Outcome following Nerve Repair of High Isolated Clean Sharp Injuries of the Ulnar Nerve 英文参考文献.docVIP

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Outcome following Nerve Repair of High Isolated Clean Sharp Injuries of the Ulnar Nerve 英文参考文献.doc

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Outcome following Nerve Repair of High Isolated Clean Sharp Injuries of the Ulnar Nerve 英文参考文献

OutcomefollowingNerveRepairofHighIsolatedClean SharpInjuriesoftheUlnarNerve Rene′ Post1,KornelisS.deBoer2,MartijnJ.A.Malessy1* 1DepartmentofNeurosurgery,LeidenUniversityMedicalCenter,Leiden,TheNetherlands,2DepartmentofRehabilitation,LeidenUniversityMedicalCenter,Leiden,The Netherlands Abstract Objective: The detailed outcome of surgical repair of high isolated clean sharp (HICS) ulnar nerve lesions has become relevantinviewoftherecentdevelopmentofdistalnervetransfer.OurgoalwastodeterminetheoutcomeofHICSulnar nerverepairinordertocreateabasisfortheoptimalmanagementoftheselesions. Methods:Highulnarnervelesionsaredefinedaslocalizedinthearearangingfromtheproximalforearmtotheaxillajust distaltothebranchingofthemedialcordofthebrachialplexus.Ameta-analysisoftheliteratureconcerninghighulnar nerveinjurieswasperformed.Additionally,aretrospectivestudyoftheoutcomeofnerverepairofHICSulnarnerveinjuries atourinstitutionwasperformed.TheRotterdamIntrinsicHandMyometerandtheRose′n-Lundborg protocolwereused. Results:Theliteraturereviewidentified46papers.Manyarticlespresentedoutcomesofmixedlesiongroupsconsistingof combinedulnarandmediannerves,ortheoutcomeofhighandlowlevelinjurieswaspooled.Inaddition,outcomewas expressed using different scoring systems. 40 patients with HICS ulnar nerve lesions were found with sufficient data for furtheranalysis.Inourinstitution,15patientshadnerverepairwithamedianintervalbetweentraumaandreconstruction of17days(range0–516).ThemeanscoreofthemotorandsensorydomainoftheRosen’sScaleinstrumentwas58%and 38%oftheunaffectedarm,respectively.Two-pointdiscriminationneverreachedlessthen12mm. Conclusion:Fromtheliterature,itwasnotpossibletodrawadefinitiveconclusiononoutcomeofsurgicalrepairofHICS ulnarnervelesions.Detailedneurologicalfunctionassessmentofourownpatientsshowedthatsomeulnarnervefunction returned.Intrinsicmusclestrengthrecoverywasgenerallypoor.Basedonthisstudy,onemightcautiouslyarguethatrepair strategiesofHICSulnarnervelesionsneedtobeimproved. Citation