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.	李凤春, 万富安, 石福明, 等. 三联松解术矫治脑性瘫——前臂旋前畸形. 中国骨伤, 1998, 11(4):31-32.
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5.	郭世绂. 临床骨科解剖学. 天津:天津科学技术出版社, 1998:505-507.
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8.	吴守义, 贺小桦, 李明. 大脑性瘫痪前臂旋前畸形的手术治疗——介绍一种手术方法与效果. 中华小儿外科杂志, 1993, 14(1):18-20.
9.	王秋根, 侯铁胜, 张春才, 等. 选择性脊神经后根切断术治疗痉挛性脑瘫远期随访. 中华外科杂志, 1998, 36(11):674-676.
10.	顾玉东, 蔡佩琴, 王涛. C₈神经根切断治疗上肢脑瘫. 中华手外科杂志, 1997, 13(3):130-132.
11.	李贵涛, 宁志杰, 黄彦杰, 等. 周围神经选择性切断术治疗肢体痉挛性瘫痪. 中华显微外科杂志, 1998, 21(3):226-227.
12.	王世杰, 陈国强, 修波, 等. 胫神经缩窄术治疗下肢痉挛性瘫痪. 中华外科杂志, 2005, 43(9):605-607.
13.	陈凤金. 周围神经缩窄术治疗痉挛型脑瘫58例的观察和护理. 中国误诊学杂志, 2012, 12(2):497-498.
14.	刘臻. 儿童痉挛型脑性瘫痪的神经外科治疗. 中国医药指南, 2011, 9(6):236.
15.	高仓公明. 脑神经外科の新领域. 东京:中外医学社出版, 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.	谢轩贵, 李鹏, 蔡德成, 等. 胫神经缩窄术在治疗脑瘫下肢痉挛肢体中的应用. 四川医学, 2011, 32(3):305-307.
18.	苗索华, 王世杰, 陈业涛, 等. 遗传性痉挛性截瘫的神经外科治疗. 立体定向和功能性神经外科杂志, 2011, 24(3):138-140.

1. 徐林, 洪毅, 易斌, 等. 痉挛性脑瘫选择性脊神经后根切断术的10年回顾(附825例随访结果分析). 中国矫形外科杂志, 2001, 8(1):42-44.
2. 李凤春, 万富安, 石福明, 等. 三联松解术矫治脑性瘫——前臂旋前畸形. 中国骨伤, 1998, 11(4):31-32.
3. 冯树贵, 李硕彦, 代明安, 等. 周围神经缩窄术治疗痉挛性脑瘫的临床应用. 中国实用医药, 2011, 6(23):117-119.
4. 周灿华. 小儿周围神经缩窄术的麻醉管理体会. 河南外科学杂志, 2011, 17(4):99-100.
5. 郭世绂. 临床骨科解剖学. 天津:天津科学技术出版社, 1998:505-507.
6. 吴强. 选择性胫神经显微切断术矫治小儿脑瘫足痉挛畸形. 中华小儿外科杂志, 1999, 20(6):371-372.
7. 王世杰, 庞红, 王东, 等. 胫神经缩窄术治疗脑瘫痉挛性马蹄内翻足康复学评定. 中国康复医学杂志, 2006, 21(4):311-313.
8. 吴守义, 贺小桦, 李明. 大脑性瘫痪前臂旋前畸形的手术治疗——介绍一种手术方法与效果. 中华小儿外科杂志, 1993, 14(1):18-20.
9. 王秋根, 侯铁胜, 张春才, 等. 选择性脊神经后根切断术治疗痉挛性脑瘫远期随访. 中华外科杂志, 1998, 36(11):674-676.
10. 顾玉东, 蔡佩琴, 王涛. C₈神经根切断治疗上肢脑瘫. 中华手外科杂志, 1997, 13(3):130-132.
11. 李贵涛, 宁志杰, 黄彦杰, 等. 周围神经选择性切断术治疗肢体痉挛性瘫痪. 中华显微外科杂志, 1998, 21(3):226-227.
12. 王世杰, 陈国强, 修波, 等. 胫神经缩窄术治疗下肢痉挛性瘫痪. 中华外科杂志, 2005, 43(9):605-607.
13. 陈凤金. 周围神经缩窄术治疗痉挛型脑瘫58例的观察和护理. 中国误诊学杂志, 2012, 12(2):497-498.
14. 刘臻. 儿童痉挛型脑性瘫痪的神经外科治疗. 中国医药指南, 2011, 9(6):236.
15. 高仓公明. 脑神经外科の新领域. 东京:中外医学社出版, 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. 谢轩贵, 李鹏, 蔡德成, 等. 胫神经缩窄术在治疗脑瘫下肢痉挛肢体中的应用. 四川医学, 2011, 32(3):305-307.
18. 苗索华, 王世杰, 陈业涛, 等. 遗传性痉挛性截瘫的神经外科治疗. 立体定向和功能性神经外科杂志, 2011, 24(3):138-140.

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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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