Collotte P, Freslon M, Brèque C, Richer J P, Gayet L E
Service de chirurgie orthopédique et traumatologique, hôpital Jean-Bernard, 2, rue de la Milétrie, 86000 Poitiers, France.
Chir Main. 2013 Oct;32(5):322-8. doi: 10.1016/j.main.2013.08.006. Epub 2013 Sep 20.
Proximal or middle lesions of median or ulnar nerves are responsible for a great loss of hand motor function. Neurotization of either deep ulnar branch of ulnar nerve (DBUN) or recurrent (thenar) branch of median nerve (RBMN) with the nerve to quadratus pronator (NPQ) from the anterior interosseous nerve (AION) could reduce length of axonal growth and therefore the reinnervation lead-time of hand intrinsic muscles. We studied the anatomy of these three nerves, to help surgeon choosing his (her) technique and approach. Twenty-three cadaver forearms were dissected. End-to-side sutures were performed to mimic these neurotizations. Distances between nerve sutures and ulnar styloid process (USP) or trapeziometacarpal joint (TM) were measured. All the sutures but one RBMN could be done. On average sutures were distant from USP by 44±17mm (neurotization of DBUN), from TM by 62±15mm (neurotization of RBMN). Knowledge of average distance to perform these neurotizations should allow choosing the best reduced approach of RBMN and DBUN. Neurotizations of DBNU and RBMN with NPQ were feasible for lesions located at 6.1cm upstream USP and 7.7cm upstream TM, respectively. End-to-side sutures remain to be clinically evaluated.
正中神经或尺神经的近端或中段损伤会导致手部运动功能严重丧失。将尺神经深支（DBUN）或正中神经返支（RBMN）与来自骨间前神经（AION）的旋前方肌神经（NPQ）进行神经转位，可缩短轴突生长长度，从而缩短手部固有肌的再支配时间。我们研究了这三条神经的解剖结构，以帮助外科医生选择其技术和入路。解剖了23具尸体的前臂。进行端侧缝合以模拟这些神经转位。测量神经缝合处与尺骨茎突（USP）或大多角骨掌关节（TM）之间的距离。除了一处RBMN缝合外，其他所有缝合均能完成。平均而言，缝合处距USP为44±17mm（DBUN神经转位），距TM为62±15mm（RBMN神经转位）。了解进行这些神经转位的平均距离应有助于选择RBMN和DBUN的最佳简化入路。分别对于位于USP上游6.1cm和TM上游7.7cm处的损伤，用NPQ对DBNU和RBMN进行神经转位是可行的。端侧缝合仍有待临床评估。
