Thumb force deficit after lower median nerve block.
Thumb force deficit after lower median nerve block.
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DOI：
10.1186/1743-0003-1-3
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发表时间：
2004-10-19
影响因子：
5.1
通讯作者：
Goitz, Robert J
中科院分区：
文献类型：
--
作者：
Li, Zong-Ming;Harkness, Daniel A;Goitz, Robert J
目的：本研究的目的是描述模拟腕部下正中神经损伤导致的拇指运动功能障碍。方法：6例健康受试者，腕管内注射盐酸布比卡因局部麻醉正中神经。随后通过测量垂直于拇指纵轴的横向平面内所有方向上的最大力产生来评价运动功能。使用这些测得的多方向力构建力包络。结果：正中神经阻滞导致力值降低，因此力包络线较小。力包络线周围的平均力减小为27.9%。最大下降42.4%发生在外展和轻微屈曲相结合的方向，而最小下降10.5%发生在内收和轻微屈曲相结合的方向。内收、伸展、外展和屈曲的相对减少分别为17.3%、21.2%、41.2%和33.5%。阻滞前和阻滞后力包络线包围的面积分别为20628 +/- 7747 N.N和10700 +/- 4474 N.N，平均减少48.1%。内收、伸展、外展和屈曲象限面积的相对减少分别为31.5%、42.3%、60.9%和52.3%。结论：通过腕部神经阻滞模拟下正中神经损伤，损害拇指的正常运动功能。正中神经阻滞会导致所有方向的力缺陷，其中外展和屈曲的损伤最严重。从我们的研究结果，这样的运动功能评估的手段可以潜在地应用于功能评估周围神经病变。
PURPOSE: The purpose of this study was to characterize thumb motor dysfunction resulting from simulated lower median nerve lesions at the wrist. METHODS: Bupivacaine hydrochloride was injected into the carpal tunnel of six healthy subjects to locally anesthetize the median nerve. Motor function was subsequently evaluated by measuring maximal force production in all directions within the transverse plane perpendicular to the longitudinal axis of the thumb. Force envelopes were constructed using these measured multidirectional forces. RESULTS: Blockage of the median nerve resulted in decreased force magnitudes and thus smaller force envelopes. The average force decrease around the force envelope was 27.9%. A maximum decrease of 42.4% occurred in a direction combining abduction and slight flexion, while a minimum decrease of 10.5% occurred in a direction combining adduction and slight flexion. Relative decreases in adduction, extension, abduction, and flexion were 17.3%, 21.2%, 41.2% and 33.5%, respectively. Areas enclosed by pre- and post-block force envelopes were 20628 +/- 7747 N.N, and 10700 +/- 4474 N.N, respectively, representing an average decrease of 48.1%. Relative decreases in the adduction, extension, abduction, and flexion quadrant areas were 31.5%, 42.3%, 60.9%, and 52.3%, respectively. CONCLUSION: Lower median nerve lesion, simulated by a nerve block at the wrist, compromise normal motor function of the thumb. A median nerve block results in force deficits in all directions, with the most severe impairment in abduction and flexion. From our results, such a means of motor function assessment can potentially be applied to functionally evaluate peripheral neuropathies.