断掌再植的神经解剖学基础

ANATOMICAL BASIS OF NERVE IN REPLANTATION OF AMPUTATED PALM

目的 :为断掌再植的神经修复提供解剖学依据。方法 :对 3 0侧成人手标本掌部浅、深两层的主要神经分支进行解剖。以远侧腕横纹为横坐标 ,以掌中线为纵坐标对掌部主要神经分支的起、止点进行坐标测量。将手掌部划分为 64个正方形小区 ,按照掌部主要神经分支起、止坐标对各神经进行小区定位 ,确定各神经分支的体表投影。模拟不同平面断掌 ,确定各断掌平面应修复的神经。结果 :R1 T3、R1 T4 、R2 T2 、R2 T3、R2 T4 5个小区集中了正中神经返支、正中神经分叉处及尺神经深支的大鱼际肌段 ,此区域神经分支较多 ,是断掌时神经修复的重要区域。U2 T1 、U2 T2 、U1 T33个小区有尺神经深支通过 ,通过此三小区的断掌应仔细修复尺神经深支。结论 :应用本方法可以对断掌及其他手掌外伤的神经损伤作出较为准确的估计预测 。

Objective: To provide anatomic data for the repair of nerve in replantation of amputated palm. Methods: Dissecting 30 adult hands, all main nerve branches in both superficial and deep layers of volar side of palm were dissected. The coordinate was set up with the distal transverse carpal crease being abscissa and the mid\|palm linea ordinate. The values of coordinate of both origin and end point of every nerve branch in palm were measured. The projection of every nerve branch was located according to the values of coordinate after 64 little squares demarcated in the palmar area. Different types of amputated palm were simulated to define the nerves that should be repaired. Results: The recurrent branch and the bifurcation of median nerve and the thenar section of the deep branch of ulnar nerve lie in the squares of R 1T 3\, R 1T 4\, R 2T 2\, R 2T 3 and R 2T 4. These five squares are very important for repair of nerve in replantation of amputated palm for there being so many nerve branches. The deep branch of ulnar nerve goes through the squares of U 2T 1\, U 2T 2 and U 1T 3. It must be repaired carefully if the amputation line pass through these squares. Conclusion: With this method the injury of nerve in replantation of amputated palm and other palmar injury can be predicted exactly. According to the prediction the injured nerves can be repaired purposely.\;