Ön kol seviyesinde median ulnar sinir kombine kesilerinin primer tamirinin uzun dönem sonuçlarý

AMAÇ: Bu klinik çalýþmada amaç ön kolda proksimal, orta ve distal seviyelerde ulnar ve median sinirin birlikte kesilerinin erken primer tamiri sonrasý geç dönemde duyu ve motor fonksiyonlarýnýn deðerlendirilmesidir.
GEREÇ VE YÖNTEM: Ulnar ve median kombine kesilerde geç dönem duyu deðerlendirilmesi iki nokta ayrým testi, monoflaman testi ile yapýldý. Motor deðerlendirme ise ulnar sinir için dorsal palmar interosseöz gücü, median sinir için abduktor pollisis brevis kas gücü deðerlendirildi. Soðuk intoleransý, obje tanýma ve aðýrlýk ayýrt etme de deðerlendirildi.
BULGULAR: Çalýþmaya ulnar median kombine kesisi olan 5–59 yaþ arasý 26 hasta dahil edildi. Hastalarýn hiç birinde duyu fonksiyonlarýnda yetersizlik gözlenmezken median duyusal alanda 12 (%46) hastada, ulnar duyusal alanda yedi (%26) hastada dokunma duyusunda azalma saptandý. Motor fonksiyon açýsýndan en anlamlý kayýp oppozisyon pinch gücünde saptandý. Ýki hastada pençeleþme, iki hastada eklem kontraktürü gözlendi.
TARTIÞMA: Periferik sinir yaralanmalarýnda ideal tedavi primer tamir olmalýdýr. Motor fonksiyon dönüþü median sinirde ulnara göre daha iyidir. Duyusal açýdan anlamlý fark yoktur. Distal seviyede median ve ulnar sinirin grup yapýsý oluþturmasý nedeniyle epiperinöral tamir yerine grup fasiküler tamir tercih edilmelidir. Proksimal ulnar kesilerde motor fonksiyon yetersizliði nedeniyle primer tamire alternatif gerekmektedir. Periferik sinir tamiri için yapýlan testlerde standartizasyon yoktur.

Long-term results of primary repair of combined cuts on the median and ulnar nerves in the forearm

BACKGROUND: The objective of this clinical study was to evaluate sensory and motor functions in the later period following primary repair of combined injuries of the ulnar and median nerves in the forearm at proximal, middle, and distal levels.
METHODS: Later period sensory evaluation of ulnar and median combined cuts was performed using two-point discrimination and monofilament tests. On the other hand, motor evaluation was performed by determining dorsal palmar interosseus strength for the ulnar nerve and abductor pollicis brevis muscle strength for the median nerve. Cold intolerance, object recognition, and weight discrimination were also reviewed.
RESULTS: In total, 26 patients with ulnar-median combined cut and aged between 5 and 59 years were included in this study. Although no deficiency was observed in the sensory functions of any of the patients, a decrease in tactile sensation was detected in the median sensory region in 12 (46%) patients and in the ulnar sensory region in 7 (26%) patients. The most significant loss in terms of motor functions was detected in the opposition pinch strength. Two patients developed claw hand and two showed joint contracture.
CONCLUSION: Ideal treatment for peripheral nerve injuries should be primary repair. Restoration of the motor function in the median nerve is relatively easier than that in the ulnar nerve. No significant difference was observed in terms of sensory function. An alternative is needed for primary repair because of lack of motor function in proximal ulnar incisions. There is no standardization of tests performed for peripheral nerve repair.