正中神经指浅屈肌肌支修复尺神经手内在肌肌支的临床应用研究  

The clinical research of flexor digitorum superiicialis muscle branch of the median nerve to repair the hand intrinsic muscle branch of the ulnar nerve

作　　者：于亚东[1] 马涛[1] 田方涛[1] 孙庆禄 曹冉[1] 崔海斌[1] 

机构地区：[1]河北医科大学第三医院,石家庄市050051

出　　处：《中华显微外科杂志》2016年第6期540-543,共4页Chinese Journal of Microsurgery

基　　金：河北省财政厅项目（361005）

摘　　要：目的：探讨正中神经指浅屈肌肌支修复尺神经手内在肌肌支的临床应用。方法自2006年6月至2010年6月，我们对肘关节以近的单纯尺神经高位损伤的7例志愿者患者，在常规修复尺神经的同时，采用正中神经指浅屈肌肌支的第4肌支移位修复尺神经手内在肌肌支，术后3个月开始随访，最长达5．5年。术后观察手内在肌的外形、肌力、尺神经支配区的感觉功能和肌电图检测结果。结果小指指端感觉恢复时间约18个月；两点辨别觉检查显示患手感觉有效恢复，为（5．13±0．73）mm但明显较健手[（4．14±0．25）mm]差。术后7个月左右，患手尺神经相关运动开始恢复，最先恢复的是小指内收、外展功能；其次是环、中、示指；最后是拇收肌。术后1．5年，手内在肌肌力为Ⅱ-Ⅳ级不等，夹纸试验（－），Froment 征（－）。6例无明显爪形手畸形，3例有不同程度的拇内收肌萎缩。结论正中神经指浅屈肌肌支移位修复尺神经手内在肌肌支可一定程度减缓手内在肌萎缩。Objective To investigate the clinical application of flexor digitorum superiicialis muscle branch of the median nerve to repair the hand intrinsic muscle branch of the ulnar nerve. Methods From June, 2006 to June,.2010, 7 volunteers of level ulanr never pure injuries near to the elbow were treated by transferring flexor dig-itorum superiicialis muscle branch of the median nerve to the hand intrinsic muscle branch of the ulnar nerve.The follow-up period ranged from 3 months to 5.5 years,with an average of 1.5 years..The shape and the musle power of hand intrinsic musle ,the sensory fuction of ulnar nerve ,and the results of EMG after operation were observed. Results The pinkie finger sensory recovery time was about 1.5 years ,.and two-point discrimination test showed that the sensory of the wounded hand recovered effectively ,.but was significantly worse than the healthy side. And the other sesory recover well. 7 months later , the motion relevant to ulnar nerve began to recover. The adduction and abduction functions of little finger recovered firstly. The ring , middle and index finger followed. Finally , the func tion of adductor muscle recovered. 1.5 years later , the intrinsic muscle strength grade was about 2-4 , paper clip test experiment （-）, Froment sign（-）. There were no obvious claw hand deformity in 6 cases,and the atrophy with varying degrees of adductor muscle occurred in 3 cases. Conclusion Flexor digitorum superiicialis muscle branch of the median nerve transfer to the hand intrinsic muscle branch of the ulnar nerve combined with functional exer-cise can effectively treated and slow down the intrinsic muscles atrophy.

关 键 词：尺神经 手内在肌肌支 正中神经 指浅屈肌肌支 手内在肌 肌萎缩 

分 类 号：R688[医药卫生—骨科学]