胫神经肌支移位修复腓深神经的显微解剖  

Anatomical study of motor branches from tibial nerve transfer to restore the deep fibular nerve

作　　者：李明恒[1] 张力成[1] 陈维波[1] 杨国敬[1] 邱海胜[1] 张雷[1] 彭辉煌[1] 吴建伟[1] 

机构地区：[1]温州医学院附属第三医院手外科,浙江省温州市325200

出　　处：《中华显微外科杂志》2011年第5期390-393,I0007,共5页Chinese Journal of Microsurgery

摘　　要：目的探讨胫神经肌支移位修复腓深神经的可行性。方法选取12具（23侧）福尔马林固定的成人下肢标本．解剖并测量胫神经各肌支的长度、直径、发出点至腓骨小头水平截面的距离（位置）和腓深神经近端的直径：模拟神经移位并测量各肌支的发出点至腓骨颈的距离。结果胫神经趾长屈肌支、躅长屈肌支和比目鱼肌浅支的平均长度分别为（95．70±13．40）mm、（96．90±13．60）mm和（73．60±12．00）mm，平均直径分别为（0．63±0．16）mm、（0．65±0．20）mm和（1．56±0．26）mm；腓深神经近端的平均直径为（2．54±0．26）mm。所有标本的胫神经趾长屈肌支和躅长屈肌支以及22侧（95．7％）标本的比目鱼肌浅支在长度上能够直接移位至腓骨颈处的腓深神经。胫神经的其他肌支均没有足够的长度直接移位至腓骨颈水平。结论实验证实胫神经肌支移位修复腓深神经在解剖学上可行。综合考虑神经的长度、直径以及手术操作难易度，比目鱼肌浅支是移位的最佳供体神经。Objective To explore the feasibility of tibial nerve motor branches transfer to the deep fibular nerve in an anatomical study. Methods Twenty-three sides lower limbs from 12 adult cadavers which preserved in Formalin were used for dissection of the tibial nerve and its all motor branches, and the proximal deep and superficial fibular nerve. Experimental measurement were performed for the parameters of each branch such as length, diameter, the location of original point relative to the level of the fibular head. The diameter of proximal part of the deep fibular nerve was measured simultaneously. Finally, the length from original point of each branch to the fibular neck was also measured during simulation of nerve transfer procedure. Results The average length of motor branches to the flexor digitorum longus muscle, to the flexor hallucis longus muscle and the superficial branches to the soleus muscle were （95.70 ± 13.40）ram, （96.90 ±13.60）mm and （73.60 ±12.00）mm respectively. Their average diameter were （0.63 ±0.16）mm, （0.65 ±0.20）mm and （1.56 ±0.26）mm respectively. The average diameter of proximal deep fibular nerve was （2.54 ± 0.26）mm. Based on length, branches to the flexor digitorum longus muscle and flexor hallucis longus mus- cle were adequate for direct nerve transfer to the deep fibular nerve in all specimens without interpositional grafr. And in 22 specimens （95.7 percent）, the superficial branches to the soleus muscle were long enough to directly transfer. Other branches of the tibial nerve were not adequate for direct nerve transfer Conclusion This study confirmed the anatomical feasibility of using motor branches from tibial nerve for direct transfer to restore the deep fibular nerve. The superficial branches to soleus muscle were the best donor nerve if considering the branches, length, diameter and the difficulty of surgical procedures.

关 键 词：胫神经 腓深神经 神经移位 腓总神经牵拉伤 应用解剖 

分 类 号：R322[医药卫生—人体解剖和组织胚胎学]