带筋膜蒂前臂外侧皮神经移植修复桡神经损伤

目的探讨桡神经深支损伤后的修复与临床疗效。方法采用带筋膜蒂的前臂外侧皮神经移植修复桡神经深支。结果30例均获得18～36个月随访,按Highet运动分级法进行评定,优18例,良9例,可3例,优良率90%。结论采用带筋膜蒂的前臂外侧皮神经移植修复桡神经深支的手术方法可行,有利于桡神经深支的功能恢复。     

Lateral antebrachial cutaneous neuropathy following the long head of the biceps rupture

Lateral antebrachial cutaneous neuropathies present as purely sensory lesions, manifesting as elbow pain or dysesthetic pain over the lateral forearm. Classically, entrapment of the lateral antebrachial cutaneous nerve has been documented at the lateral edge of the biceps tendon as it exits the deep fascia in the antecubital fossa. We report a case of lateral antebrachial cutaneous nerve traction neuritis, rather than entrapment, resulting from a rupture of the long head of the biceps. The biceps displaced the nerve laterally, resulting in sensory loss and severe allodynia. The patient's symptoms were relieved with proximal biceps tenodesis.     

正常人前臂内侧皮神经感觉传导研究

首次研究应用逆向法测定正常人前臂内侧皮神经短潜伏期体感诱发电位（ｓｈｏｒｔ ｌａｔｅｎｃｙｓｏｍａｔｏｓｅｎｓｏｒｙ ｅｖｏｋｅｄ ｐｏｔｅｎｔｉａｌｓ），并研究其感觉动作电位（ｓｅｎｓｏｒｙ ｎｅｒｖｅ ａｃｔｉｏｎ ｐｏｔｅｎｔｉａｌ）。方法：（１）ＳＮＡＰ：肱骨内上髁前外侧平均２．６ｃｍ处表面双极刺激，前臂军面内侧平均１０．３ｃｍ，处记录ＳＮＡＰ． （２）ＳＬＳＥＰ：上述刺激位置不变，用四道程记录锁骨上、颈_７棘突、对侧顶区（Ｐ_３／Ｐ_４）相应的Ｎ_９、Ｎ_（１３）、Ｎ_（２０）诱发电位。通过分别对Ｎ_９、Ｎ_（１３）、Ｎ_（２０）的潜伏期、Ｎ９－Ｎ（１３）峰间潜伏期与臂长的相关分析，认为峰间潜伏期及自身双侧对照的潜伏期差值和波幅比值为临床可靠指标，可望对胸廓出口综合征（ＴＯＳ）早期诊断有指导意义。     

正常人前臂内侧皮神经感觉传导研究

首次研究应用塑向法测定正常人前臂内侧皮神经短潜伏期体感诱发电位，并研究其感觉动作电位。     

前臂外侧皮神经营养血管逆行蒂岛状皮瓣修复手背软组织缺损

目的 探讨应用前臂外侧皮神经营养血管逆行蒂岛状皮瓣修复手背软组织缺损的临床效果.方法 11例手背软组织缺损患者,最小缺损面积为3.0 cm×2.5 cm,最大为6.5 cm×4.0cm,采用前臂外侧皮神经营养血管逆行蒂岛状皮瓣修复,皮瓣切取面积为3.5 cm×3.0 cm～7.0 cm×4.0 cm.结果 术后11例皮瓣全部成活,随访2个月至2年,皮瓣质地弹性良好,手外形与功能改善满意,皮瓣浅感觉存在;前臂供区直接缝合7例,中厚植皮4例,外观满意.结论 前臂外侧皮神经营养血管逆行蒂岛状皮瓣是修复手背软组织缺损的较理想术式.     

Anatomy of the lateral antebrachial cutaneous and superficial radial nerves in the forearm: a cadaveric and clinical study

PURPOSE: To define the anatomy of the lateral antebrachial cutaneous nerve (LACN) and the superficial radial nerve (SRN) in relation to easily identifiable landmarks in the dorsoradial forearm to minimize the risk to both nerves during surgical approaches to the dorsal radius. METHODS: In this study 37 cadaveric forearms and 20 patients having distal radius external fixation were dissected to identify these nerves in relation to various anatomic landmarks. RESULTS: Based on these dissections the anatomy was divided into 2 zones that can be identified by easily visible and palpable landmarks. Zone 1 extends from the elbow to the cross-over of the abductor pollicis longus with the extensor carpi radialis brevis and longus. Zone 2 is distal to the cross-over. In zone 1 the 2 nerves can be differentiated through limited incisions based on their depth and anatomic location. Within this zone the SRN is deep to the brachioradialis until 1.8 cm proximal to zone 2 (9 cm proximal to the radial styloid), where it becomes superficial and pierces the fascia of the mobile wad and then remains deep to the subcutaneous fat. In contrast the LACN pierces the fascia between the brachialis and biceps muscles at the level of the elbow. In all specimens the LACN ran parallel to the cephalic vein within the subcutaneous fat. In 31 specimens it ran volar to the vein and in 5 specimens the nerve crossed under the cephalic vein at the elbow and ran dorsal to the vein in the forearm. One specimen had 2 branches with 1 on either side of the vein. Differentiation of these nerves was found to be possible through limited incisions in zone 1 during placement of external fixation pins for distal radius fractures. The LACN always was located in the superficial fat running with the cephalic vein, whereas the SRN was deeper to this nerve either covered by the brachioradialis or closely adherent to it within the investing fascia of the mobile wad. In zone 2 the nerves arborized and ran in the same tissue plane, making differentiation through limited incisions difficult. CONCLUSIONS: Dividing forearm anatomy into zones aids in understanding the complex 3-dimensional anatomy. Recognition of the consistent location of both the LACN and SRN facilitates surgical exposure. This allows localization through limited incisions during nerve repair and hardware placement, thereby enhancing uncomplicated and favorable outcomes.     

前臂外侧皮神经营养血管远端蒂皮瓣的临床应用

目的报道前臂外侧皮神经营养血管远端蒂皮瓣的临床应用疗效。方法根据前臂外侧皮神经营养血管皮瓣血供来源及其与前臂筋膜皮肤血供的相互关系，在前臂外侧设计皮神经营养血管远端蒂皮瓣，转位修复手部、腕部及前臂远端软组织缺损19例。结果术后皮瓣完全成活，创面一期愈合，经3～30个月随访，皮瓣外形与手部功能恢复满意。结论前臂外侧皮神经营养血管远端蒂皮瓣解剖位置恒定，血液供应良好，手术方法简单，适用于修复手部、前臂软组织的缺损。     

Anatomy of the posterior antebrachial cutaneous nerve: practical information for the surgeon operating on the lateral aspect of the elbow

PURPOSE: To investigate the anatomic relationships of the posterior antebrachial cutaneous nerve (PABCN) to anatomic landmarks on the lateral side of the elbow. METHODS: The PABCN was explored in 30 cadaveric upper extremities. Distances were noted from easily identifiable structures including the lateral epicondyle, the lateral intermuscular septum, and the radial nerve. RESULTS: The path of the PABCN follows the spiral groove initially, diverging as the radial nerve pierces the lateral intermuscular septum. The PABCN emerges from the posterior compartment through a hiatus in the deep fascia at a mean of 6.6 cm proximal to the lateral epicondyle and passes a mean of 2.1 cm anterior to the lateral epicondyle. CONCLUSIONS: The anatomic relationships determined in this study should enable the surgeon to avoid injuring the PABCN when performing surgery in the lateral elbow region.     

健侧颈7移位术移植神经的解剖学研究

目的 研究前臂内侧皮神经与尺神经同时作为健侧颈7神经根移位术的移植神经,为临床提供解剖依据.方法 选用陈旧尸体8具16侧、新鲜尸体3具6侧.模拟健侧颈7移位术,以前臂内侧皮神经与尺神经同时作为移植神经,观测前臂内侧皮神经的行径、分支及与尺神经、周围结构的毗邻关系.结果 前臂内侧皮神经与尺神经均发自臂丛神经下干,相邻位置恒定.其中9具18侧前臂内侧皮神经在肱骨内上髁上[(7.68±3.4)cm,-x±s,下同]分为两支,即前外支和后内支.2具4侧表现为单干型,即一条主干,无明显分支.在上臂中段前臂内侧皮神经所含神经束为4～8个,平均4.8个,尺神经为6～11个,平均8.1个.前臂内侧皮神经从前臂中段至起始处可供游离长度为(25.8±2.1)cm,尺神经为(59.2±6.4)cm,同一手术切口内易于与尺神经一起逆转移位作为移植神经.结论 从解剖学角度证实前臂内侧皮神经与尺神经同时作为健侧颈7神经根移位术的移植神经,可增加桥梁神经的神经纤维含量,其方法是安全、可行的.     

Sensory restoration by lateral antebrachial cutaneous to ulnar nerve transfer in children with global brachial plexus injuries

Selective peripheral nerve transfers represent an emerging reconstructive strategy in the management of both pediatric and adult brachial plexus and peripheral nerve injuries. Transfer of the lateral antebrachial cutaneous nerve of the forearm into the distal ulnar nerve is a useful means to restore sensibility to the ulnar side of the hand when indicated. This technique is particularly valuable in the management of global brachial plexus birth injuries in children for which its application has not been previously reported. Four children ages 4 to 9 years who sustained brachial plexus birth injury with persistent absent sensibility on the unlar aspect of the hand underwent transfer of the lateral antebrachial cutaneous nerve to the distal ulnar nerve. In three patients, a direct transfer with a distal end-to-side repair through a deep longitudinal neurotomy was performed. In a single patient, an interposition nerve graft was required. Restoration of sensibility was evaluated by the “wrinkle test.”     

前臂外侧皮神经营养血管皮瓣修复手及前臂创伤

目的探讨前臂外侧皮神经营养血管皮瓣临床应用。方法自2006年3月-2009年1月,我科采用前臂外侧皮神经营养血管皮瓣修复手部、腕部、虎口、肘部区域软组织缺损45例。结果本组45例伤口均一期愈合,2例术后第2d远端肿胀,呈紫红色,并有水疱,经手术探查发现蒂部旋转时过紧,经调整后3d,皮瓣颜色红润;7例术后第3d皮瓣肿胀加重,全皮瓣紫红色,伴头静脉充盈怒张,皮下结扎头静脉后,症状逐步改善。本组术后随访3～18月,皮瓣外形满意,无臃肿,皮瓣恢复部分感觉,手功能恢复良好。结论前臂外侧皮神经营养血管皮瓣是修复手部、腕部、虎口、肘部区域软组织缺损较理想的手术方法。     

铍针治疗臀中皮神经卡压综合征

目的 :探讨在臀中皮神经卡压综合征中张力与疼痛的相关性 ,铍针减张治疗的有效性。方法 :用张力计测量铍针减张治疗臀中皮神经卡压综合征前后软组织的张力 ,并对软组织张力变化加以比较分析。结果 :经 1～ 12个月的随访 ,平均 6 3个月 ,其中治愈 2 1例 ,显效 6例 ,有效 3例 ,无效 2例 ,总有效率 93 75 %。所有患者治疗前测软组织张力指数为 3 14± 0 78,治疗后为 2 10± 0 93,经统计学处理治疗前后张力指数间的差异有非常显著意义 (P <0 0 1)。结论 :铍针可以切刺限制张力释放的纤维结缔组织如筋膜等 ,释放过高的筋膜腔内张力 ,或通过局部流体静压的调整缓解了对末梢神经的刺激     

前臂内侧皮神经后支与肘管综合征手术切口的解剖关系

目的 观察肘部前臂内侧皮神经(medial antebrachial cutaneous nerve,MACN)后支的解剖特征,探讨在肘管综合征松解手术中防止其医源性损伤的方法.方法 解剖10具(20侧)成人上肢标本,并对12例肘管综合征手术患者,在肱骨内上髁远、近各8 cm范围内,观察NACN后支的数目、横跨角度并测定其与手术切口(内上髁前1 cm)的交汇部位.结果 32侧肢体共记录到62支MACN 后支,平均每侧肢体为1.9支.其中1支者8侧(25.0%,均位于内上髁远侧),2支者19侧(59.4%),3支者4侧(12.5%),4支者1侧(3.1%).位于内上髁下方者37支(59.7%),内上髁上方者25支(40.3%).这些后支与切口线的交角均大于45°,即皮神经是横向跨过切口线的.所有标本(100%)均至少有1支后支从内上髁远侧跨过切口线,其距内上髁的平均距离为[(2.9±2.3)cm,x-±s,下同];在68.8%的标本中至少有1支后支从内上髁近侧跨过切口线,其距内上髁的平均距离为(2.1±1.8)cm.结论 MACN后支至少有1支横跨肘管综合征的手术切口线,了解其位置关系并在皮下组织中仔细解剖分出保护,有助于避免误伤.     

Median nerve reconstruction after entrapment in the elbow

Median nerve entrapment in the elbow is a known but rare complication of pediatric elbow dislocations. It is classified on the anatomical basis of entrapment. Due to a variety of factors, it is often diagnosed late. Because of this, substantial injury occurs to the nerve, requiring some form of restorative surgery in addition to release from the joint. Such nerve injury has been treated in a variety of ways including neurolysis, end-to-end anastomosis and nerve grafting. To date, there has been no conclusive evidence in the literature that one method should be preferred over another. A case of median nerve entrapment that was treated with sural nerve grafting is presented. In a review of the literature, previous treatment of such cases is discussed and compared.     

Surgery for refractory anterior cutaneous nerve entrapment syndrome (ACNES) in children

Background

Chronic abdominal pain (CAP) in children may be caused by entrapment of cutaneous branches of intercostal nerves (anterior cutaneous nerve entrapment syndrome, or ACNES). Local injection of anesthetics may offer relief, but pain is persistent in some children. This study is the first to describe the results of a ‘cutaneous neurectomy’ in children with refractory ACNES.

Methods

Chronic abdominal pain children with suspected ACNES refractory to conservative treatment received a cutaneous neurectomy in a day care setting. They were interviewed postoperatively using an adapted quality of life questionnaire (testing quality of life in children).

Results

All subjects (n = 6; median age, 15 years; range, 9-16 years) were previously healthy school-aged children without prior illness or earlier surgery. Each presented with intense abdominal pain and a positive Carnett sign. Blood, urine tests, and abdominal ultrasound investigations were normal. Delay in seeing a physician was 16 weeks, and school absence was 25 days. Before surgery, quality of life (pain, daily activities, and sports) was greatly diminished. After the neurectomy, all children were free of pain and had resumed their normal daily routine (follow-up at 6 months).

Conclusions

The role of the abdominal wall as the source of childhood CAP is underestimated. Some children with CAP have ACNES. Children with refractory ACNES should be offered a cutaneous neurectomy, as this simple technique is effective in the short and long term.     

Musculocutaneous Neuropathy: Case Report and Discussion

The musculocutaneous nerve arises from the lateral cord of the brachial plexus and contains fibers from the C5, C6, and C7 spinal nerve roots. It innervates such muscles as the biceps brachii and brachialis as well as supply branches to the skin over the lateral cubital and forearm regions via the lateral antebrachial cutaneous nerve. Musculocutaneous neuropathy can arise from exercise, participating in sports, strenuous activity, cast placement, trauma, and surgery in addition to other less understood causes such as Parsonage Turner syndrome. We present the case of a 55-year-old female who complained of numbness, weakness, and pain throughout the arm starting 1 day following a surgical procedure. Electrodiagnostic testing revealed a musculocutaneous neuropathy with significant axonal injury. Symptoms of musculocutaneous neuropathy may be similar to cervical spinal nerve root impingement or brachial plexus lesions. Therefore, magnetic resonance imaging and electrodiagnostic studies may be useful in differentiating between these conditions. Once the diagnosis of musculocutaneous neuropathy has been made, treatments include relative rest, nonsteroidal anti-inflammatory drugs, splinting, physical therapy, and surgical decompression in cases that do not respond to conservative management.     

肘下动脉穿支蒂前臂外侧皮神经营养血管皮瓣的解剖基础

目的 为肘下动脉穿支蒂前臂外侧皮神经营养血管皮瓣修复肘部软组织缺损提供解剖学基础.方法在30侧动脉内灌注红色乳胶的成人上肢标本上解剖观查:①前臂外侧皮神经的走行与分布;②肘下动脉与前臂外侧皮神经营养血管间吻合关系.另在1侧新鲜标本上进行摹拟手术设计.结果①前臂外侧皮神经主干行于前臂桡侧,分布于前臂外侧1/3区域;②营养血管为多节段、多源性,其中肘下动脉的位置相对恒定,在头静脉与深静脉系统的交通支形成的倒"V"状顶点到达皮肤,并分出众多的细小血管与前臂外侧皮神经的神经旁和神经干血管链的分支密切吻合.结论 可形成肘下动脉穿支蒂前臂外侧皮神经营养血管皮瓣顺行转位修复肘部软组织缺损.

Abstract：

Objective To provide anatomical basis for lateral antebrachial neurocutaneous flap pedi-cled with inferior cubital artery perforator in repairing tissue defects around elbow joint. Methods Thirty embalmed upper limbs of adult cadavers perfused with red latex were used for this study, and followings were observed:①The course and distribution of lateral antebrachial cutaneous nerve; ②Anastomoses between inferior cubital artery and nutrient vessels of lateral antebrachial cutaneous nerve. Mimic operation was performed on other side of fresh specimen. Results ①The main trunk of lateral antebrachial cutaneous nerve (LACN) lined in the radial forearm and distributed in the 1/3 region of lateral forearm. ①The nutritional vessels of the flap were plurisegmental and polyphyletic. The inferior cubital artery which was relatively constant reached to skin through "V"-shaped peak formed by communicating branches of cephalic vein and deep venous system. They also gave off large number of small veins, which closely aligned with perineural branches and neural stem vascular chain of lateral antebrachial cutaneous nerve. Conclusion The lateral antebrachial neurocutaneos flap pedicled with inferior cubital artery perforator can be formed to repaire tissue defects around elbow joint.     

Evaluation of local anaesthetic blockade of the lateral femoral cutaneous nerve

An assessment of local anaesthetic blockade of the lateral femoral cutaneous nerve using a standard technique was made. The rate of successful blockade was high, but the area of sensory loss was inconsistent between patients and was more anterior and distal than described in textbooks of anatomy.     

坚骨胶囊联合关节镜和尺神经松解术治疗肘关节骨关节炎伴尺神经卡压综合征的临床研究

目的探讨坚骨胶囊联合关节镜和尺神经松解术治疗肘关节骨关节炎伴尺神经卡压综合征的临床疗效。 方法选择河北省沧州中西医结合医院2018年1月至2021年5月收治的80例肘关节骨关节炎伴尺神经卡压综合征患者作为研究对象,采用随机数字表法分成观察组与对照组各40例。对照组给予关节镜和尺神经松解术治疗;在此基础上,观察组口服坚骨胶囊治疗。连续治疗6个月后采用顾玉东建议的肘管综合征功能评定标准进行疗效评定。治疗前后对两组患者进行Mayo肘关节功能评分（Mayo elbow performance score,MEPS）、视觉模拟量表（visual analogue scale,VAS）评分,测量肘关节活动度,进行肌电图检查。并统计两组患者副反应情况。 结果观察组肘管综合征功能评定优良率为75.00%（30/40）,与对照组的52.50%（21/40）相比显著升高（P<0.05）。两组治疗后MEPS评分均较治疗前显著升高（P<0.05）,疼痛VAS评分均较治疗前显著降低（P<0.05）;且治疗后,观察组MEPS评分显著高于对照组（P<0.05）,疼痛VAS评分显著低于对照组（P<0.05）。两组治疗后肘关节旋前度数、旋后度数以及屈伸度数均较治疗前显著增加（P<0.05）,且均以观察组改善更显著（P<0.05）。两组治疗后尺神经神经传导速度（nerve conduction velocity,NCV）、小指展肌复合肌肉动作电位（compound muscle action potential,CMAP）均较治疗前显著增加（P<0.05）,小指展肌运动诱发电位潜伏期（motor evoked potential latent period,MEPLP）均较治疗前显著缩短（P<0.05）;治疗后,观察组尺神经的NCV、小指展肌的CMAP显著高于对照组（P<0.05）,小指展肌的MEPLP显著短于对照组（P<0.05）。所有对象均无明显副反应发生。 结论坚骨胶囊联合关节镜和尺神经松解术治疗肘关节骨关节炎伴尺神经卡压综合征能安全有效地改善患者的手、肘功能,提高关节活动度,减轻疼痛程度。