MEDIAN NERVE CONSTRICTIVE OPERATION COMBINED WITH TENDON TRANSFER TO TREAT BRAIN PARALYSIS CONVULSIVE DEFORMITY OF HAND_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 MAShanjun ¹ , ZHOUTianjian ²

1. Department of Orthopaedics, Cerebral Palsy Hospital of Lianyungang Haizhou, Lianyungang Jiangsu, 222020, P. R. China;
2. Department of Functional Reconstruction, China;

Corresponding?author：

MAShanjun, Email: msj11022@126.com

Keywords：

Median nerve constrictive operation; Tendon transfer; Brain paralysis convulsive deformity of hand

DOI：

10.7507/1002-1892.20140135

Video：

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Objective To evaluate the effectiveness of the median nerve constrictive operation combined with tendon transfer to treat the brain paralysis convulsive deformity of the hand. Methods The clinical data from 21 cases with brain paralysis convulsive deformity of the hand were analyzed retrospectively between August 2009 and April 2012. Of them, there were 13 males and 8 females with an average age of 15 years (range, 10-29 years). The causes of the convulsive cerebral palsy included preterm deliveries in 11 cases, hypoxia asphyxia in 7, traumatic brain injury in 2, and encephalitis sequela in 1. The disease duration was 2-26 years (mean, 10.6 years). All the 21 patients had cock waists, crooking fingers, and contracture of adductors pollicis, 12 had the forearm pronation deformity. According to Ashworth criteria, there were 2 cases at level Ⅰ, 5 cases at level Ⅱ, 8 cases at level Ⅲ, 4 cases at level IV, and 2 cases at level V. All patients had no intelligence disturbances. The forearm X-ray film showed no bone architectural changes before operation. The contraction of muscle and innervation was analyzed before operation. The median nerve constrictive operation combined with tendon transfer was performed. The functional activities and deformity improvement were evaluated during follow-up. Results After operation, all the patients' incision healed by first intension, without muscle atrophy and ischemic spasm. All the 21 cases were followed up 1.5-4.5 years (mean, 2.3 years). No superficial sensory loss occurred. The effectiveness was excellent in 13 cases, good in 6 cases, and poor in 2 cases, with an excellent and good rate of 90.4% at last follow-up. Conclusion The median nerve constrictive operation combined with tendon transfer to treat brain paralysis convulsive deformity of the hand can remove and prevent the recurrence of spasm, achieve the orthopedic goals, to assure the restoration of motor function and the improvement of the life quality.

Citation： MAShanjun, ZHOUTianjian. MEDIAN NERVE CONSTRICTIVE OPERATION COMBINED WITH TENDON TRANSFER TO TREAT BRAIN PARALYSIS CONVULSIVE DEFORMITY OF HAND. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(5): 606-609. doi: 10.7507/1002-1892.20140135 Copy

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2.	李鳳春, 萬富安, 石福明, 等. 三聯松解術矯治腦性癱——前臂旋前畸形. 中國骨傷, 1998, 11(4):31-32.
3.	馮樹貴, 李碩彥, 代明安, 等. 周圍神經縮窄術治療痙攣性腦癱的臨床應用. 中國實用醫藥, 2011, 6(23):117-119.
4.	周燦華. 小兒周圍神經縮窄術的麻醉管理體會. 河南外科學雜志, 2011, 17(4):99-100.
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7.	王世杰, 龐紅, 王東, 等. 脛神經縮窄術治療腦癱痙攣性馬蹄內翻足康復學評定. 中國康復醫學雜志, 2006, 21(4):311-313.
8.	吳守義, 賀小樺, 李明. 大腦性癱瘓前臂旋前畸形的手術治療——介紹一種手術方法與效果. 中華小兒外科雜志, 1993, 14(1):18-20.
9.	王秋根, 侯鐵勝, 張春才, 等. 選擇性脊神經后根切斷術治療痙攣性腦癱遠期隨訪. 中華外科雜志, 1998, 36(11):674-676.
10.	顧玉東, 蔡佩琴, 王濤. C₈神經根切斷治療上肢腦癱. 中華手外科雜志, 1997, 13(3):130-132.
11.	李貴濤, 寧志杰, 黃彥杰, 等. 周圍神經選擇性切斷術治療肢體痙攣性癱瘓. 中華顯微外科雜志, 1998, 21(3):226-227.
12.	王世杰, 陳國強, 修波, 等. 脛神經縮窄術治療下肢痙攣性癱瘓. 中華外科雜志, 2005, 43(9):605-607.
13.	陳鳳金. 周圍神經縮窄術治療痙攣型腦癱58例的觀察和護理. 中國誤診學雜志, 2012, 12(2):497-498.
14.	劉臻. 兒童痙攣型腦性癱瘓的神經外科治療. 中國醫藥指南, 2011, 9(6):236.
15.	高倉公明. 腦神經外科の新領域. 東京:中外醫學社出版, 2002:147-154.
16.	Tieman BL, Palisano RJ, Gracely EJ, et al. Gross motor capabability and perfomance of mobility in children with cerebral palsy. a comparison across home school and outdoors/commu-nity settings. Phys Ther, 2004, 84(5):419-429.
17.	謝軒貴, 李鵬, 蔡德成, 等. 脛神經縮窄術在治療腦癱下肢痙攣肢體中的應用. 四川醫學, 2011, 32(3):305-307.
18.	苗索華, 王世杰, 陳業濤, 等. 遺傳性痙攣性截癱的神經外科治療. 立體定向和功能性神經外科雜志, 2011, 24(3):138-140.

1. 徐林, 洪毅, 易斌, 等. 痙攣性腦癱選擇性脊神經后根切斷術的10年回顧(附825例隨訪結果分析). 中國矯形外科雜志, 2001, 8(1):42-44.
2. 李鳳春, 萬富安, 石福明, 等. 三聯松解術矯治腦性癱——前臂旋前畸形. 中國骨傷, 1998, 11(4):31-32.
3. 馮樹貴, 李碩彥, 代明安, 等. 周圍神經縮窄術治療痙攣性腦癱的臨床應用. 中國實用醫藥, 2011, 6(23):117-119.
4. 周燦華. 小兒周圍神經縮窄術的麻醉管理體會. 河南外科學雜志, 2011, 17(4):99-100.
5. 郭世紱. 臨床骨科解剖學. 天津:天津科學技術出版社, 1998:505-507.
6. 吳強. 選擇性脛神經顯微切斷術矯治小兒腦癱足痙攣畸形. 中華小兒外科雜志, 1999, 20(6):371-372.
7. 王世杰, 龐紅, 王東, 等. 脛神經縮窄術治療腦癱痙攣性馬蹄內翻足康復學評定. 中國康復醫學雜志, 2006, 21(4):311-313.
8. 吳守義, 賀小樺, 李明. 大腦性癱瘓前臂旋前畸形的手術治療——介紹一種手術方法與效果. 中華小兒外科雜志, 1993, 14(1):18-20.
9. 王秋根, 侯鐵勝, 張春才, 等. 選擇性脊神經后根切斷術治療痙攣性腦癱遠期隨訪. 中華外科雜志, 1998, 36(11):674-676.
10. 顧玉東, 蔡佩琴, 王濤. C₈神經根切斷治療上肢腦癱. 中華手外科雜志, 1997, 13(3):130-132.
11. 李貴濤, 寧志杰, 黃彥杰, 等. 周圍神經選擇性切斷術治療肢體痙攣性癱瘓. 中華顯微外科雜志, 1998, 21(3):226-227.
12. 王世杰, 陳國強, 修波, 等. 脛神經縮窄術治療下肢痙攣性癱瘓. 中華外科雜志, 2005, 43(9):605-607.
13. 陳鳳金. 周圍神經縮窄術治療痙攣型腦癱58例的觀察和護理. 中國誤診學雜志, 2012, 12(2):497-498.
14. 劉臻. 兒童痙攣型腦性癱瘓的神經外科治療. 中國醫藥指南, 2011, 9(6):236.
15. 高倉公明. 腦神經外科の新領域. 東京:中外醫學社出版, 2002:147-154.
16. Tieman BL, Palisano RJ, Gracely EJ, et al. Gross motor capabability and perfomance of mobility in children with cerebral palsy. a comparison across home school and outdoors/commu-nity settings. Phys Ther, 2004, 84(5):419-429.
17. 謝軒貴, 李鵬, 蔡德成, 等. 脛神經縮窄術在治療腦癱下肢痙攣肢體中的應用. 四川醫學, 2011, 32(3):305-307.
18. 苗索華, 王世杰, 陳業濤, 等. 遺傳性痙攣性截癱的神經外科治療. 立體定向和功能性神經外科雜志, 2011, 24(3):138-140.

Chinese Journal of Reparative and Reconstructive Surgery

MEDIAN NERVE CONSTRICTIVE OPERATION COMBINED WITH TENDON TRANSFER TO TREAT BRAIN PARALYSIS CONVULSIVE DEFORMITY OF HAND

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