Uraloğlu Muhammet, Orbay Hakan, Açar Halil Ibrahim, Sensöz Omer
Department of Plastic and Reconstructive Surgery, Ankara Keçiöğren Training and Research Hospital, Turkey.
Ann Plast Surg. 2006 Jul;57(1):110-4. doi: 10.1097/01.sap.0000209028.11153.be.
Loss of pinch power associated with loss of coordinated movement of thumb and index fingers is the major disability in patients with ulnar nerve paralysis. Several tendon transfer methods utilizing different donor muscles have been used to restore adductor pollicis muscle function in ulnar nerve paralysis. In this paper, we discuss the transfer of flexor digitorum brevis muscle to the tendon of adductor pollicis muscle as an alternative method to restore key pinch in ulnar nerve paralysis. The technique was applied to 4 patients with ulnar nerve paralysis. Before clinical application, an anatomic study was carried out in 6 cadaver hands. In cadavers, radial and ulnar arteries were injected with latex and arterial pedicles of flexor pollicis brevis muscle were dissected under 4x magnification. Also, motor branches from the median nerve were shown at the entrance point to the muscle. In surgical practice, the superficial head of the muscle is detached from its insertion and the minor pedicle of the muscle is cut. Muscle is dissected proximally up to two thirds of its length. The dominant pedicle of the muscle originating from superficial palmar arcus is preserved, and the muscle is sutured to the tendon of the adductor pollicis muscle close to its insertion. Patients were evaluated in terms of key pinch strength preoperatively and at the postoperative sixth month using a pinch meter (Chattanooga Group, Inc). Key pinch strengths were recorded and expressed as percentage of the strength of the contralateral uninvolved hand. Mean key pinch strength of our patients was 29.7%. In conclusion, we believe in that flexor pollicis brevis adductorplasty may be an alternative method for restoration of adductor pollicis muscle function in ulnar nerve paralysis.
与拇指和示指协调运动丧失相关的捏力丧失是尺神经麻痹患者的主要残疾。几种利用不同供体肌肉的肌腱转移方法已被用于恢复尺神经麻痹患者的拇收肌功能。在本文中，我们讨论将屈指短肌转移至拇收肌腱作为恢复尺神经麻痹关键捏力的替代方法。该技术应用于4例尺神经麻痹患者。在临床应用前，对6具尸体手进行了解剖学研究。在尸体上，向桡动脉和尺动脉注射乳胶，并在4倍放大倍数下解剖拇短屈肌的动脉蒂。此外，显示了正中神经至该肌肉入口处的运动分支。在手术操作中，将该肌肉的浅头从其止点处分离，并切断该肌肉的小蒂。将肌肉向近端解剖至其长度的三分之二。保留源自掌浅弓的主要蒂，并将该肌肉缝合至拇收肌腱靠近其止点处。使用捏力计（查塔努加集团公司）在术前和术后第六个月对患者的关键捏力进行评估。记录关键捏力并表示为对侧未受累手力量的百分比。我们患者的平均关键捏力为29.7%。总之，我们认为拇短屈肌内收肌成形术可能是恢复尺神经麻痹患者拇收肌功能的一种替代方法。
