正中神经损伤术后感觉功能恢复训练

对正中神经损伤术后患行康复训练(康复组)与未行康复训练患(对照组)进行疗效比较，结果康复组患感觉功能恢复好于对照组，表明康复训练可促进正中神经损伤后感觉功能恢复。     

正中神经损伤术后感觉功能恢复训练

对正中神经损伤术后患者行康复训练(康复组)与未行康复训练患者(对照组)进行疗效比较,结果康复组患者感觉功能恢复好于对照组,表明康复训练可促进正中神经损伤后感觉功能恢复。     

感觉再训练及口服弥可保在周围神经损伤患者感觉功能恢复中的作用

目的探讨感觉再训练及口服弥可保片剂对周围神经修复术后患者感觉功能恢复的促进作用。方法共收集急诊腕部正中神经或尺神经切割离断伤患者92例，经神经修复术后将其随机分为4组，联合组给予感觉再训练及口服弥可保（甲基维生素B12）片剂治疗；训练组给予单纯感觉再训练治疗；弥可保组则给予单纯口服弥可保片剂治疗；对照组未给予感觉再训练及口服弥可保片剂治疗。以术后第1年及第2年随访得到的感觉功能分级及动态两点辨别觉作为疗效评测指标。结果术后第1年及第2年时，联合组、训练组及弥可保组上述各检测指标均优于对照组（P均〈0．05）；术后第1年时，联合组疗效优于弥可保组与训练组（P〈0．05），且弥可保组与训练组之间差异无统计学意义（P〉0．05）；术后第2年时，联合组与训练组疗效均优于弥可保组（P〈0．05），且联合组与训练组之间的差异无统计学意义（P〉0．05）。结论感觉再训练或口服弥可保片剂均能显著促进周围神经损伤患者感觉功能的恢复，如将两者早期联用则疗效更佳。     

早期康复训练并物理因子治疗对创伤性周围神经损伤后手功能恢复的影响

目的：观察在治疗师协助下早期运动训练并物理因子治疗对创伤性上肢周围神经损伤术后手功能恢复的疗效。方法：周围神经损伤术后手功能障碍患者60例,随机分为观察组和对照组各30例。观察组患者术后2～7d在治疗师协助下开始静力夹板或动力牵引夹板使用下的运动训练并配合物理因子疗法;术后3周去除夹板主动运动训练为主和物理因子疗法。对照组术后2～7d自行运动训练加物理因子疗法。治疗前后2组均进行手功能评定。结果：治疗3个月后,2组手功能综合评分与治疗前比较均有提高（P〈0．01）,2组间比较,观察组明显高于对照组（11．2±1．4与9．8±1．4,P〈0．01）。结论：专业人员协助下早期系统的康复训练及物理因子治疗可显著提高周围神经损伤致手功能障碍的疗效。     

手神经损伤的感觉评估与再训练58例

手的神经损伤修复后 ,多遗留不同程度感觉功能障碍。应用手的感觉评估和感觉再训练技术 ,可使手的感觉功能尽快尽好地得到改善和恢复[1] 。我科自 1994年至 1998年治疗 58例患者 ,取得较好的疗效 ,现简介如下。资料和方法　　 58例患者中 ,男 4 5例 ,女 13例 ;年龄 2 1～6 6岁 ,平均 2 9岁 ;病程 2个月 14例 ,3个月 32例 ,6个月 8例 ,1年以上 4例 ;切割伤 4 2例 ,碾挫伤14例 ,电烧伤 2例 ;损伤部位在前臂 3例 ,腕部10例 ,手部 4 5例 ;正中神经损伤 5例 ,正中神经、尺神经合并损伤 8例 ,指神经损伤 4 5例 ;行神经吻合术 51例 ,神经移植术 5例…     

再植指感觉功能康复训练的护理47例

1999～2002年,我科对各类断指 47例进行再植后均获成活,并对其中24例成活的再植指,不但进行运动功能康复训练[1],而且应用感觉功能再教育的训练方法[2],促进感觉功能的恢复,取得了满意的效果,现报告如下.     

正中神经,尺神经损伤的急诊显微外科治疗

我院骨科在近五年间急诊显微外科修复正中神经、尺神经损伤８０例，１０６条神经。对其中６５例８３条神经经过６个月～４年随访，疗效满意，现报告如下。１资料与方法１１一般资料本组男６２例，女１８例，年龄１６～５５岁。平均年龄３２岁。致伤原因：切割伤３０例、...     

周围神经损伤期修复后感觉终器的重建

通过观察灵长类动物指神经切断后感觉终器的蜕变和不同时间修复神经后感觉终器的重建过程，发现触觉小体失神经支配30周基本蜕变消失；在触觉小体消失前修复神经，再生神经纤维可以与残留的小体重建连接。环层小体蜕变缓慢，修复神经后可以恢复基本结构。提示晚期修复周围神经对重建感觉功能有重要的价值。     

分期康复训练促进断指再植术后患者手指感觉及运动功能恢复

为了预防断指再植术后并发症的发生，提高断指再植的成功率，对114例断指再植术后患按早、中、晚期实施系统的健康指导，经0．5～1年的跟踪随访，成活率为94．8％。     

神经损伤患者手功能康复(讲座)

活动手的肌肉大部分在前臂 ,支配手活动的神经来自臂丛的分支 ,这些分支的损伤可导致手功能的障碍。神经损伤常累及交感、运动和感觉的功能 ,康复治疗的目的是恢复支配区域各神经机能障碍。1　神经损伤交感机能障碍康复交感神经受损的 Brand s治疗法 :采用每日浸泡和皮肤涂油按摩恢复皮肤湿度 ,避免日常活动中因过度使用引起区域炎性反应 ;若该区域因日常活动过度使组织受损发生炎症 ,该部位则应休息以利于愈合。2　神经损伤感觉机能障碍康复2 .1　第一阶段感觉再教育内容　手感觉神经损伤的后果是手部感受物体的能力发生障碍。患手一定要…     

Reduced longitudinal excursion of the median nerve in carpal tunnel syndrome

OBJECTIVE: To determine if longitudinal excursion of the median nerve is reduced in patients with carpal tunnel syndrome (CTS). DESIGN: Case-control study. SETTING: University human movement laboratory. PARTICIPANTS: Nineteen patients with CTS (8 men, 11 women; mean age, 57+/-15 y), and 37 healthy controls (8 men, 29 women; mean age, 48+/-10 y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Longitudinal excursion of the median nerve, and the ratio of nerve to flexor digitorum superficialis tendon excursion at the carpal tunnel evoked by finger extension. Measurements were taken using a validated Doppler ultrasound technique, and tests were conducted with the elbow positioned in extension and flexion. RESULTS: Mean longitudinal excursion of the median nerve was significantly greater in controls (11.2+/-2.8 mm) than patients (8.3+/-2.6 mm) with the elbow extended (P=.013), but not with the elbow flexed (controls, 12.5+/-2.5 mm; patients, 10.2+/-3.1 mm; P=.089). Mean nerve/tendon excursion ratios were significantly greater in controls (.32+/-.07) than patients (.23+/-.06), with the elbow extended (P<.001), and flexed (controls, .36+/-.06; patients, .28+/-.10; P=.019). Discriminant analysis identified that 11 (58%) of the 19 patients and 3 (8%) of the 37 controls showed a nerve/tendon excursion ratio of .25 or less when tested with the elbow in extension. CONCLUSIONS: Reduced longitudinal excursion of the median nerve at the carpal tunnel was identified in a substantial proportion of patients with CTS. Further studies are merited to determine if reduced median nerve excursion at the carpal tunnel is clinically relevant in CTS, and can be influenced by movement-based interventions.     

Relation between median and ulnar nerve function and wrist kinematics during wheelchair propulsion

OBJECTIVE: To investigate the relation between median and ulnar nerve health and wrist kinematics in wheelchair users. DESIGN: Case series. SETTING: Biomechanics laboratory and electrodiagnostic laboratory at a Veterans Health Administration medical center and a university hospital, respectively. PARTICIPANTS: Thirty-five people with spinal cord injury who use manual wheelchairs. INTERVENTION: Subjects propelled their own wheelchair on a dynamometer at 0.9 and 1.8m/s. Bilateral biomechanic data were obtained by using force and moment sensing pushrims and a kinematic system. Bilateral median and ulnar nerve conduction studies were also completed. MAIN OUTCOME MEASURES: Wrist flexion, extension, radial and ulnar deviation peaks, and ranges of motion (ROMs) as related to median and ulnar motor and sensory amplitudes. A secondary analysis included peak pushrim forces and moments and stroke frequency. RESULTS: There was a significant, positive correlation between flexion and extension ROM and both ulnar motor amplitude (r=.383, P<.05) and median motor amplitude (r=.361, P<.05). CONCLUSIONS: Contrary to our hypothesis, subjects using a greater ROM showed better nerve function than subjects propelling with a smaller ROM. Subjects using a larger ROM used less force and fewer strokes to propel their wheelchairs at a given speed. It is possible that long, smooth strokes may benefit nerve health in manual wheelchair users.     

对正中神经、胫神经刺激同时记录C2、枕点诱发电位的初步研究

目的　研究脊髓腹侧及小脑病变是否可致胫神经刺激C2、枕点诱发电位出现异常改变以及正中神经、胫神经刺激,两者C2、枕部诱发电位的差异。方法　分别行正中神经、胫神经刺激,同时记录患者Cz、C2、枕点诱发电位。对比研究脊髓及小脑病变时,上、下肢刺激Cz、C2、枕点诱发电位的异常情况。结果　脊髓腹侧及小脑病变可致胫神经刺激,C2、枕点N30及P40电位出现同步性异常改变,且胫神经刺激出现异常者,正中神经刺激,C2、枕点电位却可保持正常。结论　正中神经、胫神经刺激,C2、枕点记录的电位,两者反映的脊髓传导通路有明显的差异。     

In-continuity neuroma of the median nerve after surgical release for carpal tunnel syndrome: case report

Iatrogenic injuries of the median nerve after surgical release for carpal tunnel syndrome resulting in the formation of a neuroma are rare. We present here the case of two patients, one with a bifid median nerve, showing in-continuity neuroma after surgical release for carpal tunnel syndrome. The patients reported persistent post-operative pain and showing symptoms. In both cases, ultrasound showed an in-continuity neuroma with a hypoechoic and enlarged median nerve at the carpal tunnel. The case report shows that ultrasound may be helpful in confirming the clinical diagnosis of neuroma and it is useful for evaluation of the percentage of the area affected by the tear.     

In-continuity neuroma of the median nerve at the elbow

Neuromas are a hyperplastic disorganised proliferation of cells that represent an attempt at nerve regeneration after trauma. They can be classified into terminal and in-continuity neuromas; the latter are observed when the nerve stumps are both connected. We present here the case of a 46-year-old male who sustained a deep cut at the volar aspect of the right elbow while repairing a glass. The injury caused partial transection of the median nerve, which was initially unrecognised. After several months, the patient presented pain at the volar aspect of the elbow, worsening with manual compression at the site of previous injury. Ultrasound showed an in-continuity neuroma with a hypoechoic and enlarged median nerve at the site of the sutured wound. The case report shows that ultrasound may be helpful in confirming the clinical diagnosis of neuroma and that it is useful to evaluate the percentage of the area affected by the lesion.     

高频超声对上肢正中神经正常值的研究

目的通过高频超声获取正中神经的横截面积(cross-sectional area,CSA)正常值并探讨其与周围组织的关系,为临床诊断不同的外周神经疾病提供依据。方法对200例健康志愿者沿正中神经行程进行高频超声观察,依次测量7个位点的CSA[腕横纹、腕管入口(豌豆骨)、腕管出口(钩骨)、腕横纹上6cm、正中神经穿出旋前圆肌处(前臂近端)、肱骨内髁上4cm、肱骨中点],每个位点重复测量3次取其平均值,并进行CSA与身高、体重的相关性分析。结果高频超声下正常人正中神经呈筛网状低回声图像,横截面在不同部位分别表现为圆形、椭圆形或三角形。正中神经在前述7个位点的CSA依次为(8.67±1.24)mm2、(8.68±1.22)mm2、(8.56±1.25)mm2、(7.11±1.33)mm2、(7.08±1.21)mm2、(9.38±1.28)mm2、(9.48±1.28)mm2;左右上肢之间比较CSA差异无统计学意义;正中神经在腕横纹上6cm、肱骨内髁上4cm、肱骨中点处的CSA同年龄组男女之间差异有统计学意义;正中神经在腕横纹处、腕管出入口、肱骨内髁上4cm处中老年人比青年人增粗;CSA与身高、体重有相关性。结论上肢正中神经基本全程可视,在不同部位的正常值及超声声像图略有差异。神经的CSA在上臂段最粗,腕管处次之,前臂段最细,与身高、体重呈正相关性。     

正中神经电刺激联合多维康复护理对颅内动脉瘤手术促醒效果及康复状况的影响

目的探讨正中神经电刺激联合多维康复护理对颅内动脉瘤手术促醒效果及康复状况的影响。方法选择我院2018年6月至2019年6月收治的颅内动脉瘤手术患者88例为研究对象,随机将其等分为对照组与观察组,对照组实施常规护理,观察组在对照组基础上实施正中神经电刺激联合多维康复护理,比较两组的促醒效果及术后康复状况。结果观察组术后促醒有效率高于对照组(P<0.05),术后恢复状况优于对照组(P<0.05)。结论正中神经电刺激联合多维康复护理在颅内动脉瘤手术中的应用,能改善术后促醒效果,促进术后康复,值得临床推广应用。     

Ultrasound imaging of the carpal tunnel during median nerve compression

Median nerve (MN) compression is a recognized component of carpal tunnel syndrome (CTS). In order to document compressive changes in the MN during hand activity, the carpal tunnel was imaged with neuromuscular ultrasound (NMUS). Ten patients with CTS and five normal controls underwent NMUS of the MN at rest and during dynamic stress testing (DST). DST maneuvers involve sustained isometric flexion of the distal phalanges of the first three digits. During DST in the CTS patients, NMUS demonstrated MN compression between the contracting thenar muscles ventrally and the taut flexor tendons dorsally. The mean MN diameter decreased nearly 40%, with focal narrowing in the mid-distal carpal canal. Normal controls demonstrated no MN compression and a tendency towards MN enlargement, with an average diameter increase of 17%. Observing the pathologic mechanism of MN injury during common prehensile hand movements could help better understand how to treat and prevent CTS.