset time of sensory blocks increased significantly in control-group patients (P < .05), but the duration of the nerve-block procedure decreased in comparison with the M group. Respectively, 10% and 20% of patients experienced mild or severe pain in the nerve-stimulation group and control group. At 20 minutes, the block was complete for the median and ulnar nerves in 96.4% and 85% of the nerve-stimulation patients and control patients (P < .05). Two patients in the control group experienced painful mechanical paresthesia. Neither permanent nor transient nerve injuries were observed during or after the nerve block or surgery. CONCLUSION: This study describes how infrequently an initial motor response is identified when a nerve stimulator is used on the median nerve at the wrist. A very high success rate of median and ulnar nerve block at the wrist is obtained by use of sensory or sensory-motor-nerve stimulation and less than 10 mL of anesthetic solution.     

Ulnar to median nerve anastomosis in the palm (Riches-Cannieu anastomosis)

This report describes an unusual case of pure bilateral ulnar innervation of the thenar and hypothenar muscles of the hands. The patient was a healthy 36-year-old woman who presented with neck pain. Examination and routine laboratory investigation findings were normal, but on electroneuromyography ulnar to median nerve anastomosis of the motor fibers in the palm was detected bilaterally. However, there was no anastomosis between the sensory fibers. On investigation of focal neuropathy the anomaly known as Riches-Cannieu anastomosis may surprise the electroneuromyographer and change the clinical signs and symptoms. It should be suspected when the hand muscles are clinically intact in the presence of a severe median nerve lesion in the forearm. In this case, a complete lesion of the median nerve at the forearm might erroneously be interpreted as a partial lesion of the median nerve. In every surgical intervention to the hand, this anomaly should be kept in mind and should be investigated electrophysiologically. Received: 25 June 1998 / Accepted: 19 August 1998     

尺神经深支卡压的解剖学及临床意义

目的：探讨尺神经深支卡压的病因及诊治方法：方法：显微镜下观测３０例成人手的尺神经深支。封闭及手术治疗９例患者。结果：尺神经深支分４段。封闭（４例）和手术（７例０各治愈同１例、５例。结论：腕尺管段尺神经深支最易受损,在其它部位也会被止准确无误。本病应尽早手术。     

肘部尺神经半脱位的解剖学和流行病学研究

目的：研究肘部尺神经半脱位的发生原因及其临床意义。方法：对１００侧成人尸体肘部的尺神经位置进行解剖观察；在人群中随机调查了８５４位正常人肘部尺神经的位置。结果：肘管深度为７．１±０．１４ｍｍ（χ±ｓχ）。解剖观察发现，６侧肢体的尺神经在屈肘时发生半脱位，肘管深度平均为４．８ｍｍ。８５４位正常人肘部尺神经半脱位发生率为８．９％（７６／８５４）。结论：绝大多数的肘部尺神经半脱位是先天性的。肘部尺神经半脱位不一定是肘部尺神经卡压的发病原因。     

健侧颈7神经根移位同时修复两条神经的初步临床疗效

目的探讨用健侧颈，神经根移位同时修复2条上肢神经的临床效果。方法设计2种移位修复的方法。(1)合干法：健侧颈，前后股→尺神经→尺神经近端分2股分别和正中神经、桡神经(或肌皮神经)缝合，共5例。(2)分干法：健侧颈前后股→尺神经、腓肠神经→正中神经、桡神经(或肌皮神经)，共3例。结果合干法4例术后随访12～19个月，1例尚在随访中。正中神经运动：2例已恢复屈腕、屈指，肌力M3。2例屈腕肌力为M1。正中神经感觉：3例为S2，1例为S0。桡神经运动：2例伸腕、伸指肌力为M2。1例伸肘肌力为M2，1例伸腕肌力为M1。桡神经感觉：1例为S2，1例为S1，2例为S0。分干法1例术后随访15个月，已恢复屈腕、屈指，肌力为M3。正中神经感觉为是。肌皮神经：屈肘肌力为M3。另2例术后时间短尚在随访中。结论健侧颈，神经根移位同时修复上肢2条主要神经的新术式，初步应用结果证实是可行的、有效的。     

Long-term results of transplantations to repair median, ulnar, and radial nerve lesions by a microsurgical interfascicular autogenous cable graft technique

A comprehensive analysis of 187 patients (78 median, 86 ulnar, and 23 radial nerve lesions) treated by an interfascicular autogenous nerve grafting technique is presented. After a follow-up of at least 18 months good motor recovery was achieved in 72% of median nerve lesions, 77% of ulnar nerve lesions, and 57% of radial nerve lesions. Good functional sensory recovery was found in 36% of median, 45% of ulnar, and 48% of radial nerve lesions. It appears by multivariate analysis that the results obtained generally were better in younger patients, in patients with a shorter preoperative delay, and in cases with a shorter transplant.     

神经束移位治疗臂丛神经根性撕脱伤70例临床报告

目的 观察应用神经束移位治疗臂丛神经根性撕脱伤的效果。方法 对７０例患者,于上臂上中部切取正中神经、心神经、胸背神经及健侧Ｃ７神经束移位给肱二头肌肌支、三角肌肌支等,重建肩、肘关节的功能。结果 供区部分神经切取后对肢体功能无明显影响。正中神经、尺神经部分束文、胸背神经、健侧Ｃ７束支移位比全干移位对肌功能的影响小,且同样有效。结论 肱二头肌肌支、三角肌肌支的神经纤维数量少,用供体神经部分神经束即可提供充足的神经纤维,且能保证移位的神经纤维能良好地长入肱二头肌和三角肌。     

程序化操作在尺神经皮下前置术中的应用

目的 探讨程序化手术操作在尺神经皮下前置术中的应用效果.方法 我院自2017年1月至2019年12月采用尺神经松解皮下前置术治疗肘管综合征病人34例.所有病人均采用程序化操作处理前臂内侧皮神经、Struthers弓、内侧肌间隔、Osborne韧带、尺侧腕屈肌两头、指浅屈肌筋膜、尺神经伴行血管、尺侧屈腕肌肌支及关节支、屈...     

任务导向性训练对上肢周围神经损伤患者肌电图及手功能的影响

目的本文拟观察任务导向性训练对上肢周围神经损伤患者手功能障碍的影响，为其提供一种新的康复治疗手段。 方法采用随机数字表法将60例上肢周围神经损伤导致手功能障碍患者随机分为治疗组（30例）和对照组（30例），两组患者均给予药物治疗及常规康复治疗，治疗组辅以任务导向性训练。于干预前及干预3个月时，通过手功能评定量表评估手功能，通过肌电图（EMG）检测周围神经的恢复情况。 结果治疗3个月时，治疗组手功能实用率高于对照组，差异有统计学意义（P<0.05）。治疗3个月时，治疗组正中神经、尺神经、桡神经运动神经传导速度（MCV）均高于治疗前，且桡神经MCV高于对照组，差异均有统计学意义（均P<0.05），对照组正中神经、尺神经、桡神经MCV均高于治疗前，差异均有统计学意义（均P<0.05）；治疗组正中神经、尺神经、桡神经EMG潜伏期（LAT）较治疗前均明显缩短，差异均有统计学意义（均P<0.05），对照组正中神经、桡神经LAT均较治疗前明显缩短，差异均有统计学意义（均P<0.05）；治疗组正中神经、尺神经、桡神经EMG波幅（AMP）均高于治疗前，且正中神经、尺神经AMP均高于对照组，差异均有统计学意义（均P<0.05），对照组正中神经、桡神经AMP均高于治疗前，差异均有统计学意义（均P<0.05）。 结论任务导向性训练能明显提高上肢周围神经损伤后手功能障碍患者的神经肌肉兴奋度，改善手功能，为一种安全、实用、有效的训练方案。     

Endoscopic Anterior Transposition of Ulnar Nerve (EATUN) for Treatment of Tardy Ulnar Nerve Palsy

BackgroundTardy ulnar nerve palsy is the development of late onset ulnar nerve dysfunction and is usually treated by open anterior transposition of ulnar nerve. Open technique is done using a longitudinal incision about 6–8 inch. in length with chances of development of medial antebrachial cutaneous nerve neuromas.PurposeIn this study, we describe the technique of Endoscopic Anterior Transposition of Ulnar Nerve (EATUN procedure) to treat tardy ulnar nerve palsy and analyze the results.MethodsSeven patients diagnosed to have tardy ulnar nerve palsy was treated by EATUN. The humerus-elbow-wrist angle (HEW), pre- and post-operative intrinsic muscle power and sensory assessment, Dellon scores, and the Q-DASH was analyzed.ResultsThe minimum follow-up was 12 months (Mean 27.4 months, Range 12–36 months). Improvement in Dellon and Q-DASH scores following EATUN procedure was statistically significant. There was objective improvement of intrinsic muscle power and sensation on follow-up, though not statistically significant. No instance of neuroma of the medial cutaneous nerve of forearm was noted.ConclusionsThe endoscopic anterior transposition of the ulnar nerve is a good option in surgical management of tardy ulnar nerve palsy.Level of evidenceTherapeutic Level IV.Supplementary InformationThe online version contains supplementary material available at 10.1007/s43465-021-00366-w.     

正中神经、尺神经部分束支移位术重建屈肘功能

目的 观察正中神经、尺神经部分束支移位术的临床疗效及手术前后供体神经功能的变化,分析影响手术疗效的因素。方法 应用正中神经、尺神经部分束支移接给肱二头肌肌支治疗臂丛神经上千型根性撕脱伤,重建屈肘功能。对施行手术的36例患者进行6个月至5年多的随访,根据肱二头肌肌力和肘关节主动活动范围,将患者术后恢复情况分为三级：优：肱二头肌肌力达4级以上,肘关节屈曲达90度以上;可：肱二头肌肌力达3级,肘关节屈曲达60～90度;差：肱二头肌肌力2级以下,肘关节屈曲60度以下。分析影响疗效的几种因素。结果 手术疗效显著,有效率(肱二头肌肌力3级以上)达94．4％,优良率(肱二头肌肌力4级以上)达63．9％。手术前后供体神经功能没有明显变化。影响手术疗效的主要因素有：损伤类型、损伤原因、手术距损伤的间隔时间、患者年龄、供体神经的选择及术后功能锻炼。准确判断患者的损伤类型,严格掌握手术适应证是手术成功的关键。结论 正中神经、尺神经部分束支移位术是治疗臂丛神经上千型根性撕脱伤的一种安全、可靠、有效的手术方法。