正中神经肌支转位治疗尺神经高位损伤的解剖学研究

Anatomical studies on muscular branches transposition of median nerve for treatment of high ulnar nerve injury

目的探讨正中神经肌支转位治疗尺神经高位损伤的可行性。方法经甲醛固定的成人尸体10具共20侧上肢标本,利用游标卡尺测量正中神经各肌支的长度、神经入肌点处的直径、分支点到肱骨内侧髁以及正中神经主干在肘窝处距肱骨内侧髁的距离。结果正中神经前臂的主要肌支有旋前圆肌支、桡侧腕屈肌支、掌长肌支、指浅屈肌支、指深屈肌桡侧半支、拇长屈肌支和旋前方肌支,其长度分别(46.3±12.5)、(44.5±9.7)、(43.5±4.1)、(53.5±7.2)、(62.4±19.8)、(64.4±7.8)、(109.4±14.9)mm;神经入肌点处的直径分别是(1.7±0.2)、(1.5±0.5)、(0.9±0.3)、(1.2±0.3)、(1.5±0.1)、(1.2±0.3)、(1.0±0.4)mm;正中神经主干距内侧髁距离为(35.4±3.3)mm;旋前圆肌支标本可直接与肱骨内侧髁上方尺神经主干无张力缝合。结论正中神经肌支转位治疗尺神经高位损伤在解剖学上是可行的,旋前圆肌支和桡侧腕屈肌支是最佳供体神经。

Objective The purpose of this study is to assess the feasibility of muscular branches trans- position of median nerve for treatment of high ulnar nerve injury. Methods Ten adult human cadavers （20 upper limbs） and digital calipers were used to measure the length of muscular branches of median nerve, the diameter of muscular branches enter the muscle at the point, the length between branching point and humeral medial condyle, the median nerve trunk distance from the humeral medial condyle at the cubital fossa, respectively. Results The main branch of median nerve divided into teretipronator branch, radiocarpus branch, palmaris longus branch, flexor digitorum superficialis branch, the radial semi- flexor disitorum profundus branch, the flexor pollicis longus branch and pronator quadratus branch. The length of the muscular branch is 46.3 ± 12.5 mm,44.5 ±9.7 mm,43.5 ±4.1 mm,53.5 ±7.2 mm,62.4 ± 19.8 mm,64.4 ± 7.8 mm, 109.4 ± 14.9 mm, respectively. The diameter of the muscular branch enter into the muscle is 1.7 ± 0.2 mm,1.5 ±0.5 mm,0.9 ±0.3 mm, 1.2 ± 0.3 mm, 1.5 ± 0.1 mm, 1.2 ± 0.3 mm, 1.0 ± 0.4 mm, respectively. The length between the median nerve trunk and humeral medial condyle is 35.4 ± 3.3 mm. the teretipronator branch should be sutured on the main branch of ulnar nerve at the humeral medial condyle without tension. Conclusion The data showed that the muscular branches transposition of median nerve for treatment of high ulnar nerve injury is feasible, the teretipronator branch and radiocarpus branch could be used as the best donor nerves for reconstruc- tion when high - ulnar nerve injuries.