摘要
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.
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.
出处
《中华手外科杂志》
CSCD
北大核心
2014年第5期355-358,共4页
Chinese Journal of Hand Surgery
基金
2012年上海市科委基金资助项目（124119a1001）
2014年国家自然科学基金资助项目（81371374）
关键词
臂丛
正中神经
肌皮神经
神经移位
旋前圆肌
Brachial plexus
Median nerve
Musculocutaneous nerve
Nerve transfer
Pronator teres
