显微外科修复联合镜像治疗尺神经离断伤的疗效研究

背景:镜像治疗是一种由上而下的治疗模式,可以调节中枢神经系统,进而提高周围神经外伤后的治疗效果。目的:研究镜像治疗对尺神经离断伤显微外科修复术后临床疗效的影响。方法:2016年6月至2018年1月收治的26例尺神经离断伤患者为对照组,2018年2月至2019年7月收治的24例尺神经离断伤患者为研究组。两组患者均采用显微外科神经束膜吻合术修复尺神经,研究组在对照组基础上联合镜像治疗,应用轻触-深压觉检查、静态两点辨别觉检查及感觉分级方法评估感觉功能,应用明尼苏达手灵巧度测试(MMDT)及普度钉板测试(PPT)评估运动功能,比较两组患者术后的感觉运动功能。结果:治疗后,轻触-深压觉在两组间比较差异无统计学意义,研究组两点辨别觉的平均距离小于对照组(P=0.004),研究组感觉分级优于对照组(P=0.007)。与对照组相比,研究组治疗后单侧PPT测试(P=0.005)、双侧PPT测试(P=0.001)及装配PPT测试(P=0.001)结果均更高。与对照组相比,研究组治疗后MMDT测试的放置时间更短(P=0.001);翻转时间也更短(P=0.002)。结论:联合镜像治疗可以改善尺神经离断伤显微外科修复术后的临床疗效,提高患者术后手部感觉运动功能。

Effect of the combination treatment of microsurgical repair and mirror therapy on ulnar nerve detachment injury

Background:Mirror therapy is a top-down treatment mode,which can regulate the central nervous system and im?prove the therapeutic effect of peripheral nerve injury.Objective:To study the combination treatment of microsurgical repair and mirror therapy protocol to improve the clinical effect for ulnar nerve detachment injury.Methods:From June 2016 to Janu?ary 2018,26 patients with ulnar nerve detachment injury were included as control group,and from February 2018 to July 2019,24 patients with ulnar nerve detachment injury were included as study group with combined mirror therapy.Ulnar nerve was repaired by microsurgery epineural anastomosis in all patients,but the patients in study group received combined mirror therapy on the basis of control group.Light touch-deep pressure test,static 2-point discrimination test and sensory grading method were applied to evaluate the sensory function;Minnesota manual dexterity test(MMDT)and Purdue pegboard test(PPT)were applied to evaluate motor function.The sensory and motor function were compared between the two groups.Results:After the treatment,there was no significant difference in light touch-deep pressure test between the two groups.The result of static 2-point discrimination test was lower in study group than in control group(P=0.004)and the result of sensory grading was better in study group than in control group(P=0.007).Compared with control group,the unilateral PPT(P=0.005),bilateral PPT(P=0.001)and assembled PPT(P=0.001)were higher in study group after treatment.Compared with control group,the placing MMDT(P=0.001)and turning MMDT(P=0.002)were shorter in study group after treatment.Conclusions:Combined mirror therapy may improve the clinical effect for ulnar nerve detachment injury after microsurgical repair,and pro?vide a better result of sensory and motor function for patients.