Higgins James P, Fisher Stephen, Serletti Joseph M, Orlando Greg S
Division of Plastic Surgery, Department of Orthopaedic Surgery, Center for Musculoskeletal Research, University of Rochester, Rochester, NY, USA.
J Hand Surg Am. 2002 Mar;27(2):286-92. doi: 10.1053/jhsu.2002.31154.
Several donor nerve graft sites commonly are used when repairing segmental defects in sensory nerves distal to the wrist. The cross-sectional area and number of fascicles of donor nerves and specific digital nerve segments were investigated to provide guidelines for selection of nerve graft harvest sites according to defects encountered. Nerve segments were harvested from 10 fresh cadavers (20 upper extremities). Five sites of nerve graft were harvested: lateral and medial antebrachial cutaneous nerves (LABCN, MABCN), posterior and anterior interosseous nerves (PIN, AIN), and sural nerves. Four sites of typical segmental nerve defects were harvested in a zone protocol: common digital nerve (zone 4), proper digital nerve (zone 3), digital nerve distal to main dorsal branch at the metacarpophalangeal joint (zone 2), and digital nerve distal to trifurcation at fingertip (zone 1). Sural nerve is the most anatomically similar nerve graft for defects in zone 4 by cross-sectional area and number of fascicles. Lateral antebrachial cutaneous nerve is most appropriate for zone 2 and 3 injuries by both criteria. Fingertip grafts for zone 1 injuries displayed cross-sectional area similarity to PIN, AIN, and MABCN. With regard to number of fascicles, zone 1 digital nerves are most similar to LABCN donors.
修复腕部远端感觉神经节段性缺损时，通常会使用几个供体神经移植部位。对供体神经和特定指神经节段的横截面积和束状结构数量进行了研究，以便根据所遇到的缺损情况为选择神经移植取材部位提供指导。从10具新鲜尸体（20条上肢）上获取神经节段。获取了五个神经移植部位：前臂外侧皮神经和内侧皮神经（LABCN、MABCN）、骨间后神经和骨间前神经（PIN、AIN）以及腓肠神经。按照分区方案获取了四个典型节段性神经缺损部位：指总神经（4区）、指固有神经（3区）、掌指关节处主背侧支远端的指神经（2区）以及指尖三叉分支远端的指神经（1区）。就横截面积和束状结构数量而言，腓肠神经是与4区缺损在解剖学上最相似的神经移植体。根据这两个标准，前臂外侧皮神经最适合2区和3区损伤。用于1区损伤的指尖移植体在横截面积上与PIN、AIN和MABCN相似。就束状结构数量而言，1区指神经与LABCN供体最为相似。
