Tubbs R Shane, Custis James W, Salter E George, Blount Jeffrey P, Oakes W Jerry, Wellons John C
Department of Cell Biology, University of Alabama at Birmingham 35233, USA.
J Neurosurg. 2006 May;104(5):800-3. doi: 10.3171/jns.2006.104.5.800.
In neurotization procedures, donor nerves--either whole or in part-with relatively pure motor function can be carefully chosen to provide the optimal nearby motor input with as little donor site morbidity as possible. In this context, the ulnar nerve branches to the forearm muscles are relatively dispensable; however, quantitation of and landmarks for these branches are lacking in the literature.
The ulnar branches to the flexor carpi ulnaris (FCU) and flexor digitorum profundus (FDP) muscles in 20 upper extremities obtained in adult cadaveric specimens were dissected and quantified. In the forearm, a mean of four nerve branches led to the FCU and FDP muscles. A mean of 3.4 branches led to the FCU muscle; of these, one to three were medial branches and zero to two were lateral. Medial branches to the FCU muscle originated a mean of 2.7 cm inferior to the medial epicondyle. Lateral branches to the FCU muscle originated at a mean of 3.3 cm inferior to the medial epicondyle. The mean length of the medial branches was 3.2 cm, whereas the mean length of the lateral branches was 3.3 cm. All nerves had a single trunk for the FDP muscle, and in all specimens this branch was located deep to the main ulnar nerve trunk, originating from the ulnar nerve a mean of 2.7 cm inferior to the medial epicondyle. These branches had a mean length of 5.6 cm. The mean diameter of all medial and lateral branches to the FCU muscle was 1 mm, and the mean diameter of the branch to the FDP muscle was 2.1 mm. All branches to both the FCU and FDP muscles arose from the ulnar nerve, over its first approximately 5 cm from the level of the medial epicondyle. Additionally, all branches could be easily lengthened by gentle proximal dissection from the main ulnar nerve.
Ulnar branches to the forearm can be easily localized and used for neurotization procedures. The branch to the FDP muscle had the greatest diameter and longest length, easily reaching the median nerve and posterior interosseous nerve via a transinterosseous membrane tunneling procedure. Furthermore, this branch could be teased away from the main ulnar nerve trunk and made to reach the distal branches of the musculocutaneous nerve in the arm.
在神经移植手术中，可以谨慎选择具有相对纯运动功能的供体神经（全部或部分），以尽可能减少供体部位的发病率，同时提供最佳的附近运动输入。在此背景下，尺神经至前臂肌肉的分支相对不重要；然而，文献中缺乏对这些分支的定量和定位标志。
对20例成人尸体标本的上肢中尺神经至尺侧腕屈肌（FCU）和指深屈肌（FDP）的分支进行解剖和定量。在前臂，平均有四条神经分支至FCU和FDP肌肉。平均有3.4条分支至FCU肌肉；其中，一至三条为内侧分支，零至两条为外侧分支。FCU肌肉的内侧分支平均起源于内上髁下方2.7厘米处。FCU肌肉的外侧分支平均起源于内上髁下方3.3厘米处。内侧分支的平均长度为3.2厘米，而外侧分支的平均长度为3.3厘米。所有神经至FDP肌肉均有单一主干，在所有标本中，该分支位于尺神经主干的深面，起源于尺神经，平均在内上髁下方2.7厘米处。这些分支的平均长度为5.6厘米。FCU肌肉所有内侧和外侧分支的平均直径为1毫米，至FDP肌肉分支的平均直径为2.1毫米。至FCU和FDP肌肉的所有分支均起源于尺神经，从内上髁水平起其最初约5厘米的范围内。此外，通过从尺神经主干进行轻柔的近端解剖，所有分支都可以很容易地延长。
尺神经至前臂的分支可以很容易地定位并用于神经移植手术。至FDP肌肉的分支直径最大、长度最长，通过经骨间膜隧道手术可轻松到达正中神经和骨间后神经。此外，该分支可以从尺神经主干分离出来，并使其到达臂部肌皮神经的远端分支。
