Center of Biological and Health Sciences, Department of Neurosurgery, University of the South of Santa Catarina (Unisul), Tubarão, Santa Catarina, Brazil; Department of Orthopedic Surgery, Governador Celso Ramos Hospital, Florianópolis, Santa Catarina, Brazil.
Wockhardt Hospital, The Umrao IMSR, Thane, Maharashtra, India.
J Hand Surg Am. 2020 Sep;45(9):877.e1-877.e10. doi: 10.1016/j.jhsa.2020.02.011. Epub 2020 Mar 21.
With nerve or tendon surgery, the results of thumb reconstruction to treat radial nerve paralysis are suboptimal. The goals of this study were to describe the anatomy of the deep branch of the posterior interosseous nerve (PIN) to the thumb extensor muscles (DBPIN), and to report the clinical results of transferring the distal anterior interosseous nerve (DAIN) to the DBPIN.
The PIN was dissected in 12 fresh upper limbs. Myelinated nerve fibers in the DBPIN and DAIN were counted. Five patients with radial nerve paralysis underwent transfer of the motor branch to the flexor carpi radialis to the PIN and a motor branch of the pronator teres to the extensor carpi radialis brevis. In addition, these patients had selective reconstruction of thumb motion by transferring the DAIN to the DBPIN, through either a combined volar and dorsal approach (n = 2) or a single dorsal approach (n = 3) with division of the interosseous membrane.
At the origin of the abductor pollicis longus, the DBPIN divided into a lateral branch that innervated the abductor pollicis longus and extensor pollicis brevis, and a medial branch that innervated the extensor pollicis longus and extensor index proprius. The number of myelinated nerve fibers in the DAIN corresponded to 65% of that of the DBPIN. In each of the 5 patients, full thumb motion at the trapeziometacarpal joint was restored with no, or minimal, extension lag at the metacarpophalangeal (MCP) joint.
The anatomy of the DBPIN is predictable. Transferring the DAIN to the DBPIN is feasible through a single dorsal approach, allowing full recovery of thumb motion.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic V.
在神经或肌腱手术中，治疗桡神经麻痹的拇指重建效果并不理想。本研究的目的是描述拇长展肌深支（DBPIN）的后骨间神经（PIN）的解剖结构，并报告前骨间神经（DAIN）向 DBPIN 转移的临床结果。
在 12 个新鲜上肢中解剖了 PIN。计数 DBPIN 和 DAIN 中的有髓神经纤维。5 例桡神经麻痹患者接受了将旋前圆肌运动支转移至 PIN 和旋前方肌运动支转移至桡侧腕短伸肌的手术。此外，这些患者通过从背侧以联合或单一入路（n=2 或 n=3），将 DAIN 转移至 DBPIN 选择性重建拇指运动，同时切断骨间膜。
在拇长展肌起点处，DBPIN 分为外侧支，支配拇长展肌和短伸肌；内侧支，支配拇长伸肌和示指固有伸肌。DAIN 中的有髓神经纤维数量相当于 DBPIN 的 65%。在 5 例患者中，通过背侧联合或单一入路，拇长展肌和短伸肌均能完全运动，掌指关节（MCP）无或仅有最小的伸展滞后。
DBPIN 的解剖结构是可预测的。通过单一背侧入路将 DAIN 转移至 DBPIN 是可行的，可使拇指运动完全恢复。
研究类型/证据水平：治疗性 V 级。
