骨间前神经旋前方肌支转位修复鱼际肌支和尺神经深支的解剖学观察和临床应用

目的了解有关应用骨间前神经旋前方肌支转位修复正中神经鱼际肌支和尺神经深支的解剖，总结应用此方法的临床效果。方法观察6具成人上肢标本，测量其旋前方肌支、正中神经鱼际肌支和尺神经深支的横径，以及正中神经鱼际肌支起始处、尺神经深支起始处至旋前方肌上缘的距离。1996年4月～1997年3月，临床应用5例。旋前方肌支转位修复陈旧性尺神经损伤3例，陈旧性正中神经损伤1例，急性正中神经损伤1例，其中3例需游离神经移植。结果骨间前神经旋前方肌支在旋前方肌上缘处、正中神经鱼际肌支起始处、尺神经深支起始处，神经干横径分别为1.3～1.9、1.5～2.3、1.8～2.3mm。正中神经鱼际肌支起始处、尺神经深支起始处至旋前方肌上缘的距离分别是75.2～84.8mm、53.5～74.0mm。临床应用经12～23个月随访，4例手内在肌功能恢复M3～M4级，1例未见恢复。结论骨间前神经旋前方肌支转位修复正中神经鱼际肌支和尺神经深支可达到肌支-肌支修复的设想，缩短再生距离和时间，有利于手内在肌的功能恢复。

Anatomy and Clinical Application of Transfer of Pronator Quadratus Muscle Branch of Anterior Interosseous Nerve in Repairing Thrhenar Muscle Branch of Median Nerve and Deep Branch of Ulnar Nerve

To introduce the anatomy and clinical application of transfer of the pronator quadratus muscle(PQ)branch of anterior interosseous nerve(AIN)in repairing thenar muscle branch of median nerve (MN) and deep branch of ulnar nerve (UN). Methods: The nerve stem diameter of PQ branch of AIN, thenar muscle branch of MN, and deep branch of the UN, as well as distance between the upper margin of PQ and the origin of thenar muscle branch and deep branch of UN were measured in 6 adult forearm specimens respectively. The surgical procedures were performed in 5 cases from April 1996 to March 1997, which included 3 cases of old injury of ulnar nerve,and 1 case of old and 1 case of fresh injury of median nerve. Nerve graft was used in 3 cases. Results:The nerve stem diameter of PQ branch of AIN, thenar muscle branch of MN,and deep branch of UN was 1.3 - 1.9 mm ,1.5 - 2.3 mm and 1.8 ~ 2. 3mm respectively. Distance between the upper margi n of PQ and the origin of thenar muscle branch and deep branch of UN was 75.2-84.8 mm, 53.5 - 74.0 mm respectively. Follow-up ranged from 12 to 23 months. The power of hand intrinsic muscle recovered in 4 cases(M3-M4). Conclusion: Transfer of PQ branch of AIN for the repair of thenar muscle branch of MN and deep branch of UN enables motor fibers to grow into the motorical end-plate, short ens distance of nerve recovery, and resumes the hand dexterous motion.