正中神经指浅屈肌肌支移位修复尺神经运动支的解剖学研究

发布时间：2018-04-18 06:41

  本文选题：指浅屈肌肌支 + 神经移位　； 参考：《河北医科大学》2008年硕士论文

【摘要】： 目的:为正中神经指浅屈肌肌支移位修复尺神经运动支,恢复手内在肌功能的临床应用提供解剖学基础。尺神经运动支(深支)支配小鱼际肌、骨间肌、拇收肌及第3、4蚓状肌,功能非常重要,当尺神经损伤后,将导致尺神经所支配的手内在肌麻痹,使手失去灵活的运动功能,对手功能影响很大。对高位的尺神经损伤用传统的神经修复方法缝接,由于缝接点至神经运动终板的再生距离长,细小的手内在肌在再生神经纤维长入神经运动终板之前,即发生废用性肌肉萎缩和机化,手术效果差;而前臂近端尺神经损伤,由于尺神经在此段内以感觉纤维为主,神经直接吻合后,有可能发生不同功能束的错接,使再生神经纤维迷失方向,长入感觉纤维膜管内,使手内在肌功能难以恢复。指浅屈肌肌支发自正中神经主干,是以运动纤维为主的神经分支,位于指浅屈肌的深面,位置恒定,变异少,易于寻找,以此肌支修复尺神经运动支是肌支对肌支的缝接,功能束对位准确,再生的神经纤维通过一个缝接口,可以最短的距离长入神经运动终板内,使手内在肌在最短的时间内重新获得神经支配,能有效防止其废用性肌肉萎缩,使手内在肌功能恢复良好。本课题通过对正中神经指浅屈肌肌支及尺神经相关研究,为临床上选择性修复尺神经运动支提供解剖学依据。 方法:选用10侧近期经福尔马林浸泡固定的成人上肢标本,肩外展90°伸直位,解剖暴露前臂段正中神经主干以及尺神经主干,显露正中神经指浅屈肌各肌支,先观察记录肌支数,然后用游标卡尺、规尺等测量工具测量指浅屈肌肌支的发出部位、入肌部位、横径、前后径、肌支从主干的起始点至入肌点间可自然分离的长度以及尺神经运动支和感觉支间自然分束无损伤分离长度。模拟操作:以适合移位的指浅屈肌肌支模拟吻合尺神经运动支(深支),修复手内在肌的功能。取指浅屈肌该肌支作横断面组织学切片,切片染色后置于光学显微镜下观察:高倍视野下测量5个随机视野的有髓神经纤维数目,求出神经纤维密度;低倍视野下测量肌支横断面神经束面积,最终计算出指浅屈肌该肌支有髓神经纤维数目。 结果:1指浅屈肌肌支:2-4支,1支型未发现,2支型1例占10%,3支型1例占10%,4支型8例占80%。对于其中的四支型,第一支发出部位距离桡骨茎突和尺骨茎突连线:200.5±12.2mm,入肌部位距离桡骨茎突和尺骨茎突连线:166.8±10.3mm,可分离长度:33.7±8.4mm,横径:1.0±0.1mm,前后径:0.6±0.1mm;第二支发出部位距离桡骨茎突和尺骨茎突连线:155.6±10.2mm,入肌部位距离桡骨茎突和尺骨茎突连线:113.9±10.5mm,可分离长度:40.4±6.4mm,横径:0.9±0.1mm,前后径:0.6±0.1mm;第三支发出部位距离桡骨茎突和尺骨茎突连线:90.9±2.8mm,入肌部位距离桡骨茎突和尺骨茎突连线:61.7±1.3mm,可分离长度:29.2±3.1mm,横径:0.8±0.1mm,前后径:0.6±0.1mm;第四支发出部位距离桡骨茎突和尺骨茎突连线:48.4±2.4mm,入肌部位距离桡骨茎突和尺骨茎突连线:21.4±1.8mm,可分离长度:27.1±1.2mm,横径:1.2±0.2mm,前后径:0.7±0.1mm。尺神经运动支和感觉支间自然分束无损伤分离距离为:7.1±0.7cm。2选择最适合移位的指浅屈肌肌支(第四肌支),经指浅屈肌深面转位模拟修复尺神经运动支获得成功。3正中神经指浅屈肌第四肌支的有髓神经纤维数为:1378.9±107.9条,满足为恢复有效的手内在肌功能所需要的有效生长神经纤维数目。 结论:1正中神经指浅屈肌肌支有足够的长度、横径以及有髓神经纤维数量,可以修复尺神经的运动支、恢复手内在肌的功能。该研究为正中神经指浅屈肌肌支移位修复尺神经运动支的临床应用打下了良好的解剖学基础。2切取部分指浅屈肌肌支后,由于保留了部分指浅屈肌的肌支以及指深屈肌具有足够的屈指功能,所以对手指的屈指功能影响较小。3正中神经指浅屈肌肌支的位置表浅,手术时的难度及其风险相对较小,且第四肌支距离被修复的尺神经运动支所支配的神经运动终板较近,可有效防止手内在肌萎缩。
[Abstract]:Objective: the median nerve superficial flexor muscle transposition to repair the ulnar nerve, and provide anatomical basis for clinical application to restore the function of intrinsic muscle of hand. The ulnar nerve motor branch (deep branch) dominates hypothenar muscles, interosseous muscle, adductor pollicis and 3,4 lumbricalis, function is very important, when the ulnar nerve injury that will lead to the ulnar nerve innervation of the hand intrinsic muscle paralysis, the hand lose flexible movement function, greatly affect the opponent function. The traditional method of using neural repair joint of high ulnar nerve injury, because the regeneration distance seam point to nervimotion end plate long before the intrinsic muscle of hand small nerve endplate ingrowth in the regeneration of nerve fibers, the disuse muscle atrophy and metaplasia, the operation effect is poor; and the proximal forearm ulnar nerve injury, because this period is dominated by ulnar nerve sensory fibers, nerve anastomosis, might have different functions of beam Wrong connection, make the nerve fiber regeneration lost, long into the sensory fibers of the membrane tube, so that the function of intrinsic muscle of hand. It is difficult to restore superficial flexor muscle from the median nerve trunk, nerve branches to motor fibers mainly located, refers to the deep layer of the superficial digital flexor constant position, less variation, easy to find, in order to muscle a repair of ulnar nerve muscular branches of muscular branches is the joint function, beam accurate positioning of the regenerated nerve fibers through a joint interface, can be the shortest distance into the long nerve endplate, the intrinsic muscle re innervation in the shortest period of time, can effectively prevent the atrophy with muscle, the intrinsic muscle recovery is good. The superficial flexor muscle and ulnar nerve of the median nerve, for clinical selective repair of ulnar nerve to provide the anatomical basis.
Methods: the recent 10 sides of adult upper limb specimens soaked by formalin fixed, shoulder abduction 90 degrees extension, forearm median nerve trunk were exposed and ulnar nerve trunk revealed median nerve superficial flexor muscle branches, first recorded muscle count, and then use the vernier caliper measuring tool gauge measurement of flexor digitorum superficialis a part of the muscular branches, into muscle, transverse diameter, anteroposterior diameter, muscular branches from the starting point of the trunk to the entrance point of diaphragm between natural separation length and the ulnar nerve and sensory branches between the natural splitting no damage separation length. Simulation of operation: for displacement of the superficial flexor muscle simulating anastomosis ulnar nerve motor branch (deep branch), repair of hand intrinsic muscle function. The superficial flexor muscle branch of the cross section for histological staining, observed under optical microscope: at high magnification measurement of 5 random fields of the number of myelinated nerve fibers The nerve fiber density was calculated, and the area of the transverse section of the muscle branch was measured in the low magnification field, and the number of the nerve fibers of the muscle branch of the finger flexor muscle was calculated.
缁撴灉:1鎸囨祬灞堣倢鑲屾敮:2-4鏀，

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