Department of Anatomy and Neuroscience, Erasmus MC, Rotterdam, The Netherlands.
J Plast Reconstr Aesthet Surg. 2013 Apr;66(4):543-50. doi: 10.1016/j.bjps.2012.12.015. Epub 2013 Jan 29.
Tendon transfers are essential for reconstruction of hand function in tetraplegic patients. To transfer the extensor carpi radialis longus (ECRL), the extensor carpi radialis brevis (ECRB) has to be sufficiently strong. However, there is currently no reliable clinical test to individually analyse both muscles. In order to develop a reliable preoperative clinical test, the anatomy of the muscle (innervation) areas of ECRB, ECRL and brachio-radialis (BR) was examined.
In 20 arms, the ECRB, ECRL and BR were dissected and localised. Subsequently, muscle-innervation points were mapped and categorised. A novel method, computer-assisted surgical anatomy mapping (CASAM), was used to visualise muscle areas and innervation points in a computed arm with average dimensions.
For both ECRL and ECRB a 100% area could be identified, a specific area in the computed average arm in which the muscle was present for all 20 arms. For the ECRL, this area was situated at 16% of the distance between the lateral epicondyle and the deltoid muscle insertion. The ECRB 100% area was 5 times bigger than that of the ECRL and was located at 40% of the distance between the lateral epicondyle and the radial styloid process. The ECRL and BR showed one to three innervation points, the ECRB one to four. In 47% of the cases, there was a combined nerve branch innervating both the ECRL and the ECRB.
It is feasible to develop a preoperative test; the 100% areas can be used for needle electromyography (EMG) or local anaesthetic muscle injections.
肌腱转移对于四肢瘫痪患者手部功能的重建至关重要。为了转移伸腕长肌（ECRL），需要有足够强壮的伸腕短肌（ECRB）。然而，目前还没有可靠的临床测试来单独分析这两块肌肉。为了开发一种可靠的术前临床测试，对 ECRB、ECRL 和肱桡肌（BR）的肌肉（神经支配）区域进行了解剖学检查。
在 20 条手臂中，对 ECRB、ECRL 和 BR 进行解剖和定位。随后，对肌肉神经支配点进行了映射和分类。采用一种新的方法，即计算机辅助手术解剖映射（CASAM），对具有平均尺寸的计算臂中的肌肉区域和神经支配点进行可视化。
ECRL 和 ECRB 的 100%区域都可以被识别，这是一个在计算平均手臂中，所有 20 条手臂都存在的特定区域。对于 ECRL，这个区域位于外侧髁和三角肌插入点之间距离的 16%处。ECRB 100%区域是 ECRL 的 5 倍大，位于外侧髁和桡骨茎突之间距离的 40%处。ECRL 和 BR 显示一个到三个神经支配点，ECRB 显示一个到四个神经支配点。在 47%的情况下，有一个联合神经分支同时支配 ECRL 和 ECRB。
开发术前测试是可行的；100%区域可用于针式肌电图（EMG）或局部麻醉肌肉注射。
