正中神经拇短屈肌肌支移位治疗高位尺神经损伤的应用解剖

摘要

Objective To explore the anatomical basis for the flexor pollicis brevis branch of median nerve transfer to the deep branch of ulnar nerve.Methods Eight fresh upper limb were dissected and observed.The specimen were dissected under the loup.Observed the number of the flexor pollicis brevis branch and measured the distances from pisiform bone to the flexor pollicis brevis branch.Then the transfer operation on the cadaver were imitated.After the anastomosis was completed,the stumps of the nerves were sectioned and stained with HE.The crossing-sectional area and the density of nerve fiber were obtained by Image-Pro Plus version 6.0,then the number of the nerve fiber were calculated.The data analyzed by SPSS 17.0.Results The flexor pollicis brevis branch constantly appear,there were two branches in 2 specimens,one branch in 6 specimens.The flexor pollicis brevis branch could transfer to the deep branch of ulnar nerve by end-to-end surture without tension.The regeneration distances was (37.3 ± 5.76) mm.The crossing-sectional area were (0.0575 ± 0.0086)mm2 and (0.2039 ± 0.0396)mm2,the number were (492.50± 62.62) and (1651.13± 79.01),the density were (8781.4246 ± 1676.2894)/mm2 and (8371.1592 ± 1677.6509)/mm2 in the flexor pollicis brevis branch and the deep branch of ulnar nerve,respectively.There were no significant differences in the density of the nerve fiber between the donor and recipient nerve (P ＜0.05).But there were differences in the crossing-sectional area and number of the nerve fiber(P ＜ 0.05).Conclusion The flexor pollicis brevis branch transfer to the deep branch of ulnar nerve can provide a short regenerating distance,but can supply a part of recipient nerve to reinnervate.%目的 探讨正中神经拇短屈肌肌支移位于尺神经深支的解剖学依据. 方法 新鲜成人上肢8侧,首先对标本的腕、手部进行显微解剖,观察拇短屈肌肌支的数量,游标卡尺测量拇短屈肌肌支到豌豆骨距离以代表神经的再生距离,并在尸体上模拟拇短屈肌肌支移位到尺神经深支的手术.切取神经标本予以苏木精-伊红(HE)染色,使用图像处理软件Image-Pro Plus version 6.0测量有髓神经纤维横截面积、密度并计算有髓神经纤维数量.数据通过SPSS 17.0软件进行统计学分析. 结果 拇短屈肌肌支无缺失,其中2侧标本肌支为两支,6侧标本肌支为一支.在所有的尸体标本中拇短屈肌肌支移位至尺神经深支后均可进行无张力缝合,移位后再生距离为(37.3±5.76)mm.拇短屈肌肌支和尺神经深支有髓神经的横截面积分别为(0.0575±0.0086)mm2和(0.2039±0.0396)mm2、数量分别为(492.50±62.62)条和(1651.13±79.01)条、密度分别为(8781.4246±1676.2894)条/mm2和(8371.1592±1677.6509)条/mm2.有髓神经纤维横截面积和数量差异均有统计学意义(P＜0.05),但两者有髓神经纤维密度差异无统计学意义(P＞ 0.05). 结论 拇短屈肌肌支移位术可提供较短的再生距离,但是只能满足部分尺神经深支神经纤维的再生.