中华显微外科杂志
中華顯微外科雜誌
중화현미외과잡지
Chinese Journal of Microsurgery
2011年
6期
464-467
,共4页
黎鸣%肖丽亚%林敏婷%周雪贤
黎鳴%肖麗亞%林敏婷%週雪賢
려명%초려아%림민정%주설현
正中神经%Riche-Cannieu吻合支%拇短展肌%神经再支配%电生理检测
正中神經%Riche-Cannieu吻閤支%拇短展肌%神經再支配%電生理檢測
정중신경%Riche-Cannieu문합지%무단전기%신경재지배%전생리검측
Median nerve%Riche-Cannieu anastomosis%Abductor pollicis brevis%Reinnervation%Electrophysiological examine
目的 了解Riche-Cannieu吻合支(尺神经深支与正中神经返支在手掌中的变异吻合支)在正中神经损伤时对拇短展肌是否存在再支配作用. 方法 收集病例共43例(男29例,女14例,年龄14 ～ 57岁,平均32.6岁),均符合以下条件:(1)前臂及前臂以下外伤所致的正中神经损伤(临床以及电生理检测证实).(2)神经电生理检测证实RCA存在,电位波幅小于1mV.(3)除外合并其他神经损伤或神经系统疾病及颈椎病、糖尿病.分别在损伤2～3周内、2～4个月内、1年之后进行患肢正中神经电生理检测,评估神经功能. 结果 43例正中神经中在临床与电生理方面均无明显恢复；8例拇指外展功能在3个月之内明显好转,相应Riche-Cannieu吻合支的CMAP波幅明显增高,相应拇短展肌的肌电图明显好转. 结论 在正中神经损伤合并存在RCA的情况下,失去正中神经支配的拇短展肌肌纤维有可能逐渐获得RCA纤维的再支配；这种再支配的速度大于一般受损神经的再生速度.
目的 瞭解Riche-Cannieu吻閤支(呎神經深支與正中神經返支在手掌中的變異吻閤支)在正中神經損傷時對拇短展肌是否存在再支配作用. 方法 收集病例共43例(男29例,女14例,年齡14 ～ 57歲,平均32.6歲),均符閤以下條件:(1)前臂及前臂以下外傷所緻的正中神經損傷(臨床以及電生理檢測證實).(2)神經電生理檢測證實RCA存在,電位波幅小于1mV.(3)除外閤併其他神經損傷或神經繫統疾病及頸椎病、糖尿病.分彆在損傷2～3週內、2～4箇月內、1年之後進行患肢正中神經電生理檢測,評估神經功能. 結果 43例正中神經中在臨床與電生理方麵均無明顯恢複；8例拇指外展功能在3箇月之內明顯好轉,相應Riche-Cannieu吻閤支的CMAP波幅明顯增高,相應拇短展肌的肌電圖明顯好轉. 結論 在正中神經損傷閤併存在RCA的情況下,失去正中神經支配的拇短展肌肌纖維有可能逐漸穫得RCA纖維的再支配；這種再支配的速度大于一般受損神經的再生速度.
목적 료해Riche-Cannieu문합지(척신경심지여정중신경반지재수장중적변이문합지)재정중신경손상시대무단전기시부존재재지배작용. 방법 수집병례공43례(남29례,녀14례,년령14 ～ 57세,평균32.6세),균부합이하조건:(1)전비급전비이하외상소치적정중신경손상(림상이급전생리검측증실).(2)신경전생리검측증실RCA존재,전위파폭소우1mV.(3)제외합병기타신경손상혹신경계통질병급경추병、당뇨병.분별재손상2～3주내、2～4개월내、1년지후진행환지정중신경전생리검측,평고신경공능. 결과 43례정중신경중재림상여전생리방면균무명현회복；8례무지외전공능재3개월지내명현호전,상응Riche-Cannieu문합지적CMAP파폭명현증고,상응무단전기적기전도명현호전. 결론 재정중신경손상합병존재RCA적정황하,실거정중신경지배적무단전기기섬유유가능축점획득RCA섬유적재지배；저충재지배적속도대우일반수손신경적재생속도.
Objective To study whether the abductor pollicis brevis been effected by the reinnervation of the Riche-Cannieu anastomosis in the median nerve injury cases. Methods Collect 43 cases (29male,14 female,mean age 32.6) corresponds with the study needs: (1)The traumatic median nerve injury (proved by the results of electrophysiological examine and the clinic diagnose)on or below the forearm.(2)The existence of RCA was verified by the electrophysiological examine results,and the amplitude of electric potential was under 1mv.(3) Rule out the cases with the other injure of nerve or nervous system disease and cervical vertebra disease,diabetes patient.The analysis base on the results of 43 case's periodical examine,the periodical criteria as following: within 2-4th week,within the 2-4th month and 1 year after the injury.Results Forty-three cases had not obvious recovery indication of the median nerve under the clinical and electrophysiological aspect,eight cases of abductor pollicis brevis function improved quickly in 3 months,the relevant CMAP amplitude of Riche-Cannieu anastomosis increased apparently,the EMG (Electromyography)results of abductor pollicis brevis ameliorated accordingly. Conclusion In the case of RCA combined with the median nerve injury,the abductor pollicis brevis fibra might be dominated by RCA reinnervation when losing domination of median nerve,the reinnervation process will much faster than the regeneration process of the broken nerve.
