Role of Preoperative Nerve Conduction Studies for Penetrating Hand Injuries Involving the Median Palmar Cutaneous Nerve.
Role of Preoperative Nerve Conduction Studies for Penetrating Hand Injuries Involving the Median Palmar Cutaneous Nerve.
复制标题
DOI：
10.5435/jaaosglobal-d-23-00110
复制
发表时间：
2023-10-01
期刊：
影响因子：
--
通讯作者：
McBeath R
中科院分区：
文献类型：
--
作者：
Patel S;Hutchinson D;Arango SD;Miller AJ;McBeath R
手的穿透性撕裂伤是神经损伤的常见原因，可导致受影响神经分布的衰弱疼痛和麻木。由于不同感觉神经的皮肤神经支配重叠，临床上很难识别受损的神经。我们提出了一个新的病例孤立的手掌皮神经损伤的穿刺刀，这是通过‘比较波形’神经传导研究发现的。使用这项技术，我们可以将正中神经掌侧皮支的损伤与正中神经、尺背感觉神经和前臂外侧皮神经分离。此外，感觉神经检查证实传导阻滞是损伤的机制，手术后8周消失。术前神经传导检查仅能辨别PCBmdn的神经损伤程度，从而消除了前臂正中和桡神经探查、不必要的切开、疼痛和疤痕形成的需要。本病例报告的目的是阐明术前比较波形神经传导检查，特别是PCBmdn，在手部持续穿透撕裂伤后出现神经功能缺陷的患者中的价值。
Penetrating lacerations to the hand are a common cause of nerve injury and can lead to debilitating pain and numbness in the distribution of the nerve affected. Owing to an overlap in the cutaneous innervation from different sensory nerves, clinically identifying the injured nerve can be difficult. We present a novel case of isolated injury to the palmar cutaneous nerve from a penetrating knife injury which was detected using ‘comparison waveform’ nerve conduction studies. Using this technique, we can isolate injuries to the palmar cutaneous branch of the median nerve (PCBmdn) from the median nerve, dorsal radial sensory nerve, and lateral antebrachial cutaneous nerve. In addition, sensory nerve testing identified conduction block as the mechanism of injury, which resolved after surgery at 8 weeks postoperatively. Preoperative nerve conduction study can discern the level of nerve injury to PCBmdn only, thus eliminating the need for median and radial nerve exploration at the forearm, unnecessary incisions, pain, and scarring. The objective of this case report is to illustrate the value of preoperative comparison waveform nerve conduction study, particularly the PCBmdn, in patients presenting with neurologic deficits who have sustained penetrating lacerations to the hand.