正中神经分支移位修复尺神经深支解剖学研究.docVIP

正中神经分支移位修复尺神经深支解剖学研究 　　[摘要] 目的 探讨正中神经的分支旋前方肌肌支和拇短屈肌肌支移位修复尺神经深支的解剖学依据。 方法 选择新鲜成人上肢标本8侧，通过对标本进行显微解剖和模拟手术，评估两种神经移位术供受体神经是否匹配以及神经再生距离缩短的程度。数据通过SPSS17.0软件进行分析。 结果 拇短屈肌肌支和旋前方肌肌支移位术供受体神经纤维数量差异均有统计学意义（P0.05），两者极大缩短神经再生距离至（37.30±5.76）mm 和（74.44±8.90）mm。 结论 旋前方肌肌支和拇短屈肌肌支移位修复尺神经深支术的共同优点是极大缩短神经再生距离，但是两者神经纤维数量与受体神经均存在差异。 　　[关键词] 正中神经；尺神经深支；神经移位；解剖 　　[中图分类号] R322 [文献标识码] A [文章编号] 1673-9701（2015）25-0024-03 　　An anatomical study of the branch of median nerve transfer to the deep branch of ulnar nerve 　　DING Jian TAO Xianyao FENG Xiaoliang WANG Long JIANG Liangfu 　　Department of the Hand Surgery， the Second Affiliated Hospital of Wenzhou Medical University， Wenzhou 325000， China 　　[Abstract] Objective To explore the anatomical basis for the pronator quadratus branch and the flexor pollicis brevis branch transfer to the deep branch of ulnar nerve. Methods Eight fresh upper limb were dissected and observed. Then the transfer operation on the cadaver were imitated. The regenerating distance were recorded and nerve fiber were calculated. All data were analyzed by SPSS17.0. Results The nerve fiber number existed significant differences between the donor and the recipient nerve of both operation（P0.05）. The regenerating distance of the flexor pollicis brevis branch and the pronator quadratus branch were （37.30±5.76） mm and （74.44±8.90） mm. Conclusion Both of the pronator quadratus branch and the flexor pollicis brevis branch transfer to the deep branch of ulnar nerve can provide a short regenerating distance， but neither could provide enough nerve fiber. 　　[Key words] The median nerve； The deep branch of ulnar nerve； Nerve transfer； Anatomy 　　尺神经损伤术后深支支配的手内在肌功能恢复效果较差，神经移位术通过缩短神经再生距离减缓运动终板退化，促进手内在肌的恢复[1-3]。拇短屈肌肌支和旋前方肌肌支分别是正中神经在前臂和手部的运动神经终末支，移位修复尺神经深支可提供较短的神经再生距离。但是目前尚无拇短屈肌肌支移位术的解剖学研究。旋前方肌肌支移位术的应用解剖学研究较多，但是关于旋前方肌肌支能否提供足够的神经纤维供尺神经深支再生尚无统一结论，Sukegawa等[4]认为供受体神经纤维数量存在较大差异，供受体神经百分比为30%，Wang Y等[5]和？?Bstün等[6]研究结果显示供受体神经纤维数量差异不大，供受体神经百分比分别为62.5%和76.9%。神经测量平面不同是导致上述研究结果存在偏差的原因之一，Sukegawa