Faculté de Médecine Lyon Est (Université Claude Bernard Lyon 1), 8 Avenue Rockefeller, 69003 Lyon, France.
Service de Chirurgie du Membre Supérieur - SOS Main, Hôpital Edouard Herriot, 5 Place d'Arsonval, 69003 Lyon, France.
Hand Surg Rehabil. 2022 Feb;41(1):103-106. doi: 10.1016/j.hansur.2021.11.006. Epub 2021 Nov 29.
Reinnervation of the intrinsic hand muscles after proximal ulnar nerve repair is often unsatisfactory. Promising results have nevertheless been reported recently for supercharged end-to-side anterior interosseous to deep branch of the ulnar nerve (DBUN) transfer. The aim of this study was to determine whether the DBUN can be reliably identified without retrograde intraneural dissection from Guyon's canal. Twenty cadaveric wrists were dissected. In a first stage, nerve transfer was performed through a limited 4 cm incision without releasing Guyon's canal. In a second stage, correct identification of the DBUN was assessed by retrograde intraneural dissection from its point of exit from Guyon's canal. The DBUN was correctly identified in 18 of the 20 wrists (90%). Although anatomical landmarks provide valuable clues, identifying the DBUN by neurolysis is technically challenging. All the elements required for nerve transfer can be exposed through a 4 cm incision, but the DBUN was nevertheless incorrectly identified in 10% of cases. Guyon canal release seems advisable to guarantee correct DBUN identification.
尺神经近端修复后内在手部肌肉的再神经支配往往不理想。然而，最近有研究报道，增强后的尺神经掌侧骨间支到尺神经深支（DBUN）端侧吻合术具有良好的效果。本研究旨在确定是否可以在不从 Guyon 管逆行神经内解剖的情况下可靠地识别 DBUN。对 20 个尸体腕关节进行解剖。在第一阶段，通过不松解 Guyon 管的有限 4cm 切口进行神经转移。在第二阶段，通过从 Guyon 管出口逆行神经内解剖来评估 DBUN 的正确识别。在 20 个腕关节中有 18 个（90%）正确识别出 DBUN。尽管解剖标志提供了有价值的线索，但通过神经松解术识别 DBUN 在技术上具有挑战性。通过 4cm 切口可以暴露进行神经转移所需的所有要素，但仍有 10%的病例错误地识别出 DBUN。释放 Guyon 管似乎是保证正确识别 DBUN 的明智选择。
