Xu Bin, Dong Zhen, Zhang Cheng-Gang, Zhu Yi, Tian Dong, Gu Yu-Dong
Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, People's Republic of China; Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, People's Republic of China; and Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, People's Republic of China.
Neurosurgery. 2015 Feb;76(2):196-200; discussion 200. doi: 10.1227/NEU.0000000000000585.
In lower brachial plexus injury, finger flexion after brachialis motor branch transfer is relatively weak. We sought to screen potential branches of the median nerve from the upper trunk for strengthening finger flexion in addition to the brachialis motor branch. However, the spinal origin of the muscular branches of the median nerve based on electrophysiological study was unclear.
To determine the spinal origin of the muscular branches of the median nerve.
An intraoperative electrophysiological study was carried out in 18 patients who underwent contralateral C7 nerve transfer. After exposure of the brachial plexus nerve roots on the healthy side, the amplitude of the compound muscle action potential of each median nerve-innervated muscle was recorded while the different nerve roots were stimulated.
The pronator teres received fibers from C5, C6, and C7. It had more contribution from C5 and C6 than from C7 (P<.05). The flexor carpi radialis was innervated mainly by C6 and C7. The nerve branches of the palmaris longus and flexor digitorum superficialis stemmed primarily from C7 and the lower trunk, and no significant difference was found between them (P>.05). The flexor digitorum profundus, flexor pollicis longus, pronator quadratus, and abductor pollicis brevis were innervated predominantly by the lower trunk (P<.05).
This electrophysiological study indicates that the pronator teres branch might be the most feasible alternative donor nerve to supplement the brachialis motor branch and strengthen finger flexion after lower brachial plexus injury.
在下臂丛神经损伤中，肱肌运动支移位术后手指屈曲相对较弱。我们试图从上干筛选正中神经的潜在分支，以在肱肌运动支之外增强手指屈曲。然而，基于电生理研究的正中神经肌支的脊髓起源尚不清楚。
确定正中神经肌支的脊髓起源。
对18例行健侧C7神经移位术的患者进行术中电生理研究。在暴露健侧臂丛神经根后，刺激不同神经根时记录各正中神经支配肌肉的复合肌肉动作电位幅度。
旋前圆肌接受来自C5、C6和C7的纤维。其来自C5和C6的贡献多于来自C7的贡献（P<0.05）。桡侧腕屈肌主要由C6和C7支配。掌长肌和指浅屈肌的神经分支主要来自C7和下干，两者之间无显著差异（P>0.05）。指深屈肌、拇长屈肌、旋前方肌和拇短展肌主要由下干支配（P<0.05）。
本电生理研究表明，旋前圆肌支可能是补充肱肌运动支并增强下臂丛神经损伤后手指屈曲最可行的替代供体神经。
