Institute for Plastic Surgery, Southern Illinois University School of Medicine, Springfield, IL.
Institute for Plastic Surgery, Southern Illinois University School of Medicine, Springfield, IL.
J Hand Surg Am. 2020 Sep;45(9):802-812. doi: 10.1016/j.jhsa.2020.04.019. Epub 2020 Jul 27.
Targeted muscle reinnervation (TMR) has emerged as a treatment for, and prevention of, symptomatic neuromas and has been reported to be of benefit in the hand. Anatomical studies establishing landmarks for consistent identification of the motor entry points (MEPs) to the intrinsic muscles have not been performed. The purpose of this study was to provide details regarding the MEPs to the intrinsic muscles, determine which MEPs are identifiable dorsally, and develop recommended sensory to MEP nerve coaptations for prophylactic TMR at the time of ray amputation or for management of symptomatic neuromas.
Motor entry points to the intrinsic hand muscles were dissected in 5 fresh latex-injected cadavers. Number of MEPs, diameter, surface of entry, and distance from dorsal (Lister tubercle) and volar (hamate hook) landmarks were recorded for each target muscle. The digital sensory nerve diameters were measured for size comparison.
Motor entry points were identified to all 19 intrinsic muscles through a volar approach and 12 through a dorsal approach. For all fingers, at least 2 MEPs were consistently identified dorsally at the base of each amputation site innervating expendable muscles. Motor entry points to the thenar muscles were only reliably identified through a volar approach. Two recommended nerve coaptations for each digit amputation were identified. All had a favorable sensory-to-MEP diameter ratio less than 2:1.
The intrinsic hand muscles have MEPs at consistent distances from bony landmarks both dorsally and volarly.
These results can be applied clinically to assist surgeons in identifying the locations of MEPs to the intrinsic muscles when performing TMR in the hand for both neuroma treatment and prevention.
靶向肌肉再支配（TMR）已成为治疗和预防症状性神经瘤的一种方法，并且已被报道对手部有益。尚未进行建立用于一致识别内在肌肉运动入口点（MEPs）的解剖学研究地标。本研究的目的是提供有关内在肌肉 MEPs 的详细信息，确定哪些 MEPs 可以在背部识别，并为射线截肢时预防性 TMR 或管理症状性神经瘤开发推荐的感觉至 MEP 神经吻合。
在 5 个新鲜乳胶注入的尸体中解剖了内在手部肌肉的运动入口点。记录了每个目标肌肉的 MEPs 数量，直径，进入表面和距离，从背面（Lister 结节）和掌侧（钩状骨钩）地标。测量了数字感觉神经的直径以进行大小比较。
通过掌侧入路可以识别到所有 19 个内在肌肉的运动入口点，通过背侧入路可以识别到 12 个运动入口点。对于所有手指，至少在每个截肢部位的底部在背部都可以一致地识别出 2 个 MEPs，从而为可消耗肌肉提供神经支配。只有通过掌侧入路才能可靠地识别大鱼际肌肉的运动入口点。每个手指截肢都确定了两个推荐的神经吻合。所有的感觉至 MEP 直径比都小于 2:1，具有良好的比值。
内在手部肌肉在背侧和掌侧都具有与骨地标保持一致距离的 MEPs。
这些结果可以在临床上应用于帮助外科医生在手部进行 TMR 时识别内在肌肉 MEPs 的位置，无论是用于治疗神经瘤还是预防。
