正中神经返支的解剖及临床研究

目的　研究正中神经返支的解剖特点 ,提高腕管综合征的手术疗效。方法　通过应用解剖观察正中神经返支在走行过程中存在的易卡因素。 2 0 0 2 -2 0 0 4年 ,对 2 3例 3 4侧腕管综合征 ,在作正中神经松解时 ,同时探查及松解正中神经返支 ,并切除对返支形成卡压的拇短屈肌尺侧缘腱纤维束和致密的纤维弓。结果　 3 4侧术中均发现正中神经返支存在易卡压解剖因素 ,其中 8侧受到纤维弓及腱纤维束的明显卡压。全部病例获得 2个月～ 1年随访。功能评定 :优 17侧 ,良 7侧 ,可 10侧 ,优良率为 70 .6%。结论　中、重度腕管综合征在松解正中神经时 ,应同时行返支松解术。

Compression of median nerve recurrent branch: anatomical basis and clinical study

ObjectiveTo explore the etiology of compression of the recurrent branch of the median nerve and improve the surgical outcome of carpal tunnel syndrome.Methods20 cadaver hands were dissected to observe the course of median nerve recurrent branch and its investment. Compression structures along the anatomical course were identified. From 2002 to 2004, 34 sides of carpal tunnel syndrome (CTS) in 23 patients were treated. In addition to carpal tunnel release, the recurrent branch of the median nerve was explored and any compression structure was excised. Postoperative follow up ranged from 2 months to 1 year.ResultsIn 70 85% of the cadavers tendinous fibers along the ulnar part of the flexor pollicis brevis were found to form tendinous band or arch that could cause compression of the median nerve recurrent branch. These tendinous structures were found in all 34 cases of CTS and released in the operation. Obvious compression of the nerve branch was seen in 8 cases. Functional assessment using Kelly's grading system revealed excellent results in 17 cases, good in 7 and fair in 10. The overall excellent and good rate was 70.6%.ConclusionThere exsits tendinous structures which frequently compress the recurrent branch of the median nerve along its course. It is necessary to explore and neurolyse the recurrent branch of the median nerve in the operation of moderate to severe carpal tunnel syndrome.