钩骨脱位合并正中神经返支损伤课件.pptVIP

正中神经损伤机制？Median nerve palsy ? 钩骨后移 TCL后移 腕管容积变小 腕管内 压力增加 正中神经受压 hamate moves dorsally pulls the TCL dorsally volume of carpal tunnel decreased pressure increased median nerve compressed Summary 钩骨脱位是一种罕见损伤 Isolated dislocation of the hamate is a rare entity 该种损伤是一种高能损伤，早期发现并及时处理术后疗效满意，简单的脱位闭合复位，复杂的损伤切开复位 a kind of high energy injury, the satisfactory recovery ，isolated dislocation closed reduction ，complex injuries surgical procedure 损伤机制（脱位，神经）Injury Mechanism 诊断钩骨脱位后注意是否合并神经损伤，尤其是RMB损 （无正中神经感觉异常，伤后因为疼痛难以检查大鱼际肌肌力） Identified diagnose , the possibility of nerve injury ，RMB 钩骨脱位合并正中神经返支损伤Dislocation of the hamate associated with the injury of the recurrent motor branch of median nerve 王凌宇，熊革，戴鲁飞 北京积水潭医院手外科 Introduction 单纯钩骨脱位非常罕见 Isolated dislocation of the hamate is a rare entity 至今13例，第一例 Buchanan 1882 13 case 12M 1F, 7Isolated 6Complex, 3Closed 10Excision, 7Palmar 6Dorsal 1882, first case, Buchanan Introduction 至今损伤机制不明确 The pathomechanism is still unrevealed 鲜有合并神经损伤报道，Ohshio 正中神经损伤，Matsumoto 尺神经损伤 Not note any associated neurogical injury Ohshio median nerve ，Matsumoto ulnar nerve injury Introduction 为什么这种损伤罕见？ Rare， Why? 掌背侧脱位损伤机制？ Injury Mechanism? 正中神经损伤机制？ Median nerve palsy ? Clinical Report 2009年8月，21岁，女，右，冲床伤 2009.Apr A 21-year-old woman worker, Right hand, Punching machine, 1 hour later 尺神经感觉区异常，正中神经感觉区正常 Sensibility of the ulnar nerve distribution was impaired Sensibility of the median nerve distribution was intact Palmar and Dorsal “stamp” 2周尺神经恢复 2 weeks recheck, sensibility of the ulnar nerve was restored 6周拆除固定物 功能锻炼 6 weeks removed the internal and external fixation Clinical Report 2009年8月，四个月后，右拇指无力 2009, Aug, 4 months later， Right thumb weakness 大鱼际萎缩、肌力减弱、正中神经感觉正常 remarkable atrophy of her right thenar eminence ，Thenar muscles powerless; Normal sensibility and two-point discrim