尺、桡侧腕屈肌内神经分布和血供特点的研究

目的研究人尺侧腕屈肌和桡侧腕屈肌内神经分布、血供模式及肌肉结构。探讨将其分成两个或两个以上具有独立神经和血管支配肌肉束的可能性,指导临床切取部分肌肉移植重建运动功能的应用。方法以解剖学、血管造影、肌内神经染色等方法,研究神经和血管在两肌内的分布特点;电刺激神经支,检测相应肌束可否具有独立收缩功能及正常血供;测量肌肉的生理横截面积和肌纤维长度,并与相关肌肉比较。结果支配和供应两肌肉的主要神经和血管均在肌腹的近、中1/3结合部入肌,神经在肌内分成2支,分别在肌中央腱两侧沿长轴走向远端,直至肌肉的末端,且与血管紧密伴行;电生理证实,沿中央腱将肌肉分成的两部分在功能上具有独立性;该两肌的尺侧部和桡侧部生理横截面积和肌纤维长度与支配手的有关肌肉相近。结论尺侧腕屈肌和桡侧腕屈肌都可分成两个具有独立的神经支配及血管供应、功能上相对独立的肌束,可用于转位移植重建运动功能,而且对供区的功能影响也较小。

The neuromuscular compartments of the flexor carpi ulnaris and the flexor carpi radialis

ObjectiveReport on the intramuscular innervation and vascular supply of the flexor carpi ulnaris (FCU) and the flexor carpi radialis (FCR), the musculotendon architecture, i.e. the physiological cross-sectional area and fiber length; and explore the possibility of splitting FCU and FCR into 2 parts with individual independent function. Methods Anatomic study, angiogram and Sihler's staining technique were carried on human and monkey cadavers. The electric stimulation study was used to reveal independent contraction of each part on monkey FCU and FCR. Results It was found that the innervation and blood supply of FCU and FCR come primarily from the proximal neurovascular pedicles. The primary nerve and vascular branch supplying the muslces were divided into 2 subbranches and inserted the proximal quarter of the muscle belly. Then each of the nerve and blood subbranches run parallel to the central tendon on each side supplying the radial and ulnar compartments of FCU and FCR toward the distal musculotendinous junction. Independence of function of each compartment was confirmed in electrical stimulation studies in primate FCU and FCR. The results of each compartment of the human FCU and FCR architectures were measured and compared with the extensor pollicis longus and the extensor digitorum communis to the index, middle, ring, and small. ConclusionsBoth FCU and FCR can be split from the distal to the proximal along its tendon into 2 independently functioning neuromuscular compartments. Both radial compartment and ulnar compartment have its own nerve and adequate blood supply. And the study provides useful information for enabling the local transfer of the two muscles as a whole or two separate compartments, both for resurfacing skin soft-tissue defects and for functional tendon transfer.