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目的为临床应用胸小肌移植重建拇对掌功能手术过程中神经吻接提供解剖学依据。方法解剖观测胸内侧神经及尺神经深支分支特点,比较相关神经有髓神经纤维数目,确定手术过程中神经吻接。结果胸内侧神经为胸小肌的主要支配神经,其在第3肋间隙近锁骨中线处入胸小肌,有髓神经纤维计数为(868±130)根;尺神经深支穿出内侧肌间隔后在第3、4掌骨间隙分别发出两明显肌支,其有髓神经纤维计数分别为(394±49)根、(708±78)根;P3L4(尺神经深支在第4掌骨间隙的分支,其分布于第3骨间掌侧肌和第4蚓状肌)与胸内侧神经、正中神经返支有髓神经纤维数目都比较接近。结论胸小肌移植重建拇对掌功能手术中,在切取胸小肌时以胸内侧神经作为供体神经,以第3肋间隙与锁骨中线交点为标记寻找该神经;尺神经深支中P3L4肌支与胸内侧神经吻合最匹配。
Objective To provide anatomical basis for clinical application of pectoralis minor muscle transplantation to reconstruct thumb hallux function in the process of nerve fusion. Methods The anatomical characteristics of the deep branches of the medial thoracic nerve and the ulnar nerve were observed. The number of related myelinated nerve fibers was compared to determine the nerve connection during the operation. Results The thoracic medial nerve was the main dominating nerve of the pectoralis minor muscle. The thoracic medial nerve was inserted into the pectoralis minor muscle near the midclavicular line of the third intercostal space. The count of myelinated nerve fibers was (868 ± 130) roots. After the third and fourth metacarpal were issued two significant muscle branches, the myelinated fibers count (394 ± 49), (708 ± 78) root; P3L4 (ulnar nerve deep branch in the fourth metacarpal of the branch , Which distributed in the third interosseous and fourth lumbar muscle) with the medial thoracic nerve, median nerve myelinated nerve fibers are relatively close to the number. Conclusions In the operation of reconstructing the thumb halberd in the pectoralis minor muscle transplantation, the medial thoracic nerve is taken as the donor nerve during the operation of the pectoralis minor muscle. The intersection of the third intercostal space and the midline of the clavicle is used as a marker to find the nerve. The P3L4 muscle Branch and thoracic anastomosis best match.