上肢神经肌支的显微解剖及其在痉挛性瘫痪治疗中的意义

目的：为寻求解除上肢痉挛性瘫痪的新途径提供理论依据。方法：在手术显微镜下，对43例成人上肢标本解剖观测，了解痉挛性脑瘫所致上肢痉挛性屈肘，旋前和屈腕畸形的主动肌神经肌支的来源，直径，可分离长度及发出部位。结果：肱二头肌肌支平均2．72支，来源于肌皮神经（97．5％）和正中神经（2．5％），肱肌肌支平均2．74支，来源肌皮神经（80．5％），其余分别来源于桡神经（15．3％），正中神经（4．2％），肱桡肌肌支平均1．77支，来源于桡神经，旋前圆肌肌支平均2．33支，来源于正中神经；尺侧腕屈肌肌支平均1．72支，来源于尺神经，它们的可分离长度分别为：肱二头肌肌支23．94mm，肱肌肌支21．63mm，肱桡肌肌支21．38mm，旋前圆肌肌支27．27mm，尺侧腕屈肌肌支21．70mm，神经肌支的横径分别为：0．99，1．00，0．86，0．84，0．83mm,在起始与进入肌门处的横径比较（t)检验无显著性差异（P＞0．05）。结论：神经肌支的横径考虑与神经所含数量有关，术中可在志始处选择性切断，切除的长度以术后不再出现神经再连续为度。

Microanatomical study of muscular branches of upper extremity nerves and it's clinical significance in the treatment of spastic paralysis

Objective:To provide anatomic basis for exploring a new way to treat spastic paralysis of upper extremities.Methods:Forty-three cadaveric upper extremities were dissected under operation microscope to observe the origins,amounts,lengths and diameters of the muscular branches of upper extremity nerves(MBUEN).Results:Four hundred and eighty-five muscular branches of nerves were observed,they were biceps branchii muscular branches(total,117;average,2.72)from musculocutaneous nerves(97.5%) and median nerves(2.5%),branchialis muscular branches(total,118;average,2.74)from musculocutaneous nerves(80.5%) or radialis nerves(15.3%) or median nerves (4.2%) ,brachioradialis muscular branches(total,76;average,1.77) from radalis nerves,pronator teres muscular branches(total,100;average,2.33)from median nerves and flexor carpi ulnaris muscular branches(total,74;average,1.72)from ulnar nerves.And their divided lengths were 23.94,21.63,21.38,27.27 and 21.70 mm respectiveily in turn.The transverse diameters of these branches in the origin location were 0.99,1.00,0.86,0.84,0.83 mm respectively in turn,and there was no statistical significant difference between the diameters in the origin location and entering location( P > 0.05) .Conclusion:The results show that it is possible to undertake selective partial neurectomy at the level of the muscular branches of the peripheral nerve.