成人腕部正中神经断裂后靶皮肤血流灌注的初步研究

A preliminary study on skin blood perfusion following median nerve transection at wrist in adult human patients

目的:初步了解成人周围神经断裂后靶皮肤的血流灌注特点。方法:采用激光多普勒血流灌注成像技术,检测成人腕部正中神经断裂缝合后早期受损神经支配区皮肤的基础血流灌注及在冷、热等刺激后的血流灌注变化,采用两点辨别觉和单丝触觉评定感觉功能。结果:神经断裂缝合后22～37 d,患侧手掌桡侧半皮肤及示、中指指腹基础血流灌注较正常减少约90%,且以0℃冰水或45℃温水刺激30 s后局部血流灌注无明显变化。患侧示、中指指腹不能感知规格6.65单丝触压,两点辨别觉超过25 mm。结论:失神经皮肤区域处于低血流灌注状态,且对冷、热等刺激无反应。

Objective： This study was to elucidate preliminarily the change of blood perfusion in denervated skin after peripheral nerve transection injury.Methods： For adult patients with median nerve transection injury at wrist,cutaneous blood perfusion was assessed by the aid of laser Doppler perfusion imaging,while sensation was evaluated via measurement of two-point discrimination（2PD） and monofilament sensory testing.Results： 22 to 37 days after nerve injury,the radial half of the palm exhibited 90% reduction of blood perfusion as compared to normal and it showed no significant perfusion change after being stressed 30 sec either with icy water at 0 ℃ or with warm water at 45 ℃.Besides,the index and middle fingers showed insensitive to touch with the size-6.65 monofilament and 2PD over 25 mm.Conclusion： The denervated skin area showed very low blood perfusion,which was insensitive to cold and hot stimuli.