正中神经的显微外科解剖学研究

A STUDY OF THE MICROSURGICAL ANATOMY OF THE MEDIAN NERVE

根据显微外科技术发展情况,我们在23例成人上肢研究了正中神经内部结构。其中20例用醋酸溶液滴浸下,在手术显微镜下解剖分离,3例作断面对照观察。重点记录运动束或束组的局部定位。一、观察测量了正中神经干的形态、大小、束数,绘制了正中神经干断面的局部定位图。二、正中神经干及其内部束组在前臂及上臂均有一定程度的扭转,都是由下向上呈外旋性移动。三、鱼际肌枝发出平面在桡骨茎突下方40.1毫米,从桡侧前方入神经干后,沿桡侧上行,至前臂下部转至后外方。以后逐渐混合,混合后在前臂中部占居后方,至肘窝以上占居中央部分,最后多数加入内侧头。四、前臂浅组屈肌有关肌枝,进入神经干内分居前后两部。在上臂神经干的前后两部,仍然是以运动纤维为主的混合束组。五、讨论了显微外科神经束膜吻合法与神经干内部结构局部定位的关系。

The upper limbs of 23 adult cadavers were dissected and the internal structures of the median nerve were studied for microsurgery of the nerve.Under operative micros-cope(24X),the median nerves of 20 cadavers treated with 10%acetic acid were dissec-ted.The median nerves of the remaining three were cross-sectioned,inch by inch,and stained with Sudan Ⅲ for microscopic observation.Microscopic ptotographs were taken to visualize the intra-neural topography of motor bundles or bundle groups.1.The morphology,topographic relationships,size and number of bundles of the median nerves were observed under microscope and were recorded.2.At the level of the arm and forearm,the nerve trunk and its internal bundles appear to twist to a certain degree in the way of external rotation from the distal to proximal.3.The motor bundles of the thenar muscles emerge at the level about 40.1mm below the styloid process of radius.They enter the nerve trunk anteriorly on the radial side,and run upward at the Rower part of the forearm,and continue postero-laterally and appear as a admixture of sensory and motor nerves.At the mid-portion of the fore-arm,they are situated posteriorly,while at the level of antecubital fossa and above,they occupy the central position and finally most of the bundles join the medial head of the median nerve.4.The motor bundles that supply the flexor muscles of the forearm are located anteriorly and posteriorly in separate portions after entering the nerve trunk.At the level of the arm,these two portions of median nerve are mixed bundles but motor nerve fibers predominate.5.The fundamental method of funicular suture were discussed in relation to the intra-neural topography of the median nerve.