Tung Thomas H, Barbour John R, Gontre Gil, Daliwal Gurpreet, Mackinnon Susan E
Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Saint Louis, MO 63110, USA.
J Hand Surg Am. 2013 Jan;38(1):98-103. doi: 10.1016/j.jhsa.2012.10.010.
To present a technique for restoration of ulnar intrinsic function using a nerve transfer of the extensor carpi ulnaris (ECU) and extensor digiti minimi (EDM) nerve branches of the posterior interosseous nerve (PIN) to the deep branch of the ulnar nerve in the forearm when the anterior interosseous nerve is unavailable.
We dissected 6 cadaveric upper extremities to identify the location of the EDM and ECU branches of the PIN and their distance to the ulnar nerve near the wrist. We present a case of a high combined median and ulnar nerve injury. We performed transfer of the EDM branch and 1 of the branches to the ECU of the PIN to the motor component of the ulnar nerve for intrinsic hand function.
Our anatomic data demonstrate the branching pattern of the PIN and the length of regeneration and nerve graft required. Our patient required a 10-cm nerve graft, and the length of regeneration to reach the wrist was 19 cm. The patient recovered useful but incomplete reinnervation of the intrinsic muscles and rated hand recovery at 70%.
Transfer of the EDM and ECU branches of the PIN to the motor component of the ulnar nerve is feasible with the use of a nerve graft. Using some of the branches to the ECU as well increases the axonal load to maximize muscle reinnervation.
Proximal ulnar nerve injuries with paralysis of the intrinsic hand muscles lead to severe disability. Distal nerve transfers eliminate key factors that result in poor outcomes by allowing for faster muscle reinnervation. This nerve transfer had no functional donor morbidity and could be useful in the setting of a combined high median and ulnar nerve injury.
介绍一种在前臂骨间前神经无法利用时，通过将骨间后神经（PIN）的尺侧腕伸肌（ECU）和小指伸肌（EDM）神经分支转移至尺神经深支来恢复尺侧固有功能的技术。
我们解剖了6具尸体上肢，以确定PIN的EDM和ECU分支的位置及其在腕部附近与尺神经的距离。我们报告了1例高位正中神经和尺神经联合损伤的病例。我们将EDM分支和PIN至ECU的分支之一转移至尺神经的运动成分，以恢复手部固有功能。
我们的解剖学数据显示了PIN的分支模式以及所需的再生长度和神经移植长度。我们的患者需要10厘米的神经移植，到达腕部的再生长度为19厘米。患者手部固有肌恢复了有用但不完全的神经支配，手部恢复评分为70%。
使用神经移植将PIN的EDM和ECU分支转移至尺神经的运动成分是可行的。利用一些至ECU的分支也增加了轴突负荷，以最大限度地实现肌肉再支配。
近端尺神经损伤伴手部固有肌麻痹会导致严重残疾。远端神经转移通过允许更快的肌肉再支配消除了导致不良结果的关键因素。这种神经转移没有功能性供体并发症，在高位正中神经和尺神经联合损伤的情况下可能有用。
