以尺侧上副动脉为蒂尺神经移植的临床研究

Ulnar nerve grafting pedicled by the superior collateral ulnar artery: a clinical study

目的 术中观测尺侧上副动脉对尺神经肘下段的血供及检测尺神经游离后末端的功能。方法 对 8例全臂丛根性撕脱伤患者 ,作以尺侧上副动脉为蒂的尺神经移植 ,在切断尺神经前后检测尺神经干 (1 2cm长 )感觉神经动作电位 (SNAP)的波幅及传导速度。观察其远端的出血情况 ,并用脉搏血氧饱和度仪测定其末端的血氧饱和度。结果 8例尺神经远端 (腕部段 )有持续渗血。游离后 2 0min ,尺神经的感觉传导速度、SNAP波幅较游离前分别下降了 0 .63 %～ 1 9.0 2 %和 2 .2 8%～ 3 7.47%。下降程度与尺神经肘下段的游离长度与肘部横径之比 (长宽比 )成正的直线相关 ,直线回归方程分别为Y =0 .92 83X - 4 1 .50 66、Y =2 .1 43 3X - 98.4498,r值分别为 0 .81 3 8、0 .8977,t值分别为 3 .43 0 5、4.990 6,P <0 .0 1。游离后 2 0min ,尺神经肘上段血氧饱和度为 97%～ 1 0 0 % ,而其末端血氧饱和度为72 %～ 89% ,与长宽比成负的直线相关 ,回归方程为Y =1 2 4.1 2 66- 0 .81 68X ,r值为 - 0 .861 7,t值为 4.1 599,P <0 .0 1。结论 尺侧上副动脉能为于腕部切断的尺神经全长提供血供 ,越靠近肘部尺神经血供越佳。

Objective To investigate the blood supply at the distal end of ulnar nerve vascularized by the superior collateral ulnar artery (SCUA) and check its function following the dissociation of the ulnar nerve. Methods Eight patients with whole brachial plexus roots avulsion were randomly involved in the ulnar nerve grafting pedicled by the SCUA . In every case nerve conduction velocity (NCV) and the amplitude (Amp) of sensory nerve action potential (SNAP) were measured at the distal 12 cm portion of ulnar nerve before and after dissection. The bleeding of the ulnar nerve was observed and degree of blood oxygen saturation measured at the end of graft using the pulse blood oxygen saturation instrument. Results Slow continuous bleeding from the cut surface of the distal end of the ulnar nerve (at the wrist) was observed . 20 minutes after the dissociation of the ulnar nerve, NCV and Amp of SNAP at the distal end of the ulnar nerve decreased 0.63 %～19.02 % and2.28 %～37.4 %, respectively, when compared with those before dissociation of ulnar nerve. The decreasing rate was positively correlated to the ratios between the length and width of dissected ulnar nerve below the elbow. The linear regression equations were: Y=0.928 3 X-41.506 6 and Y= 2.143 3X -98.449 8, respectively. The correlation coefficients (r) were 0.813 8 and 0.897 7, t=3.430 5 and 4.990 6 ( P <0.01). The SpO 2 at the elbow and the end of ulnar nerve were 97 %～100 % and 72 %～89 %, respectively .It was negatively correlated to the ratios between the length and width of the dissected ulnar nerve below the elbow. The linear regression equation was: Y=124.126 6-0.816 8 X, r=-0.861 7, t=4.159 9 ( P < 0.01). Conclusions The superior collateral ulnar artery can supply the whole ulnar nerve graft when the nerve was transected at the wrist portion. The shorter distance to the elbow, the more rich blood supply is found in the graft.