尺神经深支损伤的解剖学研究及临床应用

ANATOMIC STUDY ON INJURY OF SIMPLE DEEP BRANCH OF ULNAR NERVE

目的解剖观测前臂截肢标本钩骨钩以远的三角形小隙及其内的尺神经深支,为临床诊治单纯尺神经深支损伤提供解剖学依据。方法取15个自愿捐献前臂远端以近新鲜截肢标本进行解剖。以手掌第4指指蹼中点为A点,钩骨钩为B点,小指屈指浅肌腱尺侧缘为OD,尺神经浅支及第4指总神经桡侧缘为OE,O为三角形顶点;C点为经B点向OE所作垂线并与其相交点,F点为CB延长线与OD相交点;OCF即为三角形小隙。观测OCF及尺神经深支在其内的走行及毗邻情况。2000年5月-2007年6月,收治3例玻璃刺伤手掌尺侧患者,均诊断为单纯尺神经深支损伤。伤口均位于小鱼际部并通过钩骨钩远端,尺神经支配区域出现肌力下降。术中2例直接断端外膜缝合,1例取桡神经浅支游离移植。结果OB距离为(19.20±1.30)mm;B点距尺神经浅支和第4指总神经距离BC为(7.80±1.35)mm。尺神经深支在OCF内走行亦不同。OCF包含了腕尺管的对掌肌管,小鱼际肌支均于对掌肌管前发出。临床治疗3例均获随访,随访时间2个月～4年。术后症状消失,握物有力,手指活动自如。按中华医学会手外科学会上肢周围神经功能评定试用标准,综合评价均为优。结论单纯尺神经深支损伤均位于三角形小隙OCF内;手掌部锐器伤不易致单纯尺神经深支损伤,由于伤口小、小鱼际功能存在和感觉正常,早期容易漏诊。

Objective To provide anatomy evidence of the simple injury of the deep branch of the unlar nerve for clinical diagnosis and treatments.Methods Fifteen fresh samples of voluntary intact amputated forearms with no deformity were observed anatomically,which were mutilated from the distal end of forearm.The midpoint of the forth palm fingerweb was defined as dot A,the midpoint of the hook of the hamate bone as dot B,the ulnar margin of the flexor digitorum superficialis of the little finger as OD,and the superficial branch of the unlar nerve and the forth common finger digital nerve as OE,dot O was the vertex of the triangle,dot C was intersection point of a vertical line passing dot B toward OE;dot F was the intersection point of CB＇s extension line and OD.OCF formed a triangle.OCF and the deep branch of the unlar nerve were observed.From May 2000 to June 2007,3 cases were treated which were all simple injury of the deep branch of the unlar nerve by glass,diagnosed through anatomical observations.The wounds were all located in the hypothenar muscles,and passed through the distal end of the hamate bone.Muscle power controlled by the unlar nerve got lower.The double ends was sewed up in 2 cases directly intra operation,and the superficial branch of radial nerve grafted freely in the other 1 case.Results The distance between dot B and dot O was（19.20±1.30）mm.The length of BC was（7.80±1.35）mm.The morpha of OCF was various,and the route of profundus nervi ulnaris was various in OCF.OCF contains opponens canales mainly.The muscle branch of the hypothenar muscles all send out in front of the opponens canales.The wounds of these 3 cases were all located at the distal end of the hook of the hamate bone,intrinsic muscles controlled by the unlar nerve except hypothenar muscles were restricted without sensory disorder or any other injuries.Three cases were followed up for 2 months to 4 years.Postoperation,the symptoms disappeared,holding power got well,patients＇fingers were nimble.According to the trial standard of the function of the upper limb peripheral nerve established by Chinese Medieal Surgery of the Hand Association,the synthetical evaluations were excellent.Conclusion Simple injuries of the deep branch of the unlar nerve are all located in OCF;it is not easy to be diagnosed at the early time because of the little wounds,the function of the hypothenar muscles in existence and the normal sense.