带蒂骨间后神经示指固有伸肌支移位修复尺神经深支及鱼际肌支的解剖学研究

Transfer of extensor indicis proprius branch of the posterior interesseous nerve to ulnar uerve deep branch and thenar branch： an anatomical study

目的 探讨应用带蒂示指固有伸肌支移位修复尺神经深支及鱼际支术式的可行性，为临床应用提供解剖依据。方法 在放大10倍手术显微镜视下，观测18侧成人新鲜上肢标本中正中神经鱼际肌支、尺神经深支和骨间后神经示指固有伸肌支、终末支的神经束数目、直径、有髓神经纤维数、神经束间无损伤分离和强行分离长度。以带血管蒂骨间后神经终末支为桥接神经，模拟带血管蒂示指固有伸肌支移位术。结果 示指固有伸肌支横径为[（1．10±0．24）mm，^x±s，下同]，有髓神经纤维数为（618±76）根；尺神经深支直径为（2．04±0．42）mm，有髓神经纤维数为（1342±120）根；鱼际肌支直径为（1．62±0．36）mm，有髓神经纤维数为（1088±95）根。示指固有伸肌支走行恒定，具有一定的横径和一定数目的有髓神经纤维，可携带血管移位修复尺神经深支及正中神经鱼际肌支。结论 应用带血管蒂的示指固有伸肌支移位修复尺神经深支及鱼际肌支术式可行，为临床尺、正中神经高位损伤后手内在肌功能修复提供了一种新方法及可靠的解剖学依据。

Objective To provide anatomical basis for transfer of extensor indicis proprius branch of the posterior interossecos nerve to the deep branch of ulnar nerve and thenar branch. Methods Eighteen flesh specimens of adult upper extremity were dissected. The course, diameter, faseich number, myelinated axon number, atraumafic interfascicular dissectible length, forced interfascicular dissectible length of extensor indicis proprius branch of the posterior interosseous nerve, thenar branch of the median nerve and deep branch of the ulnar nerve were investigated. Extensor indicis proprius branch transfer was simulated using terminal branch of the posterior interosseous nerve to bridge the pedicled extensor indicis proprius branch to the deep branch of the ulnar nerve or thenar branch of the median nerve. Results The diameter of extensor indicis proprius branch of the posterior interosseous nerve is （ 1.10±0.24） mm,and the number of myelinated nerve fibers is 618±76. The diameter of deep branch of the ulnar nerve is （2.04±0.42） mm,and the number of myelinated nerve fibers is 1342±120. The diameter of thenar branch is （ 1.62 ±0.36） mm, and the number of myelinated nerve fibers is 1088 ±95. The course of extensor indicis proprius branch of the posterior interesseous nerve is consistent. It has a certain diameter and a certain number of myelinated nerve fibers. It can be transferred to repair median nerve thenar branch and deep branch of the ulnar nerve. Conclusion It is feasible to reconstruct deep branch of the ulnar nerve and thenar branch of the median nerve by transferring extensor indicis propfius branch of the posterior interosseous nerve with vascular pedicle. The new nerve transfer procedure provides an option for restoration of intrinsic muscle function after proximal injury of ulnar nerve and median nerve.