CAJ | 학술논문

目的观察肘部和前臂段桡神经的解剖学特征及损伤修复的方法.方法 36侧成人上肢标本,于肘外侧做"S"形切口,从肱肌和肱桡肌间隙内解剖出桡神经肘段,沿桡神经干向远端追踪,找出桡神经深支出旋后肌的各个分支,测量深支各肌支的发出点、入肌点距肱骨髁上水平的距离和长度.逆行分离各分支,观察各分支的神经纤维在桡神经干内的分布定位特征.对12例肘部桡神经损伤的患者,采用桡神经定位缝合和不定位缝合的方法进行修复.结果 12例获得平均2.4年的随访.根据桡神经深支支配的运动区肌腱肌力恢复情况,神经定位缝合6例,术后有效率为83.3%.非定位缝合6例,有效率为50.0%.桡神经定位缝合组的有效率明显高于不定位缝合组.结论前臂背侧距肱骨外上髁10～15cm范围内的锐器伤,伸拇困难者应考虑有骨间背神经肌支的损伤.运动支的神经纤维在桡神经干的内侧,对肘部桡神经断裂伤修复时重点应缝合内侧部分.显微定位缝合技术修复肘部和前臂段桡神经损伤是有效的方法.
목적 관찰주부화전비단뇨신경적해부학특정급손상수복적방법.방법 36측성인상지표본,우주외측주"S"형절구,종굉기화굉뇨기간극내해부출뇨신경주단,연뇨신경간향원단추종,조출뇨신경심지출선후기적각개분지,측량심지각기지적발출점、입기점거굉골과상수평적거리화장도.역행분리각분지,관찰각분지적신경섬유재뇨신경간내적분포정위특정.대12례주부뇨신경손상적환자,채용뇨신경정위봉합화불정위봉합적방법진행수복.결과 12례획득평균2.4년적수방.근거뇨신경심지지배적운동구기건기력회복정황,신경정위봉합6례,술후유효솔위83.3%.비정위봉합6례,유효솔위50.0%.뇨신경정위봉합조적유효솔명현고우불정위봉합조.결론 전비배측거굉골외상과10～15cm범위내적예기상,신무곤난자응고필유골간배신경기지적손상.운동지적신경섬유재뇨신경간적내측,대주부뇨신경단렬상수복시중점응봉합내측부분.현미정위봉합기술수복주부화전비단뇨신경손상시유효적방법.
Objective To observe the anatomical features of radial nerve in the elbow and forearm and apply the anatomical data in surgical nerve repair. Methods Thirty-six adult cadaver arms were carefully dissected. The elbow part of radial nerve was identified from the space between brachial muscle and brachioradialis muscle via an "S" shape incision at the lateral side of the elbow. The deep branch of the radial nerve distal to its supinator muscle exit was traced distally to explore and identify all the muscular branches. The length of the muscular branches and the distance of the take off and muscle entry point of these branches to the epicondyle of the humerus were measured. Retrograde dissection of the muscular branched was also done to locate the distribution of these branches in the radial nerve proper at the level of epicondyle. Twelve cases of radial nerve injury at the elbow were treated with either oriented repair or non-oriented repair. Recovery of muscle power of deep radial nerve innervated muscles was measured and the effective recovery rates were compared between the group of oriented nerve repair and non-oriented repair. Results The motor nerve fibers lied in the medial portion of the radial nerve trunk. Extensor pollicis longus was the distal most muscle innervated by radial nerve deep branch. The average follow-up time of the 12 cases was 2.4 year. The effective rate of the group (n=6) with oriented nerve repair was 83.3% while that of the group (n=6) of non-oriented nerve repair was 50.0%. Conclusion The diagnosis of posterior interosseous nerve injury must been considered when patients complain about difficulty in thumb extension following blunt injury to the dorsolateral forearm in the level 10 to 15cm to the lateral epicondyle. Based on the distribution radial nerve motor fibers. the medial portion of the radial nerve trunk should be carefully reapproximated with microsurgical repair.