Riche-Cannieu吻合支再支配作用的初步研究  

A preliminary study on the reinnervation effect of the Riche-Cannieu anastomosis

作　　者：黎鸣[1] 肖丽亚[2] 林敏婷[1] 周雪贤[1] 

机构地区：[1]广东省佛山市中医院骨科肌电图室,528000 [2]广东省佛山市中医院骨科

出　　处：《中华显微外科杂志》2011年第6期464-467,共4页Chinese Journal of Microsurgery

基　　金：佛山市科技发展专项资金项目（201008083）

摘　　要：目的了解Riche—Cannieu吻合支（尺神经深支与正中神经返支在手掌中的变异吻合支）在正中神经损伤时对拇短展肌是否存在再支配作用。方法收集病例共43例（男29例，女14例．年龄14—57岁，平均32．6岁），均符合以下条件：（1）前臂及前臂以下外伤所致的正中神经损伤（临床以及电生理检测证实）。（2）神经电生理检测证实RCA存在，电位波幅小于1mV。（3）除外合并其他神经损伤或神经系统疾病及颈椎病、糖尿病。分别在损伤2～3周内、2～4个月内、1年之后进行患肢正中神经电生理检测，评估神经功能。结果43例正中神经中在临床与电生理方面均无明显恢复；8例拇指外展功能在3个月之内明显好转，相应Riche—Cannieu吻合支的CMAP波幅明显增高．相应拇短展肌的肌电图明显好转。结论在正中神经损伤合并存在RCA的情况下，失去正中神经支配的拇短展肌肌纤维有可能逐渐获得RCA纤维的再支配；这种再支配的速度大于一般受损神经的再生速度。Objective To study whether the abductor pollicis brevis been effected by the reinnervation of the Riche-Cannieu anastomosis in the median nerve injury cases. Methods Collect 43 cases （29 male, 14 female, mean age 32.6） corresponds with the study needs： （1）The traumatic median nerve injury （proved by the results of electrophysiological examine and the clinic diagnose）on or below the forearm. （2） The existence of RCA was verified by the electrophysiological examine results,and the amplitude of electric potential was under lmv. （3） Rule out the cases with the other injure of nerve or nervous system disease and cervical vertebra disease, diabetes patient. The analysis base on the results of 43 case＇s periodical examine, the periodical criteria as following： within 2-4th week, within the 2-4th month and 1 year after the injury. Results Forty-three eases had not obvious recovery indication of the median nerve under the clinical and electrophysiological aspect,eight cases of abductor pollicis brevis function improved quickly in 3 months, the relevant CMAP amplitude of Riche-Cannieu anastomosis increased apparently, the EMG （Electromyography） results of abductor pollieis brevis ameliorated accordingly. Conclusion In the ease of RCA combined with the median nerve injury, the abductor pollicis brevis fibra might be dominated by RCA reinnervation when losing domination of median nerve, the reinnervation process will much faster than the regeneration process of the broken nerve.

关 键 词：正中神经 Riche—Cannieu吻合支 拇短展肌 神经再支配 电生理检测 

分 类 号：R658[医药卫生—外科学]