Cizmár I, Svízenská I, Masek M, Bujok T, Ira D
Oddelení úrazové chirurgie FN, Brno, Bohunice.
Acta Chir Orthop Traumatol Cech. 2005;72(1):47-51.
The aim of the study was to optimize, on the basis of an anatomical study, the technique of partial denervation of the wrist in terms of safety for preserving motor innervation of the quadrate pronator muscle, and to include this technique in the range of reconstruction operations for the treatment of degenerative carpal diseases.
The technique of partial denervation of the wrist, using excision of the sensitive branches of the dorsal and volar interosseous nerves, carried out by one-stage surgery from the dorsal approach is presented in a group of 28 patients. The partial denervation was always performed in addition to reconstructive surgery on the proximal carpals and the distal radioulnar joint. On the basis of an anatomical study involving 40 cadaverous upper extremities, the authors determined the location for resection of the sensitive branch of the volar interosseous nerve that is not associated with the risk of damaged motor innervation of the quadrate pronator muscle.
A reliable identification of the motor branches of the volar interosseous nerve was achieved when an approximately 2-cm incision in the interosseous membrane was made 1 cm distal to the passing anterior branch of the interosseous artery that was clearly seen in the operating field. This corresponded to an incision in the skin, leading in the proximal direction at a length of about 7 cm, made 2 cm proximal to the distal radio-ulnar joint.
The identification of motor branches is often difficult and therefore the authors recommend resection of the sensitive branch of the volar interosseous nerve to be performed in a safe zone that was determined by a large number of anatomical dissections. Partial denervation carried out according to the principles of a physiological procedure does not pose a burden for the patient and can markedly enhance the effect of reconstructive surgery.
Partial denervation of the wrist performed from the dorsal approach is a simple procedure easy to combine with other reconstructive operations on the wrist.
本研究旨在基于解剖学研究，优化腕部部分去神经支配技术，以确保保留旋前方肌的运动神经支配安全，并将该技术纳入治疗退行性腕关节疾病的重建手术范围内。
对28例患者采用经背侧入路一期手术切除背侧和掌侧骨间神经感觉支的腕部部分去神经支配技术。部分去神经支配总是在近端腕骨和桡尺远侧关节重建手术之外进行。基于对40具尸体上肢的解剖学研究，作者确定了掌侧骨间神经感觉支的切除位置，该位置与旋前方肌运动神经支配受损风险无关。
当在手术视野中清晰可见的骨间动脉前支远端1 cm处的骨间膜上做一个约2 cm的切口时，可可靠地识别掌侧骨间神经的运动支。这对应于在皮肤表面做一个切口，该切口在桡尺远侧关节近端2 cm处向近端延伸约7 cm。
运动支的识别通常很困难，因此作者建议在通过大量解剖确定的安全区域内切除掌侧骨间神经感觉支。按照生理程序原则进行的部分去神经支配对患者来说并无负担，并且可以显著提高重建手术的效果。
经背侧入路进行腕部部分去神经支配是一种简单的手术，易于与腕部的其他重建手术相结合。
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