骨间前神经旋前方肌支移位在高位尺神经损伤中的应用

Clinical application of transfer of pronator quadratus muscle branch of the anterior interosseous nerve for treatment of high level ulnar nerve injuries

目的研究高位尺神经损伤后用骨间前神经旋前方肌肌支移位修复尺神经深支的手术方法。方法2002年10月—2005年8月,对18例高位尺神经损伤的患者,应用骨间前神经旋前方肌肌支移位与尺神经腕部深支进行吻合。结果术后15例获得随访,随访时间为3个月～3年,平均1.7年。手内肌肌力恢复M_22例,M_32例,M_46例,M_55例,优良率为73%。结论骨间前神经旋前方肌支转位修复尺神经深支可达到肌支-肌支修复,缩短了神经再生的距离和时间,有利于手内在肌功能的恢复,是一种有效的手术方法。

Objective To evaluate the surgical procedure of pronator quadratus muscle branch transfer to deep branch of the ulnar nerve for treatment of high level ulnar nerve injury. Methods From October 2002 to August 2005, 18 cases of high level ulnar nerve injuries were treated by transferring pronator quadratus muscle branch of the anterior interosseous nerve to deep branch of the ulnar nerve. Results Fifteen cases had substantial postoperative follow-up. The follow-up period ranged from 3 months to 3 years, with an average of 1. 7 years. Intrinsic hand muscle power recovered to M2 in 2 cases, M3 in 2 cases, M4 in 6 cases and Ms in 5 cases, with an overall satisfactory rate of 73%. Conclusion Pronator quadratus muscle branch transfer to deep branch of the ulnar nerve is a distal motor-to-motor transfer. It substantially shortened the distance and time for reianervation, and is therefore favorable for functional recovery of hand intrinsic muscles. It is an effective method for treatment of high level ulnar nerve injuries.