CAJ | 학술논문

目的在应用显微解剖学方法对上臂段桡神经深支部位进行研究的基础上,探讨将全长膈神经移位到上臂段桡神经深支部分以恢复伸腕、指功能的手术疗效.方法对16具32侧尸体标本应用显微解剖学的方法,研究桡神经深、浅支在上臂段的特点及背阔肌的肌腱止点处桡神经深支在主干中的部位;在临床上开展2例经胸将全长膈神经移位到背阏肌止点处桡神经深支部分的手术,并评价其疗效.结果通过显微解剖学研究发现上臂段桡神经前臂支内均可看见2个大的神经束组,在背阔肌的肌腱止点处桡神经深支主要位于前臂支的内侧神经束组中.1例术后1年10个月随访,肩外展80°,屈肘90°,伸肘0°,伸腕、指到位,屈腕10°,屈指尚不能;伸腕肌力达到M4,伸指肌力达到M3.另1例术后2年随访,肩外展40°,屈肘30°,伸肘0°,伸腕到位,伸指轻限,屈腕、指尚不能;伸腕肌力M,,伸指肌力达到M3-.结论将全长膈神经移位到背阔肌的肌腱止点处桡神经前臂支的内侧神经束组可能是恢复全臂丛根性撕脱伤患者伸腕、指功能的有效方法.
목적 재응용현미해부학방법대상비단뇨신경심지부위진행연구적기출상,탐토장전장격신경이위도상비단뇨신경심지부분이회복신완、지공능적수술료효.방법 대16구32측시체표본응용현미해부학적방법,연구뇨신경심、천지재상비단적특점급배활기적기건지점처뇨신경심지재주간중적부위;재림상상개전2례경흉장전장격신경이위도배알기지점처뇨신경심지부분적수술,병평개기료효.결과 통과현미해부학연구발현상비단뇨신경전비지내균가간견2개대적신경속조,재배활기적기건지점처뇨신경심지주요위우전비지적내측신경속조중.1례술후1년10개월수방,견외전80°,굴주90°,신주0°,신완、지도위,굴완10°,굴지상불능;신완기력체도M4,신지기력체도M3.령1례술후2년수방,견외전40°,굴주30°,신주0°,신완도위,신지경한,굴완、지상불능;신완기력M,,신지기력체도M3-.결론 장전장격신경이위도배활기적기건지점처뇨신경전비지적내측신경속조가능시회복전비총근성시탈상환자신완、지공능적유효방법.
Objective To find out the topographic location of radial nerve deep branch in the main trunk of radial nerve at the upper arm level,and to investigate the results of transferring full length phrenic nerve to the deep branch of the radial nerve for restoration of wrist and finger extension.Methods Thirtytwo sides of 16 cadavers were dissected.Microsurgical retrograde dissection of the radial nerve was carried out to delineate the fascicular features of the deep and superficial branches of the radial nerve at the upper arm.The topographic location of the deep branch in the main trunk of radial nerve at the level of latissimus dorsi insertion was also observed.Clinically full length phrenic nerve was transferred to the deep branch of the radial nerve at the level of latissimns dorsi insertion in 2 cases.Postoperatively the results of the tansfer were evaluated.Results There were two large fascicular groups in the antebrachial portion of the radial nerve in the arm.The deep branch of the radial nerve was mostly in the medial portion at the level of latissimns dorsi insertion.One of the 2 cases was followed for 1 year and 10 months.The patient had 80°of shoulder abduction,90°of elbow flexion,0°of elbow extension,10°of wrist flexion,full wrist and finger extension but no finger flexion.Muscle power of wrist extensor and finger extensor was M4 and Ms respectively.The other patient had 40°of shoulder abduction,30°of elbow flexion,0° of elbow extension,full wrist extension,slightly impaired finger extension but no wrist and finger flexion at 2-yesx follow-up.Muscle power of wrist extensor and finger extensor was M3 and M3.respectively.Condnsion Targeted transfer of full lengh phrenic nerve to the medial fascicles of the antebrachial portion of the radial nerve at the level of latissimus dorsi insertion could be an effective procedure to recover wrist and finger extension in total brachial plexus injury patients.