Tran Paul, Bennett Dallas, Mendoza Mathew, Sarpong Albert, Ayala Madeline, Sadacharan Chakravarthy, Tippen Samantha P
Department of Biomedical Sciences, Tilman J. Fertitta Family College of Medicine, Houston, USA.
Department of Anatomy, Baylor College of Medicine, Houston, USA.
Cureus. 2025 Jan 28;17(1):e78139. doi: 10.7759/cureus.78139. eCollection 2025 Jan.
The Martin-Gruber anastomosis (MGA) is a neural communication between the median nerve (MN) and ulnar nerve (UN), typically located in the proximal forearm. Despite its clinical significance in diagnosing and treating nerve pathologies such as carpal and cubital tunnel syndromes, anatomical variations of MGA remain underexplored. This cadaveric study aimed to determine MGA prevalence, characterize its morphological patterns, and evaluate implications for peripheral nerve surgeries such as ulnar nerve transplantation and upper extremity neuropathies.
Cadaveric dissections of 101 forearms were conducted at Tilman J. Fertitta Family College of Medicine and Baylor College of Medicine. Only intact MGA specimens were included. Nerves were exposed by reflecting fascia and muscle layers, and MGA pathways were traced retrogradely. Measurements included the distance of MGA origins from the medial epicondyle (ME) and the width of the communication ramus. A custom classification system categorized MGA patterns based on anatomical configurations. The Martin-Gruber anastomosis prevalence found within the study was 37.6% (n = 38/101), with type I being the most common at 58% (n = 22/38), followed by type III at 32% (n = 12/38), and type II at 11% (n = 4/38). Unilateral MGA predominated at 53% (n = 20/38) and most patterns were intramuscularly embedded in the flexor digitorum profundus (FDP) muscle. Communication fiber lengths ranged from 3 to 10 cm from the ME. Findings corroborate prior classifications while highlighting subtle variations in morphology.
This study reveals a higher MGA prevalence compared to global averages, underscoring its clinical importance. Detailed morphological insights enhance understanding of MGA variations, aiding surgical precision, and improving outcomes in nerve repair and transplantation. Further research on MGA functional dynamics is recommended to refine classification frameworks and surgical approaches.
马丁-格鲁伯吻合（Martin-Gruber anastomosis，MGA）是正中神经（MN）与尺神经（UN）之间的一种神经连接，通常位于前臂近端。尽管其在诊断和治疗诸如腕管综合征和肘管综合征等神经病变方面具有临床意义，但MGA的解剖变异仍未得到充分研究。这项尸体研究旨在确定MGA的发生率，描述其形态学模式，并评估其对诸如尺神经移植和上肢神经病变等周围神经手术的影响。
在蒂尔曼·J·费尔蒂塔家庭医学院和贝勒医学院对101只前臂进行尸体解剖。仅纳入完整的MGA标本。通过翻转筋膜和肌肉层暴露神经，并逆行追踪MGA路径。测量包括MGA起点距内上髁（ME）的距离以及交通支的宽度。一种定制的分类系统根据解剖结构对MGA模式进行分类。该研究中发现的马丁-格鲁伯吻合发生率为37.6%（n = 38/101），其中I型最为常见，占58%（n = 22/38），其次是III型，占32%（n = 12/38），II型占11%（n = 4/38）。单侧MGA占主导，为53%（n = 20/38），且大多数模式肌内嵌入指深屈肌（FDP）。交通纤维长度距ME为3至10厘米。研究结果证实了先前的分类，同时突出了形态学上的细微差异。
本研究显示MGA发生率高于全球平均水平，强调了其临床重要性。详细的形态学见解增强了对MGA变异的理解，有助于提高手术精度，并改善神经修复和移植的效果。建议进一步研究MGA的功能动力学，以完善分类框架和手术方法。
