發(fā)布時間：2018-04-18 06:41

  本文選題：指淺屈肌肌支 + 神經(jīng)移位　； 參考：《河北醫(yī)科大學》2008年碩士論文

【摘要】： 目的:為正中神經(jīng)指淺屈肌肌支移位修復尺神經(jīng)運動支,恢復手內(nèi)在肌功能的臨床應用提供解剖學基礎。尺神經(jīng)運動支(深支)支配小魚際肌、骨間肌、拇收肌及第3、4蚓狀肌,功能非常重要,當尺神經(jīng)損傷后,將導致尺神經(jīng)所支配的手內(nèi)在肌麻痹,使手失去靈活的運動功能,對手功能影響很大。對高位的尺神經(jīng)損傷用傳統(tǒng)的神經(jīng)修復方法縫接,由于縫接點至神經(jīng)運動終板的再生距離長,細小的手內(nèi)在肌在再生神經(jīng)纖維長入神經(jīng)運動終板之前,即發(fā)生廢用性肌肉萎縮和機化,手術(shù)效果差;而前臂近端尺神經(jīng)損傷,由于尺神經(jīng)在此段內(nèi)以感覺纖維為主,神經(jīng)直接吻合后,有可能發(fā)生不同功能束的錯接,使再生神經(jīng)纖維迷失方向,長入感覺纖維膜管內(nèi),使手內(nèi)在肌功能難以恢復。指淺屈肌肌支發(fā)自正中神經(jīng)主干,是以運動纖維為主的神經(jīng)分支,位于指淺屈肌的深面,位置恒定,變異少,易于尋找,以此肌支修復尺神經(jīng)運動支是肌支對肌支的縫接,功能束對位準確,再生的神經(jīng)纖維通過一個縫接口,可以最短的距離長入神經(jīng)運動終板內(nèi),使手內(nèi)在肌在最短的時間內(nèi)重新獲得神經(jīng)支配,能有效防止其廢用性肌肉萎縮,使手內(nèi)在肌功能恢復良好。本課題通過對正中神經(jīng)指淺屈肌肌支及尺神經(jīng)相關(guān)研究,為臨床上選擇性修復尺神經(jīng)運動支提供解剖學依據(jù)。 方法:選用10側(cè)近期經(jīng)福爾馬林浸泡固定的成人上肢標本,肩外展90°伸直位,解剖暴露前臂段正中神經(jīng)主干以及尺神經(jīng)主干,顯露正中神經(jīng)指淺屈肌各肌支,先觀察記錄肌支數(shù),然后用游標卡尺、規(guī)尺等測量工具測量指淺屈肌肌支的發(fā)出部位、入肌部位、橫徑、前后徑、肌支從主干的起始點至入肌點間可自然分離的長度以及尺神經(jīng)運動支和感覺支間自然分束無損傷分離長度。模擬操作:以適合移位的指淺屈肌肌支模擬吻合尺神經(jīng)運動支(深支),修復手內(nèi)在肌的功能。取指淺屈肌該肌支作橫斷面組織學切片,切片染色后置于光學顯微鏡下觀察:高倍視野下測量5個隨機視野的有髓神經(jīng)纖維數(shù)目,求出神經(jīng)纖維密度;低倍視野下測量肌支橫斷面神經(jīng)束面積,最終計算出指淺屈肌該肌支有髓神經(jīng)纖維數(shù)目。 結(jié)果:1指淺屈肌肌支:2-4支,1支型未發(fā)現(xiàn),2支型1例占10%,3支型1例占10%,4支型8例占80%。對于其中的四支型,第一支發(fā)出部位距離橈骨莖突和尺骨莖突連線:200.5±12.2mm,入肌部位距離橈骨莖突和尺骨莖突連線:166.8±10.3mm,可分離長度:33.7±8.4mm,橫徑:1.0±0.1mm,前后徑:0.6±0.1mm;第二支發(fā)出部位距離橈骨莖突和尺骨莖突連線:155.6±10.2mm,入肌部位距離橈骨莖突和尺骨莖突連線:113.9±10.5mm,可分離長度:40.4±6.4mm,橫徑:0.9±0.1mm,前后徑:0.6±0.1mm;第三支發(fā)出部位距離橈骨莖突和尺骨莖突連線:90.9±2.8mm,入肌部位距離橈骨莖突和尺骨莖突連線:61.7±1.3mm,可分離長度:29.2±3.1mm,橫徑:0.8±0.1mm,前后徑:0.6±0.1mm;第四支發(fā)出部位距離橈骨莖突和尺骨莖突連線:48.4±2.4mm,入肌部位距離橈骨莖突和尺骨莖突連線:21.4±1.8mm,可分離長度:27.1±1.2mm,橫徑:1.2±0.2mm,前后徑:0.7±0.1mm。尺神經(jīng)運動支和感覺支間自然分束無損傷分離距離為:7.1±0.7cm。2選擇最適合移位的指淺屈肌肌支(第四肌支),經(jīng)指淺屈肌深面轉(zhuǎn)位模擬修復尺神經(jīng)運動支獲得成功。3正中神經(jīng)指淺屈肌第四肌支的有髓神經(jīng)纖維數(shù)為:1378.9±107.9條,滿足為恢復有效的手內(nèi)在肌功能所需要的有效生長神經(jīng)纖維數(shù)目。 結(jié)論:1正中神經(jīng)指淺屈肌肌支有足夠的長度、橫徑以及有髓神經(jīng)纖維數(shù)量,可以修復尺神經(jīng)的運動支、恢復手內(nèi)在肌的功能。該研究為正中神經(jīng)指淺屈肌肌支移位修復尺神經(jīng)運動支的臨床應用打下了良好的解剖學基礎。2切取部分指淺屈肌肌支后,由于保留了部分指淺屈肌的肌支以及指深屈肌具有足夠的屈指功能,所以對手指的屈指功能影響較小。3正中神經(jīng)指淺屈肌肌支的位置表淺,手術(shù)時的難度及其風險相對較小,且第四肌支距離被修復的尺神經(jīng)運動支所支配的神經(jīng)運動終板較近,可有效防止手內(nèi)在肌萎縮。
[Abstract]:Objective: the median nerve superficial flexor muscle transposition to repair the ulnar nerve, and provide anatomical basis for clinical application to restore the function of intrinsic muscle of hand. The ulnar nerve motor branch (deep branch) dominates hypothenar muscles, interosseous muscle, adductor pollicis and 3,4 lumbricalis, function is very important, when the ulnar nerve injury that will lead to the ulnar nerve innervation of the hand intrinsic muscle paralysis, the hand lose flexible movement function, greatly affect the opponent function. The traditional method of using neural repair joint of high ulnar nerve injury, because the regeneration distance seam point to nervimotion end plate long before the intrinsic muscle of hand small nerve endplate ingrowth in the regeneration of nerve fibers, the disuse muscle atrophy and metaplasia, the operation effect is poor; and the proximal forearm ulnar nerve injury, because this period is dominated by ulnar nerve sensory fibers, nerve anastomosis, might have different functions of beam Wrong connection, make the nerve fiber regeneration lost, long into the sensory fibers of the membrane tube, so that the function of intrinsic muscle of hand. It is difficult to restore superficial flexor muscle from the median nerve trunk, nerve branches to motor fibers mainly located, refers to the deep layer of the superficial digital flexor constant position, less variation, easy to find, in order to muscle a repair of ulnar nerve muscular branches of muscular branches is the joint function, beam accurate positioning of the regenerated nerve fibers through a joint interface, can be the shortest distance into the long nerve endplate, the intrinsic muscle re innervation in the shortest period of time, can effectively prevent the atrophy with muscle, the intrinsic muscle recovery is good. The superficial flexor muscle and ulnar nerve of the median nerve, for clinical selective repair of ulnar nerve to provide the anatomical basis.
Methods: the recent 10 sides of adult upper limb specimens soaked by formalin fixed, shoulder abduction 90 degrees extension, forearm median nerve trunk were exposed and ulnar nerve trunk revealed median nerve superficial flexor muscle branches, first recorded muscle count, and then use the vernier caliper measuring tool gauge measurement of flexor digitorum superficialis a part of the muscular branches, into muscle, transverse diameter, anteroposterior diameter, muscular branches from the starting point of the trunk to the entrance point of diaphragm between natural separation length and the ulnar nerve and sensory branches between the natural splitting no damage separation length. Simulation of operation: for displacement of the superficial flexor muscle simulating anastomosis ulnar nerve motor branch (deep branch), repair of hand intrinsic muscle function. The superficial flexor muscle branch of the cross section for histological staining, observed under optical microscope: at high magnification measurement of 5 random fields of the number of myelinated nerve fibers The nerve fiber density was calculated, and the area of the transverse section of the muscle branch was measured in the low magnification field, and the number of the nerve fibers of the muscle branch of the finger flexor muscle was calculated.
緇撴灉:1鎸囨祬灞堣倢鑲屾敮:2-4鏀，

本文編號：1767229