DISTAL MEDIAN TO ULNAR NERVE TRANSFERS TO RESTORE ULNAR MOTOR AND SENSORY FUNCTION WITHIN THE HAND: TECHNICAL NUANCES
DISTAL MEDIAN TO ULNAR NERVE TRANSFERS TO RESTORE ULNAR MOTOR AND SENSORY FUNCTION WITHIN THE HAND: TECHNICAL NUANCES
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DOI：
10.1227/01.neu.0000358951.64043.73
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发表时间：
2009-11-01
期刊：
影响因子：
4.8
通讯作者：
Mackinnon, Susan E.
中科院分区：
文献类型：
--
作者：
Brown, Justin M.;Yee, Andrew;Mackinnon, Susan E.
尺神经损伤可导致严重衰弱，并导致腕关节屈曲无力、手固有功能丧失和尺侧手麻木。当这些损伤导致桑德兰四度或五度损伤时，手术干预对于功能恢复是必要的。尺神经麻痹后恢复手内在功能的传统方法包括及时进行神经移植或肌腱转移以治疗复杂损伤或晚期表现。远端正中神经至尺神经移位以恢复尺神经肌肉功能于1991年首次施行。我们继续发现，通过显著减少失神经支配时间并将运动纤维定向到这一关键的运动分布，对近端尺神经损伤患者的尺神经固有功能恢复有利。已经发表了几个案例报告，讨论了这种方法背后的概念，但没有一个概述了这种操作所涉及的具体步骤。因此，本文讨论了我们的手术方法背后的远端正中到尺骨神经，其中包括一个Guyon管释放，识别供体正中和受体尺神经分支解剖前臂内，和手术教程的正确技术神经移植，以恢复尺骨运动和感觉功能。我们提出了以下神经转移的技术细微差别，以恢复尺神经功能的手：骨间前神经深运动分支的尺神经，第三蹼感觉正中神经的尺神经掌侧感觉成分的贡献，和端侧神经再支配的尺背侧皮肤的其余正中感觉干。
ULNAR NERVE INJURIES can be severely debilitating and result in weakness of wrist flexion, loss of hand intrinsic function, and ulnar-sided hand anesthesia. When these injuries produce a Sunderland fourth- or fifth-degree injury, surgical intervention is necessary for functional recovery. Traditional methods for restoring hand intrinsic function after ulnar nerve palsy include interposition nerve grafting for timely presentations or tendon transfers for either complex injuries or late presentations. Distal median to ulnar nerve transfer to restore ulnar intrinsic nerve muscle function was first performed in 1991. We continue to find it advantageous for recovery of ulnar intrinsic function in patients with proximal ulnar nerve injuries by significantly reducing denervation time and directing motor fibers into this critical motor distribution. Several case reports have been published discussing the concept behind this approach, but none have outlined the specific steps involved in this operation. As such, this article discusses our operative methodology behind the distal median to ulnar neurotization, which includes a Guyon canal release, identification of donor median and recipient ulnar nerve fascicular anatomy within the forearm, and an operative tutorial on proper technique for neurotization to restore both ulnar motor and sensory function. We present the technical nuances of the following nerve transfers to restore ulnar nerve function within the hand: anterior interosseous nerve to deep motor branch of ulnar nerve, third webspace sensory contribution of median nerve to volar sensory component of ulnar nerve, and end-to-side reinnervation of ulnar dorsal cutaneous to the remaining median sensory trunk.