吻合神经血管的趾短伸肌移植重建手内肌功能的解剖学研究  

Applied anatomy of extensor digitorum (hallucis) brevis transplantation for reconstruction of intrinsic hand function after brachial plexus injury

作　　者：尹博[1] 顾立强[2] 金丹[1] 林晓岗[1] 相大勇[1] 

机构地区：[1]南方医科大学南方医院创伤骨科,广州在读硕士510515 [2]中山大学附属第一医院显微创伤骨科

出　　处：《中华创伤骨科杂志》2006年第5期458-461,共4页Chinese Journal of Orthopaedic Trauma

基　　金：广东省科技攻关项目(2002C31003)

摘　　要：目的探讨吻合神经血管的趾短伸肌游离移植重建臂丛根性损伤后手内肌功能的相关解剖学基础。方法利用经甲醛防腐固定成人尸体下肢标本30侧,显露腓深神经沿其走行追踪腓深神经趾短伸肌肌支,显微解剖分离趾短伸肌,观察趾短伸肌肌肉形态、主要血供来源及主要支配神经走行,测量趾短伸肌的长度、宽度、厚度及腓深神经、趾短伸肌肌支的直径和最大可逆行分离长度。结果短伸肌有一个相对独立的肌腹和一条肌腱,趾短伸肌有一个共同的肌腹,3条肌腱,也有4腱发出其中3腱型占80%,4腱型占20%。趾短伸肌长度为(6.15±0.40)cm,宽度为(3.85±0.04)cm,厚度为(0.21±0.02)cm,其主要血供来自足背动脉,受腓深神经的趾短伸肌肌支支配,后者在腓深神经可主干中逆行分离的最大长度为(27.41±2.54)cm。结论趾短伸肌为羽状肌,有独立、恒定的血管、神经支配,且神经逆行分离长度较长,适合行利用吻合血管神经的趾短伸肌移植以重建臂丛根性损伤后手内在肌功能。Objective To provide an anatomical basis for reconstruction of intrinsic hand function with extensor digitorum （hallueis） brevis transplantation ＂after brachial plexus injury. Methods Thirty leg specimens from human corpses were fixed and preserved by formaldehyde. The deep peroneal nerve （DPN） was revealed to trace its muscular branch. The extensor digitorum （hallucis） brevis was carefully dissected and separated to observe its shape, main blood supply and main innervation. Its length, breadth, and thickness were measured. The diameter and maximum retrograde dissection length of deep peroneal nerve and its muscular branch were also measured. Results The extensor hallucis brevis has a relatively independent muscle belly and tendon, while the extensor digitorum brevis has one muscle belly but three tendons in 80% cases and even four tendons in 20% cases. On average, the extensor digitorum （hallucis） brevis has a length of （6. 15 ± 0.40）cm, a breadth of （3.85 ± 0.04）cm and a thickness of （0. 21 ± 0. 02 ）cm. The lateral tarsal artery was found to be the main blood supply to the muscle. The extensor digitorum （hallucis） brevis was observed to be innervated by the muscular branch of the deep peroneal nerve, whose maximum retrograde dissection length was found to be （27.41 ± 2.54 ）cm. Conclusion The muscle flap of extensor digitorum （hallucis） brevis can be used in the functional reconstruction of intrinsic hand after brachial plexus injury, because it has stable blood supply and sufficient innervation, and allows for long retrograde dissection of the nerve.

关 键 词：拇趾短伸肌 应用解剖 臂丛损伤 肌肉移植 

分 类 号：R322[医药卫生—人体解剖和组织胚胎学] R687.2[医药卫生—基础医学]