中华手外科杂志
中華手外科雜誌
중화수외과잡지
CHINESE JOURNAL OF HAND SURGERY
2014年
5期
355-358
,共4页
臂丛%正中神经%肌皮神经%神经移位%旋前圆肌
臂叢%正中神經%肌皮神經%神經移位%鏇前圓肌
비총%정중신경%기피신경%신경이위%선전원기
Brachial plexus%Median nerve%Musculocutaneous nerve%Nerve transfer%Pronator teres
目的 臂丛神经中、下干损伤后,在肌皮神经肱肌肌支移位术的基础上,同时引入新的动力神经并设计新的术式,以期加强患者屈指功能的恢复.方法 通过对10侧新鲜尸体上肢标本,观察和测量正中神经旋前圆肌肌支及骨间前神经的解剖学研究.对1例臂丛神经下干损伤的男性患者,设计正中神经旋前圆肌肌支移位至骨间前神经,联合肌皮神经肱肌肌支移位至正中神经指浅屈肌肌支术.结果 解剖学研究发现旋前圆肌肌支分为三种类型:Ⅰ型(三支型)6侧,Ⅱ型(二支型)2侧,Ⅲ型(单支型)2侧.但是无论旋前圆肌肌支发出类型为何型,最终都分成三支肌支进入旋前圆肌.1例临床病例术后证实,该术式对前臂旋前功能无明显影响.术后18个月,患肢拇长屈肌、示指指深屈肌肌力达M4,中、环指指浅屈肌肌力达M3,握力2.6kg.结论 利用正中神经旋前圆肌肌支移位骨间前神经加强臂丛神经中、下干损伤患者的屈指功能,该术式是可行、安全、有效的.
目的 臂叢神經中、下榦損傷後,在肌皮神經肱肌肌支移位術的基礎上,同時引入新的動力神經併設計新的術式,以期加彊患者屈指功能的恢複.方法 通過對10側新鮮尸體上肢標本,觀察和測量正中神經鏇前圓肌肌支及骨間前神經的解剖學研究.對1例臂叢神經下榦損傷的男性患者,設計正中神經鏇前圓肌肌支移位至骨間前神經,聯閤肌皮神經肱肌肌支移位至正中神經指淺屈肌肌支術.結果 解剖學研究髮現鏇前圓肌肌支分為三種類型:Ⅰ型(三支型)6側,Ⅱ型(二支型)2側,Ⅲ型(單支型)2側.但是無論鏇前圓肌肌支髮齣類型為何型,最終都分成三支肌支進入鏇前圓肌.1例臨床病例術後證實,該術式對前臂鏇前功能無明顯影響.術後18箇月,患肢拇長屈肌、示指指深屈肌肌力達M4,中、環指指淺屈肌肌力達M3,握力2.6kg.結論 利用正中神經鏇前圓肌肌支移位骨間前神經加彊臂叢神經中、下榦損傷患者的屈指功能,該術式是可行、安全、有效的.
목적 비총신경중、하간손상후,재기피신경굉기기지이위술적기출상,동시인입신적동력신경병설계신적술식,이기가강환자굴지공능적회복.방법 통과대10측신선시체상지표본,관찰화측량정중신경선전원기기지급골간전신경적해부학연구.대1례비총신경하간손상적남성환자,설계정중신경선전원기기지이위지골간전신경,연합기피신경굉기기지이위지정중신경지천굴기기지술.결과 해부학연구발현선전원기기지분위삼충류형:Ⅰ형(삼지형)6측,Ⅱ형(이지형)2측,Ⅲ형(단지형)2측.단시무론선전원기기지발출류형위하형,최종도분성삼지기지진입선전원기.1례림상병례술후증실,해술식대전비선전공능무명현영향.술후18개월,환지무장굴기、시지지심굴기기력체M4,중、배지지천굴기기력체M3,악력2.6kg.결론 이용정중신경선전원기기지이위골간전신경가강비총신경중、하간손상환자적굴지공능,해술식시가행、안전、유효적.
Objective To introduce a new donor nerve and design a new procedure for augmenting finger flexion in middle and lower trunk brachial plexus injuries.Methods The pronator teres branch and anterior interosseous nerve were dissected and measured in 10 fresh cadaveric upper limbs.The anatomic findings were used to design a surgical procedure to transfer the pronator teres branch to the anterior interosseous nerve in combination with the brachialis motor branch transfer to the flexor digitorum superficialis branch.This combined transfer was applied to treat one male patient of lower trunk brachial plexus injury.Results The anatomical study revealed three branching patterns of pronator teres branch.Type Ⅰ (6/10) was defined as a triple-branch pattern,type Ⅱ (2/10) as a double-branch pattern,and Type Ⅲ (2/10) as a single branch pattern.Regardless of its branching pattern,there were always three twigs that entered the pronator teres.Follow-up evaluation of the one case showed no impairment of pronation after the surgery.Moreover,recovery of both the superficial and deep finger flexors was achieved.At 18 months postoperatively muscle power of flexor pollicis longus and flexor digitorum profundus of the index finger reached M4.Muscle power of the flexor digitorum superficialis of the middle and ring fingers recovered to M3.Grip strength was 2.6 kg.Conclusion Transfer the pronator teres branch to the anterior interosseous nerve can effectively augment finger flexion in patients with middle and lower trunk brachial plexus injuries.It is a practical,safe and effective procedure.
