胸小肌移植重建拇对掌功能的临床解剖研究

Clinical anatomic study on partial pectoralis minor muscle transplantation for reconstructing thumb opposition function

目的:为吻合血管神经的选择性胸小肌移植重建拇对掌功能术式提供解剖学依据。方法:在20侧成人胸部及手部标本中,解剖观察胸小肌的血管神经分布及胸小肌和大鱼际肌的形态、大小并将二者进行比较;然后按照大鱼际肌纤维走行方向,参考血管神经位置,将胸小肌修剪合适后移植固定于同侧手部大鱼际,模拟正常手部拇对掌功能予以牵拉,观察标本手部拇对掌过程。结果:胸小肌位置恒定,具备独立的动、静脉和神经支配;有针对性地选择部分胸小肌进行移植模拟,获得了标本手部的拇对掌过程。结论:在标本上选取部分胸小肌移植于手部大鱼际重建拇对掌功能的术式是可行的。

Objective： To provide anatomic basis for pectoranis minor muscle transplantation by vessels and nerves anastomosis to reconstruct thumb opposition function. Methods： The blood supply and nerve innervation of pectoralis minor muscle, the comparison of the morphology and dimension of both pectoralis minor muscle and thenar muscle were investigated on 20 sides of adult cadaveric thoraxes and hands. According to the locations of the vessels and nerves of the pectoralis minor, the clipped pectoralis minor muscle at the same side were transplanted and fixed to thenar muscles with the same direction of thenar muscle fiber. After that, the process of dragging simulating opposition movement of hand were performed and observed. Results： Pectoralis minor muscles, taking its own nutrient arteries, veins and nerves, showed constant anatomical position. The opposition process of cadaveric hand can be finished after transplantation process as the clinic. Conclusions： It is possible to select partial pectoralis minor muscle transplantation to reconstruct thumb opposition function.