肌皮神经肱肌支在股薄肌移植治疗下臂丛损伤中的解剖学研究及临床应用  

The anatomic study of nerve branch to brachialis muscle in treatment of lower brachial plexus injury by free gracilis transplantation

作　　者：邹学军[1,2] 顾立强[3] 

机构地区：[1]南方医科大学南方医院创伤骨科,广州510515 [2]九一七0八部队医院骨科 [3]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》2007年第10期951-954,共4页Chinese Journal of Orthopaedic Trauma

基　　金：广东省科技攻关项目（2002C31003）

摘　　要：目的通过解剖学研究，设计选择性肌皮神经肱肌支移位联合股薄肌移植术重建屈拇屈指功能术式，验证该术式在下臂丛神经损伤治疗中的安全性和有效性。方法30侧甲醛固定的成年国人上肢标本，经逐层解剖，观察肌皮神经肱肌支的走行，测量肱肌支的长度、直径。对2例创伤性下臂丛损伤上肢功能障碍患者进行选择性肌皮神经肱肌支移位联合股薄肌移植术重建屈拇屈指功能术式。术后观察屈拇屈指功能及手握持功能恢复情况。结果在30侧标本中，肌皮神经肱肌支分型：单支型25侧，占83．33％，粗细两支型1侧，多支型4侧，未见变异及异常发出。肌皮神经肱肌支长度平均为（52．66±6．45）mm，横径平均为（1．39±0．09）mm。肌皮神经肱肌支神经束平均为（2．83±0．46）束。2例患者术后4～6个月出现股薄肌收缩，恢复屈拇屈指功能。其中1例术后6个月屈拇屈指肌力达M4，可握持200g物品；术后12个月可握持500g物品，初步恢复手握持功能。结论以肌皮神经肱肌支为缝接神经的股薄肌移植治疗下臂丛根性撕脱伤可较好地恢复屈指屈拇功能，初步重建手握持功能。肌皮神经肱肌支可作为股薄肌移植治疗下臂丛神经损伤移位神经较理想的供体。Objective To study the efficacy and safety of transfer of selective musculocutaneous nerve （MCN） branch to brachialis muscle combined with free gracilis transplantation in treatment of lower brachial plexus injury on the basis of an anatomic observation. Methods This study was performed in 30 formalin-fixed specimens of upper limb from Chinese adult cadavers. The anatomic course, length and width of MCN branch to brachialis muscle were observed and measured. Two patients with root avulsion of lower brachial plexus were treated with transfer of selective MCN branch to brachialis muscle combined with free gracilis transplantation to reconstruct their inflexional function of thumb and fingers. After surgery they were followed up for 12 months to observe their functional recovery of thumb and finger inflexion and hand prehension. Results The anatomic dissection showed that 25 （83.33%） MCN branches to brachialis had a single ramus, 1 had a thick and a thin rami, and 4 had over 3 rami. The length of MCN branch to brachialis muscle was 52.66 ± 6. 45 mm. The width of MCN branch to brachialis muscle was 1.39 ± 0. 09 mm. The number of nerve tracts of MCN branch to brachialis muscle was 2.83 ± 0, 46. Muscle contraction of gracilis was observed in 2 patients 4 to 6 months after surgery and flexion of thumb and fingers was retrieved. Retrieving a muscle power of M4 in flexion of thumb and fingers, 1 patient could hold a weight of 200 g 6 months after surgery, and a weight of 500 g 12 months after surgery. Conclusions Transfer of selective MCN branch to brachialis muscle combined with free gracilis transplantation to reconstruct inflexional function of thumb and fingers may be effective and safe in treatment of root avulsion of lower brachial plexus. The MCN branch to brachialis muscle can be used as a fairly ideal donor nerve in treatment of lower brachial plexus injury by free gracilis transplantation.

关 键 词：臂丛 创伤和损伤 肌皮神经 组织移植 解剖学 

分 类 号：R686[医药卫生—骨科学]