Multiple tendons of the additional belly of flexor pollicis longus in the carpal tunnel: Embryological perspective and their clinical significance

Although the flexor pollicis longus is known to show the additional head of the origin, the occurrence of its additional tendons in the carpal tunnel are seldom reported. The presence of such additional tendons in the carpal tunnel cannot be overlooked during the radiological and surgical procedures in this region. Herein, we report a rare case of additional muscle belly of flexor pollicis longus. The additional muscle belly after a short course divided into three tendons. All three tendons entered the carpal tunnel along with flexor pollicis longus, passing deep to the flexor retinaculum. Within the carpal tunnel, two of these tendons fused and terminated by merging with the undersurface of the flexor retinaculum. The third tendon terminated by joining the flexor digitorum superficialis tendon for the index finger, in the palm. An additional slip of the first lumbrical muscle took origin from the third tendon of the additional muscle belly of flexor pollicis longus. Further, the embryological basis and clinical significance of current case is discussed.

腕部支持带的影像学研究进展

腕部支持带是前臂深筋膜在腕关节周围增厚的部分,可分为掌侧的屈肌支持带和背侧的伸肌支持带,对腕部肌腱和神经具有稳定、支持和保护作用,但腕部支持带的存在也与某些疾病的发生密切相关。本文就腕部支持带的解剖结构、正常影像学表现及发生相关疾病时的影像学表现进行综述。

屈肌支持带不同比例切开对屈肌腱功能影响的探讨

目的：探索腕部手术时，屈肌支持带切开对屈肌腱功能的影响。方法：采用６只尸体手标本，共分５种状态：即为屈肌支持带完整，从近侧中点按不同比例纵行切开屈肌支持带的部分（近１／３、近１／２、近２／３和全切）；测量腕关节由０°到屈曲５０°时，腕管内各肌腱的滑动距离，分析比较不同比例切开与完整状态的百分比变化。结果：在屈肌支持带切开近侧 １／３时，肌腱滑动距离增大４％～ ７％；切开近侧 １／２时，肌腱滑动距离增大７％～９％；切开近侧２／３时，肌腱滑动距离增大１２％～１４％；全部切开后，肌腱滑动距离增大２０％～７０％。结论：腕管内手术时，将屈肌支持带切开１／２～２／３，可基本保持屈肌腱的功能。

腕管综合征内镜诊治新方法——改良奥津法(附11例报告)

目的:介绍应用改良内镜技术治疗腕管综合征,术前和术后应用肌电图检测,从腕管内直接切断腕管横韧带和屈肌支持带远侧纤维束,解除其对正中神经压迫的手术方法及技巧。方法:臂丛麻醉,不使用驱血带,皮肤1cm切口,应用USE系列,在内镜下切断腕管横韧带和屈肌支持带远侧纤维束,经肌电图验证,术后正中神经末端CMAP平均潜伏期较术前加快1ms。结果:临床应用11例腕管综合征病人,于术后第1,第3个月随访,结果据Kelly疗效评定标准,优9例;良2例;一般或差无。结论:与常规手术相比,皮肤切口小,组织创伤轻,手术时间短,术后不需石膏外固定,不残留手术瘢痕。术中注意减压彻底,在微创伤条件下,能与常规手术取得相同的疗效。

手掌神经血管、腕横韧带和腕远纹关系的研究

目的:为腕管松解术及掌中间隙引流术提供解剖学基础。方法:在50例(男34、女16)福尔马林固定成人尸体100侧手掌上,对其血管神经、腕横韧带及其位置关系进行解剖学观测。结果:正中神经及其腕掌部分支均位于掌长肌腱尺侧与第3指蹼连线的桡侧,尺动脉位于尺神经桡侧,尺动脉终末支与正中神经平行,间距为11.2±2.3mm。有尺/正中神经交通支者占94%,有掌浅弓者占78%,在掌长肌腱尺侧缘与环指中轴的连线上,腕远纹至交通支的距离为35.5±3.5mm,至掌浅弓的距离为37.4±3.6mm,腕横韧带下缘至交通支的距离为6.5±3.2mm,至掌浅弓的距离为8.4±3.7mm。结论:在掌长肌腱尺侧缘至环指中轴的连线上,腕远纹远侧35.5mm内以及37.4mm以下无主要血管、神经,此区域是手术相对安全区。

Motor versus Sensory Nerve Conduction Monitoring of Median Nerve during Carpal Tunnel Surgery

Background/Aim: Carpal tunnel syndrome (CTS) is one of the most common compressive, canalicular neuropathies of the upper extremities, causing hand pain and impaired function. This clinical study was designed to compare the intraoperative median nerve distal motor latency (DML) versus the distal sensory latency (DSL) and sensory nerve conduction velocity (SNCV) during surgical treatment of CTS. Patients and Methods: A total number of 36 wrists in 30 patients with CTS diagnosed by preoperative median MNCS who underwent surgical intervention for median nerve release. Intraoperative measurements of motor distal latency (DML) and proximal latency, amplitude, and conduction velocity and distal sensory latency (DSL), amplitude, and conduction velocity of both the median and ulnar nerves before and after division of the flexor retinaculum (FR). Results: A significant decrease of the intraoperative median nerve distal motor latency (DML) after release (8.89 ± 0.93) in comparison with the preoperative median nerve DML (6.24 ± 1.06) with (p < 0.001*). But intraoperative distal sensory latency (DSL) and sensory nerve conduction velocity (SNCVM) show non-significant decrease (p = 0.161). Conclusion: Intraoperative monitoring of median nerve show rapidly improve Intraoperative motor nerve conduction than the sensory nerve conduction after release the FR during carpal tunnel surgery.

掌长肌腱转位重建屈肌支持带的临床应用

目的:介绍用掌长肌腱逆行转位重建屈肌支持带的方法。方法:应用掌长肌腱逆行转位,折返、重叠、编织等方法,在涉及屈肌支持带延长、松解、缺失等术式中重建屈肌支持带21例(23侧)。结果:本组重建屈肌支持带21例(23侧)全部成功,随访16例(18侧),在对抗强阻力下屈曲腕关节无一例出现腕部"弓弦畸形"及肌力减低,正中神经卡压等情况。肌腱按TAM评价法评定:总优良率88.9%。结论:掌长肌腱转位重建屈肌支持带是一种简便易行,疗效确切的方法。

骨间背神经损伤28例分析

我院于1987～1998年共收治骨间背侧神经损伤28例,其中神经断裂12例,粘连卡压16例。均行手术治疗。经随访1～12个月功能恢复满意,报告如下。 1.临床资料 一般资料 本组28例,男20例,女8例,年龄6～48岁。陈旧性切割伤12例,陈旧性孟氏骨折4例,小夹板应用不当造成压迫3例,前臂摔伤5例,动物踢伤1例,过劳损伤3例。发病至就诊时间1～6个月。