游离前骨间神经综合征远端神经移植正中神经分支的解剖学研究

Q3 Medicine

Journal of Hand Surgery Global Online Pub Date : 2025-05-21 DOI:10.1016/j.jhsg.2025.100739

Krit Utrapat MD , Nuttapat Khusritheppratan MD , Parunyu Vilai MD , Vichununt Kerdput PhD , Wisuit Pradidarcheep PhD

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引用次数: 0

摘要

目的孤立性前骨间神经综合征是一种前臂压迫性神经病变。一种可行的治疗方法是远端神经移植。然而，正中神经供体神经分支的选择仍然存在争议。本研究旨在通过评估神经直径、神经束和轴突计数以及供、受神经之间的距离，确定AIN综合征患者最适合远端神经转移的正中神经分支。方法解剖20只尸体手臂，观察AIN作为受体神经的情况。候选供体神经包括掌长肌分支（PL）、桡侧腕屈肌分支（FCR）和指浅屈肌第一和第二分支（FDS1和FDS2）。测量各神经长度和供、受神经之间的距离。组织化学染色测定横断直径和轴突计数。结果所有供体神经均有足够的长度可供移植，其中FCR长度最大（32.8 mm），术后张力最小。其中AIN神经直径最大（2.3±0.4 mm），其次为FCR（2.1±0.3 mm）、PL（2.0±0.4 mm）、FDS2（1.6±0.6 mm）和FDS1（1.5±0.3 mm）。与FDS2（888±458）、FCR（869±366）、PL（678±277）和FDS1（426±192）相比，AIN的平均轴突数（2747±710）也最高。结论FCR分支转移可能不是AIN性麻痹的最终最佳选择；然而，它仍然是一个高度可行和有效的神经移植选择，在其他供体神经存在解剖或功能限制的情况下提供了一个很好的选择。临床相关性本研究提供了AIN转移的最佳正中神经分支的解剖学和组织学见解。

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An Anatomical Study of Median Nerve Branches for Distal Nerve Transfer in Isolated Anterior Interosseous Nerve Syndrome

Purpose

Isolated anterior interosseous nerve (AIN) syndrome is a forearm compression neuropathy. A viable treatment for the syndrome is distal nerve transfer. However, the option of a donor nerve branch from the median nerve remains debated. This study aimed to identify the most suitable median nerve branch for distal nerve transfer in AIN syndrome patients by evaluating nerve diameter, fascicle and axon count, and distance between donor and recipient nerves.

Methods

Twenty cadaveric arms were dissected to examine the AIN as the recipient nerve. Candidate donor nerves included branches to the palmaris longus (PL), flexor carpi radialis (FCR), and first and second branches of the flexor digitorum superficialis (FDS1 and FDS2). Each nerve length and the distance between donor and recipient nerves were measured. Histochemical staining was used to measure cross-sectional diameter and axon count.

Results

All donor nerves had sufficient length for transfer, with FCR providing the greatest length (32.8 mm) and causing the least postoperative tension. Among the studied nerves, AIN had the largest diameter (2.3 ± 0.4 mm), followed by FCR (2.1 ± 0.3 mm), PL (2.0 ± 0.4 mm), FDS2 (1.6 ± 0.6 mm), and FDS1 (1.5 ± 0.3 mm). The AIN also had the highest average axon count (2747 ± 710), compared with FDS2 (888 ± 458), FCR (869 ± 366), PL (678 ± 277), and FDS1 (426 ± 192).

Conclusions

The FCR branch transfer may not be the definitive best option for AIN palsy; however, it remains a highly viable and effective choice for reinnervation, providing a good alternative in cases where other donor nerves present anatomical or functional limitations