问题1：正中、尺、桡神经各支配哪些手部肌肉？

解答：（1）正中神经支配手外在肌共9块：即掌长肌、桡侧腕屈肌、拇长屈肌、食中指指深屈肌和4块指浅屈肌；支配的内在肌共有4．5块：分别是拇短展肌、拇对掌肌、拇短屈肌浅头（为半块）和第一、二蚓状肌。（2）尺神经支配外在肌共3块：即尺侧屈腕肌、环小指指深屈肌；内在肌共14．5块：即骨间肌7块、第3、4蚓状肌2块、小鱼际肌群4块、     

单、双杠训练后旋后肌综合征1例

1病例报告患者男，21岁，某部战士。1996年2月始参加单、双杠规定练习训练，参训3个风后感左手伸腕、伸指乏力，不伴皮肤麻木，发病1周后住入我院。查体：左前臂轻度肌肉萎缩，旋后运动受限，伸腕肌力三级，且伸腕时手掌向烧侧偏斜。左伸拇、伸指肌力0级，不能伸掌格关节，可伸指间关节。左前臂上端烧骨小头前方局部压痛，Tinel征阳性。中指伸直试验因伸指不能而未成功。左手、左前臂皮肤无痛觉减退区。诊断：左侧旋后肌综合征。住院1周后行神经探查及松解手术治疗。术中见烧神经深支进入旋后肌浅、探头之间，旋后肌浅头上份呈键性，边缘锐…     

背阔肌肌皮瓣转位术重建手指屈、伸功能（附3例报告）

1973年Axer曾报告用部份背阔肌连接一条阔筋膜蒂来修复屈指功能。国内卢世壁等采用背阔肌转位与屈指肌缝合的新方法来恢复屈指功能。我科收治二例前臂缺血性肌挛缩致手屈指功能完全丧失，一例桡神经，正中神经损伤致手伸、屈指功能丧失，采用带血管神经蒂的背阔肌肌皮瓣重建屈、伸指功能，均获成功，现介绍如下。     

背阔肌-肌皮瓣治疗前臂Volkmann肌挛缩3例

例1 男,19岁。因左肱骨髁上骨折,经石膏固定1月后,致前臂、腕、手指功能障碍10年。诊断:左前臂Volkmann肌挛缩。在高位硬膜外加臂丛麻醉下行同侧背阔肌-肌皮瓣转位术,背阔肌面积7cm×36cm。皮瓣面积5cm×18cm。在腕部将背阔肌筋膜分为2条,分别与屈拇长肌、2～5指屈指深肌腱缝合,用皮瓣将前臂瘢痕创面覆盖。石膏固定于屈肘、屈腕、屈掌指关节位。术后切口一期愈合,经6年随访,肘关节伸     

桡神经损伤的肌腱移行手功能重建

目的：评估桡神经损伤后前臂屈肌腱移位术重建伸腕、伸拇及伸指功能的效果。方法：1992年10月-2005年10月,前臂屈肌腱移位术治疗不可逆桡神经损伤20例。其中桡神经损伤后缺损12例,桡神经不可逆的挫裂伤8例,均伴伸腕、伸拇及伸指功能障碍,肌力0-1级,前臂背侧肌群萎缩。肌腱移位术距神经损伤或修复时间为6个月-2年。结果：术后20例均经2-60个月随访,术后采用费起礼等〔1〕疗效评定法：优10例,良8例,手功能恢复基本满意;中2例,均为移位肌腱张力不足。结论：前壁屈肌腱移位术可作为不可逆桡神经损伤功能重建的首选方法。     

带蒂第二掌骨瓣治疗陈旧性腕舟状骨骨折26例

腕舟状骨骨折多发生在其腰部。腕舟骨主要尺、桡动脉分支经附着舟骨结节、腰部韧带内细小的血管分支供血 ,近1 3为关节软骨覆盖 ,无血管分支进入。因此 ,腕舟骨骨折时舟骨近骨折段血供阻断 ,易发生骨吸收坏死 ,造成骨折延迟愈合或不愈合[1 ] 。在治疗上虽有桡骨茎突切除术、带血管蒂桡骨膜瓣或骨瓣、带旋前方肌桡骨瓣移植等多种方法 ,其效果均不满意。我院自 1992年 11月以来 ,应用带蒂第二掌骨瓣移植方法 ,治疗腕舟状骨腰部陈旧性骨折不连接 2 6例 ,效果满意。临　床　资　料1.应用解剖 :桡动脉深支在发出第1掌背动脉后 ,进入手掌之前发出…     

神经端侧吻合治疗尺神经缺损2例

我院自2001年10月以来,采用神经端侧吻合法成功治疗尺神经缺损2例,现报告如下。1临床资料病例1:男,41岁。因车祸致左前臂异位畸形,骨质外露急诊入院。查体:左前臂后内侧中段约12cm×6cm皮肤及肌肉挫伤,尺、桡骨粉碎性骨折,尺动脉无搏动,尺神经支配区感觉丧失,手指收展不能,小指对掌不能。入院后急诊手术:术中见掌长肌,尺侧腕屈肌,指深屈肌大部,尺侧腕深肌,小指伸肌挫灭断裂,尺、桡骨中段粉碎性骨折,尺神经、尺动脉断裂缺失,尺神经在腕上6cm处缺损达8cm。正中神经连续性完好。清除坏死肌肉组织后,恢复骨连续性及断裂肌肉。见尺神经无法直接缝…     

颈神经后根切断术治疗上肢痉挛性脑瘫14例

1995年10月～1997年6月,我院采用选择性颈神经后根切断术治疗上肢痉挛性脑瘫14例,取得了解除上肢痉挛,改善上肢功能的效果。1　临床资料1.1　一般情况　本组男9例,女5例;年龄7～14岁。双上、下肢脑瘫8例,单纯双上肢3例,单侧上肢3例。其中,以肩关节内收,肘屈曲,前臂旋前,屈腕,屈指畸形为主,曾行前臂屈肌腱起点下移、屈指肌腱延长术4例。1.2　手术方法　取俯卧位,全麻,自颈5～胸1做纵切口,咬除颈5～胸1棘突及椎板,切开硬膜,分离颈5～胸1脊神经后根。颈神经后根从脊髓发出到出椎间孔长约1.0cm,后根自然分成3或4小束,分别测定每个小束的神经刺激…     

应用阔筋膜移植矫正电烧伤后蚓状肌瘫痪手畸形1例

1　病例介绍　　男 ,30岁。于 1998年 12月右腕及前臂遭受 6 6万Ｖ接触性电烧伤 ,引起局部皮肤软组织缺损、正中神经损伤、尺神经损伤 ,于当地医院早期扩创腹部皮瓣覆盖。 1999年 7月因右手功能障碍来我院治疗。检查 :右腕及前臂掌侧皮瓣肿厚 ,14指掌侧感觉丧失 ,小指掌侧感觉迟钝 ,拇指内收 ,2 4掌指关节背屈、指间关节屈曲 ,大小鱼际肌群及骨间肌萎缩 ,手指伸屈活动受限。在行皮瓣去脂修薄同时 ,进行屈指肌腱粘连松解 (屈指浅肌腱腕部缺如 ,手掌部分予剥离去除 )、腓肠神经移植 (12 0ｃｍ)正中神经修补、尺神经松解术。 2 0 0 0年 1月再…     

旋前圆肌肌腱重建骨间膜中央束对Essex-Lopresti损伤后前臂纵向稳定的作用

目的 研究旋前圆肌肌腱转位重建骨间膜中央束在恢复Essex-Lopresti损伤中前臂纵向稳定中的效果.方法 10具新鲜成人前臂标本,各标本依次按桡骨头切除、桡骨头+三角纤维软骨复合体(TFCC)切除、桡骨头+TFCC+骨间膜中央束切除、旋前圆肌肌腱转位重建中央束、单纯桡骨头置换、旋前圆肌肌腱转位+桡骨头置换6个步骤进行试验.应用单因素重复测量数据的方差分析比较各步骤桡骨向近端移位5 mm时施加在标本两端的负荷差异,进而判断各步骤对前臂纵向稳定的恢复效果.结果 各个步骤中桡骨向近端移位5 mm时所需平均负荷差异均有统计学意义(P＜0.01).使桡骨向近端移位5 mm时,旋前圆肌重建中央束所需负荷是骨间膜完整时的55.66%;旋前圆肌肌腱转位+桡骨头置换时所需负荷是单纯旋前圆肌肌腱重建中央束时的599.31%,是桡骨头切除时的333.56%.结论 单纯旋前圆肌肌腱转位重建中央束不足以恢复Essex-Lopresti损伤后前臂纵向稳定性;旋前圆肌重建中央束结合金属桡骨头假体置换更有利于恢复前臂的纵向稳定性.     

MR imaging findings of anterior interosseous nerve lesions

OBJECTIVE: To study and characterise the MR imaging findings of lesions of the anterior interosseous nerve (AIN). MATERIALS AND METHODS: Magnetic resonance imaging (MRI) findings of the forearm of ten patients referred to our institution with suspected AIN lesions were retrospectively studied. Five healthy volunteers with normal forearm MRI findings formed a control group. Two musculoskeletal radiologists assessed the forearm musculature for oedema in the distribution of the AIN, median, posterior interosseous and radial nerves on T2-weighted (T2W) fat-saturated sequences. T1-weighted (T1W) images were assessed and graded for the presence of muscle atrophy and fatty involution. RESULTS: Six patients had undergone surgical exploration; five of these had surgically confirmed AIN compression. Four patients had diagnoses other than AIN compression made on imaging features. Of the cases of proven AIN compression, oedema within the pronator quadratus (PQ) muscle was identified in all cases. PQ atrophy and fatty involution were seen in three (43%) surgically confirmed cases. Cases 2 and 3 also demonstrated oedema in the flexor digitorum profundus (FDP)1 and FDP2 muscles. These cases also showed oedema in the flexor-carpi radialis (FCR) and FDP3/FDP4 muscles, respectively. The four cases of non-AIN compression demonstrated muscle oedema patterns that were atypical for the AIN distribution. They included a rupture of the flexor pollicis longus (FPL) tendon, brachial neuritis, amyotrophic lateral sclerosis and compression of the proximal median nerve. CONCLUSIONS: MRI is a useful investigation in the diagnostic workup of AIN syndrome. AIN syndrome is likely when there is diffuse oedema of AIN innervated muscles on T2W fat-saturated images. The most reliable sign of an AIN lesion is oedema within the PQ. Oedema in the flexor carpi radialis, FDP3 and FDP4, although not in the classical distribution of the AIN, does not preclude the diagnosis of AIN syndrome.     

Initial experience with visualizing hand and foot tendons by dual-energy computed tomography

PurposeTo assess the feasibility of visualizing hand and foot tendons by dual-energy computed tomography (CT).Methods and materialsTwenty patients who suffered from hand or feet pains were scanned on dual-source CT (Definition, Forchheim, Germany) with dual-energy mode at tube voltages of 140 and 80 kV and a corresponding ratio of 1:4 between tube currents. The reconstructed images were postprocessed by volume rendering techniques (VRT) and multiplanar reconstruction (MPR). All of the suspected lesions were confirmed by surgery or follow-up studies.ResultsTwelve patients (total of 24 hands and feet, respectively) were found to be normal and the other eight patients (total of nine hands and feet, respectively) were found abnormal. Dual-energy techniques are very useful in visualizing tendons of the hands and feet, such as flexor pollicis longus tendon, flexor digitorum superficialis/profundus tendon, Achilles tendon, extensor hallucis longus tendon, and extensor digitorum longus tendon, etc. It can depict the whole shape of the tendons and their fixation points clearly. Peroneus longus tendon in the sole of the foot was not displayed very well. The distal ends of metacarpophalangeal joints with extensor digitoium tendon and extensor pollicis longus tendon were poorly shown. The lesions of tendons such as the circuitry, thickening, and adherence were also shown clearly.ConclusionDual-energy CT offers a new method to visualize tendons of the hand and foot. It could clearly display both anatomical structures and pathologic changes of hand and foot tendons.     

An electromyographic analysis of the elbow in pitching

Elbow injuries are common in baseball pitchers. Curve balls are thought to increase this risk, particularly if the athlete begins throwing this pitch at an early age. The purpose of this paper is to identify forearm muscle firing patterns during the pitching cycle in an effort to understand this etiology. Dynamic EMG was performed on eight collegiate pitchers to evaluate extensor digitorum communis, brachioradialis, flexor carpi radialis, flexor digitorum superficialis, extensor carpi radialis longus, extensor carpi radialis brevis, pronator teres, and supinator. Each subject threw a fast ball and curve ball, which were filmed at 450 frames per second and synchronized with the EMG. These signals were converted from analog to digital records. Results showed low to moderate activity in all muscles during all phases of the pitch. The function is probably positioning to accept the transfer of energy from the larger trunk and girdle structures. The most notable difference between the fast ball and curve ball is a slight increase in the extensor carpi radialis longus and extensor carpi radialis brevis activity during late cocking, acceleration, and follow-through of the curve ball as compared to the fast ball. This difference, however, is not significant. In addition, there was no significant difference between the fast ball and the curve ball in the flexor-pronator group in any phase. We cannot substantiate that medial elbow problems are a result of an increase in the use of flexor muscles during the curve ball pitch.     

Median nerve entrapment at the elbow in athletes

Median nerve compression at the elbow in athletes presents a challenge to the practicing orthopaedic surgeon/sports medicine clinician. The surgeon should first carefully evaluate the athlete to determine where the source of compression is localized. If surgery is indicated, complete decompression must include release of the median nerve at (1) the ligament of Struthers, (2) lacertus fibrous, (3) between the two heads of the pronator teres, and (4) arcade of the flexor digitorum superficialis, which are all implicated in pronator syndrome. The anterior interosseous nerve may require additional decompression into the deep volar compartment of the forearm for relief of anterior interosseous syndrome symptoms.     

石膏固定骨折出现的前臂Volkmann挛缩和治疗

目的为了减少和防止上肢骨折手法复位石膏外固定后发生前臂Volkmann挛缩,探讨挛缩后手腕功能重建的方法。方法回顾性分析我科手术治疗的7例已发生前臂Volkmann挛缩的病例,并对其原因、手术方法和急性期减压时机进行讨论。结果7例Volkmann挛缩患者中,使用桡侧腕长伸肌腱、尺侧腕肌腱转位重建屈指、屈拇功能,效果良好。骨折后肌间隙压力高和石膏外固定过紧及减压不及时可能是发病的原因。结论对于如肱骨髁上骨折等危险性较大的骨折,要密切观察;骨折复位石膏固定操作细致,术后注意事项交代清楚,一旦发生,及时急诊手术,充分减压;通过肌腱转移重建屈指功能可以较好地治疗Volkmann挛缩。     

Closed ruptures of the flexor digitorum tendons: MRI evaluation

Objective. To assess the MRI findings in cases of closed rupture of the flexor digitorum tendons (FDT). Patients and design. Ten patients with a clinical suspicion of rupture of FDT underwent MRI before surgery. None of the patients presented a skin injury. Fingers were imaged using axial T1-weighted SE sequences, three-dimensional GE images, and curved reconstructions. Results. Twelve FDT had surgical confirmation of rupture. Flexor digitorum profundus (FDP) and flexor pollicis longus (FPL) tendons were more frequently ruptured (n=8) than flexor digitorum superficialis (FDS) tendons (n=4). MR images accurately depicted the level of the rupture. The gap between the tendon ends (mean 45 mm, range 21–70 mm) was assessed best with curved reconstructions and was well correlated with the surgical findings. The proximal end mainly retracted into the palm or the carpal tunnel (n=8), and less frequently into the digital canal (n=4). In two cases, the proximal end curled up in the palm, clinically simulating a rupture of a lumbrical muscle in one case. MRI also showed the appearance of the adjacent tendons. Conclusion. MRI accurately depicted the level of rupture and the gap between the tendon ends, which assisted the surgical choice between suture, graft or tendon transfer.     

Basilic vein aneurysm and palmar intramuscular hemangioma with peri and inter tendinous growth

In this report, we describe a case of concomitant basilic vein aneurysm and palmar hemangioma with peri- and inter-tendinous growth around the fourth and fifth flexor digitorum superficialis and flexor digitorum profundus tendons.It seems reasonable for physicians and radiologists to keep in mind the possibility of venous aneurysms in the presence of soft tissue hemangiomas; as they can present as palpable mass and be mistaken for other pathologies. Familiarity with clinical and imaging findings of this entity could be helpful to prevent misdiagnosis.     

“Intersection syndrome” of the foot: treated by endoscopic release of master knot of Henry

Intersection syndrome of the forearm is a painful condition in the area where the muscle bellies of the abductor pollicis longus and extensor pollicis brevis cross the common wrist extensors. A similar case of the foot with marked fibrosis at the interconnection of flexor hallucis longus and flexor digitorum tendons is reported and the fibrous interconnection was extended proximally. This was successfully treated with endoscopic release of the master knot of Henry.     

An electromyographic analysis of the elbow in normal and injured pitchers with medial collateral ligament insufficiency.

Electromyography and high-speed film were used to examine the muscle activity in the elbows of pitchers with medial collateral ligament insufficiency compared to the activity in uninjured elbows. Ten competitive baseball pitchers with medial collateral insufficiency and 30 uninjured competitive pitchers were tested while throwing the fastball and the curveball. The extensor carpi radialis brevis and longus in the injured pitchers showed greater activity than in the uninjured pitchers for both pitches. The triceps, flexor carpi radialis, and pronator teres all showed less activity in the injured pitchers during the fastball, but only the triceps had less activity during the curveball. The differences were seen during the late cocking and acceleration phases, which place the greatest stress on the medial collateral ligament. If the flexor carpi radialis and pronator teres were substituting for the deficient medial collateral ligament and functioning as dynamic stabilizers, one would expect enhanced muscle activity. However, the opposite was found. This pattern of asynchronous muscle action with medial collateral ligament injury may predispose the joint to further injury. The muscular differences seen are critical to the understanding of the pathomechanics of patients with medial collateral ligament deficiency, and provide a basis for rehabilitation.