异位支配对正中神经尺神经损伤诊断影响的研究

目的 了解正中神经和尺神经之间交通支的存在对前臂这两条神经损伤诊断的影响,前臂正中神经至尺神经的交通支(Martin-Gruber anastomosis,MGA)、前臂尺神经至正中神经的交通支(reversed Martin-Gruber anastomosis,RMGA)和手部尺神经至正中神经的交通支(Riche-Cannieu anastomosis,RCA).方法 将160例正中神经或尺神经损伤合并存在异常交通支的患者分为三组:尺神经损伤并MGA组65例;正中神经损伤并RMGA组8例;正中神经损伤并RCA组87例.就其解剖基础、临床表现、电生理表现以及诊断进行讨论.结果 正中神经或尺神经损伤时,受损神经所支配肌肉的功能由于异常交通支的存在而得以代偿,导致其临床表现与神经损伤情况及其电生理表现不符.结论 充分了解正中神经和尺神经之间三种异常交通支的特点,对正中神经或尺神经损伤的临床诊断和治疗有重要意义,同时也可以避免错误地解释相关神经电生理检测的结果.

A study of the effects of anomalous innervation on the diagnosis of median or ulnar nerve injury

Objective To study the effects on the diagnosis of median or ulnar nerve injury by the presence of anomalous anastomosis between median and ulnar nerves in the forearm and the palm of the hand, including the anastomosis from median nerve in the forearm to the ulnar nerve (Martin-Gruber anastomosis, MGA), the anastomosis from ulnar nerve in the forearm to the median nerve(reversed Martin-Gruber anastomosis, RMGA), and the anastomosis from median nerve in the palm of the hand to the ulnar nerve (Riche-Cannieu anastomosis, RCA). Methods An 160 cases of median or ulnar nerve injury with the presence of anomalous anastomosis were assigned to three groups: 65 cases of ulnar nerve lesion with MGA, 8 cases of median nerve lesion with RMGA, and 87 cases of median nerve lesion with RCA. The anatomical bases, clinical manifestations, electrophysiological data and diagnosis were discussed. Results In the case of median or ulnar nerve lesion, the function of the muscle which was controlled by the injured nerve can be compensated due to the existence of the anomalous anastomosis. This could result in discrepancy between the clinical symptoms and the degree of nerve lesion and electrophysiological findings. Conclusion Thorough understanding of the characteristics of these three types of anomalous innervation between median and ulnar nerves is crucial to the clinical diagnosis and treatment of median or ulnar nerve injuries, as well as to the correct interpretation of the electrophysiological data.