带血管蒂前臂后皮神经电缆式移植修复上臂桡神经缺损

Cable Grafting of Vascularized Posterior Antebrachial Cutaneus Nerve for Defect of Radial Nerve in Upper Arm

目的：介绍带血管蒂前臂后皮神经电缆式移植修复上臂桡神经缺损的应用解剖、手术方法及临床效果。方法：在２０侧成人上肢标本上，观测前臂后皮神经及桡侧副动脉的行程及外径，设计以桡侧副动脉为蒂的前臂后皮神经电缆式移植修复上臂桡神经缺损的新术式并应用于临床。结果：前臂后皮神经与桡侧副动脉伴行关系密切，具有形成带血管蒂前臂后皮神经转移的解剖学条件；前臂后皮神经横径２．０ｃｍ左右，可切取长度１５．０ｃｍ左右，折叠后可以修复７．０ｃｍ左右的桡神经缺损。同时，术中发现神经供体断端出血活跃，说明带血供的前臂后皮神经移植的血供是可靠的。临床应用８例，神经缺损３．５～６．０ｃｍ，随访１０个月～３年，效果满意。按陆裕朴介绍的评定标准：优４例，良３例，可１例。结论：该术式转移灵活，操作简单、安全、可靠，对供区影响小，是修复上臂桡神经缺损的一种有用的方法。

Objective: To introduce the applied anatomy, operative method and clinical result of the cable grafting of the vascularized posterior antebrachial cutaneus nerve for defect of radial nerve in upper arm.Method: On 20 upper limbs of adult cadavers, the topical anatomy of the posterior antebrachial cutaneus nerve and the radial collateral vessel were observed. The new operation for defect of radial nerve by the posterior antebrachial cutaneus nerve with a pedicle of the radial collateral vessel was designed and applied in clinically. Result: The posterior antebrachial cutaneus nerve is accompanied closely with radial collateral vessel. So a donor nerve with a pedicle of radial collateral vessel may be raised and can be used to repair defect with the folded nerve. Moreover, active bleeding indicating good blood supply was found at the end of the donor nerve after it was raised. Clinically, 8 cases, with a 3.5-6.0cm defect of radial nerve, were treated with a satisfactory result. The period of follow up was from 10 months to 3 years. According to Lu's evaluating standard: 4 cases were excellent, 3 good and 1 fair. Conclusion: The operation is simple,safe and reliable in the manipulation and it is a useful method of treatment for defect of radial nerve.