Anatomical Study And Clinical Application Of A Single Fascicles Of The Ulnar Nerve Transfer To Biceps Brachii Of Musculocutaneous Nerve

Purpose:Shift the clump of inner nerve near target to restorethe function of bending the elbow is currently the important meansto treat the rip wound an arm clump of nerve. At present, there aremany disputes about how many feet of bundle of nerves should cutto satisfy the restoring of the branches of biceps and to reduce theloss of the function of donor nerve target, and about how manysquares to intercept. We studied on micro anatomization andhistology through the upper arm of any fascicles of the single nervebundles and branches of biceps of musculocutaneous muscle, todiscuss the feasibility of this means that ulnar nerve with a bouquetof single-shift repair muscle nerve biceps muscle branch of theresumption of the elbow flexion.Dataandmethods:Selecting and using 8 male cadaverformalin fixed, and gaining 14 specimen of branches of biceps ofmusculocutaneous nerve and ulnar nerve. Unfolding sufficientlyeach muscular branches of ulnar nerve and musculocutaneous nerve,surveying the distance from biceps brachii of musculocutaneousnerve with Vernier caliper to send out inside and outside the distancehumerus from the nervus musculocutoneous branch the condylesegment distance; the biceps brachii of musculocutaneous nervebranch number and separation length; sends out the spot to belocated the upper arm the scope; the ulnar nerve branch ties thebranch number thickly. Cuting with a bouquet of the ulnar nerve and biceps muscle branch of the seven groups, by HE staining, in theoptical nerve fibers under a microscope, the distribution of color bypathological analysis on the biceps muscle and ulnar nerve with asingle myelinated fiber bundle branch several counts, and analyzedstatistically. Clinical cures specifically for 5 representative examplecase carries out operation , the patient takes the supination place, theupper arm fetches a cut on the inner side from armpit the highest armmiddle piece , forearm revealed medial musculocuta neous nerve,the median nerve, the ulnar nerve and musculoc utaneous nerve, andpart for to the far end, two muscle branches finding and breakingbiceps branch, are based on whose nerve length , cut the ulnar nerveoutside film apart, with 9－0 noninvasive nylon wire makes twomuscle branches being sure to take any fascicles of the ulnar nervethat the person is moved being located in a fascicles of bicepsbrachii of musculocutaneous nerve under the surgical operationmicroscope fitting , elbow-bit fixed after three weeks.Result:We dissect acquisition one baked type (account for86% about on the side of 12), the quality of work type (account for7%, about on the side of 1), and disperse a type (account for 7%about on the side of 1). One example is musculocutaneous nerve andmutual median nerve traffic. Biceps muscle teams from themusculocutaneous nerve trunk issued pitch lateral humeral condylein connection 20.9±1.35cm. Biceps brachii of musculocutaneousnerve has 2 ~ 4 branches, sends out location 3/5 ~4/5 range inner in the upper arm, biceps brachii enters muscle burning be located in thebiceps brachii length faces the head relative predestined relationshipdepths, every muscle abdomen is hitted by head segment of inner of4 ~ 5.5 cm, the short muscle the head entering is partial to close end,The long muscle of the head entering counts remote end. Under themicroscope, a little separation between the beam can be separatedfor a longer period of the independence of the nerve bundle branch.The separation of biceps brachii branch on the side of 14 is for thelongest length of 25.5 cm separation, a minimum of 18.3 cm, 21.9±1.6cm. Biceps muscle branch myelinated nerve fibers number737±310.Anatomy of the ulnar nerve (arm) suffered lacerations on theobservation that no branch for the area in the upper 5 / 10 to 10/10,we isolated from the trunk thick bundle branch 5 ~ 8 branches. Asingle fascicles of the ulnar nerve myelinated nerve fibers with a few1 986±545.According to the principle of plane geometry, the design has theshortest path. We have a fascicles to biceps brachii of musculocutaneous nerve points to cut into the muscle at an distance of1.80±0.40 cm, that biceps brachii of musculocutaneous nerve entersmuscle is 2.64±0.40cm to perpendicularity from ulnar nerve , theulnar nerve of the length from the point cut-off to the separation is3.26±0.52cm, we design the most short-path which in the techniquemay tally namely for this length.The clinical practice patient has slight muscle to contract in skill last 2 moon muscle. The average technique after 4 monthreexamination muscles biceps brachii strength reaches M4, bendsthe elbow close 90°. Moving and feeling the forearm, and handingpart ruler nerve distribution area not to have accepted obvious effect.Discussion:Single-handed loss of musculocutaneous nerve isvery rare, completely brachial plexus injury by more than C5, 6 androot avulsion shoulder and axilla of cutting injury caused,accompanied vascular and other nerve injury. Graveness tomusculocutaneous nerve closure harms as a result, taking thefunction restoring the elbow flexion as purpose actively, the directline function rebuilds a skill. Repairing operation should givepriority to the use of nerve transposition. But great majority openmindednerve shifting method is in the cards carrying out the nervetransplanting being unlike the length, moreover dynamic nerve fibrenumber deficiency , distant shortcoming of distance target organlocation. But, the current close thicket inner nerve target of recentshift restore elbow flexion has becomed the treatment of dry rootbrachial plexus avulsion an important means. According to the ulnarnerve and biceps muscle branch of anatomy morphologicalmeasurement and analysis of the data after that: nerve approaches aulnar on anatomy comparing with musculo cutaneous nerve,anastomotic distance muscular branches closer to the point ofmuscular and nerve function recovery time lacks, the displacementof myelinated nerve fiber volume is quantity to be pretty sufficient,to be able to restore musculocutaneous nerve, the function restoring muscle sufficiently as an effective donor nerve.Having needed the dyadic certain skill defect to have strictoperation to adapt to indications, and also having become in clinicaljob. Preoperative normal routines examination. Examining that ulnarnerve controls the area function is regular, loss degree and locationbeing able to examine that, the ulnar exists regular action electricpotential in nerve, and may make musculocutaneous nerve clear byelectrophysiological examination. Needing the careful searchingbiceps brachii branch and ulnar nerve, protecting brachialarteriovenous, avoiding breaking of a blood vessel in the skill. Weshould try our's best to cut off before biceps brachii props up abranch, in order to ensure the restoration of biceps functionsufficiently.Drainage tube stanching bleeding intraoperative placingcompletely, avoid haematoma oppressing and adhesion, nerveregeneration impact of the resumption.According to clinical practice, we think that operation has as followsmerit: first, The function restores satisfaction, the strength of fourrestoration. Second ,operation self wound is less. Third, the ulnarnerve transposition with a bouquet of a single shorter distances, thescope of small injury. Fourth, being close to the muscle door place'sfits, making to regenerate from when shortening, improving havingefficiency that shifted nerve fibre regenerates,increasing recoveryelbow flexion function probabilities. Fifth, having no obvious effectto ulnar nerve area function, the operation curative effect affirms that.Sixth, ulnar nerve and musculocutaneous nerve have the identical flexor muscle function , beneficial to function after training. Seventh,after a short recovery time, significant recovery of motor function.Eighth, the operation can be a clear separation of the ulnar nervewith a bouquet of a single accord can be highly workable.Conclusion:1. Through any fascicles of the ulnar nerve and afascicles of biceps brachii of musculocutaneous nerve of anatomystudy in the anatomy of the ulnar nerve with the musculocutaneousnerve close .Ulnar nerve in the arm in the previous paragraph nearlyas mixed beam, in the biceps muscle branch level cut part of theulnar nerve bundle branch, it will not only donor nerve feeling beammistake, but also would not make a single piece of muscle paralysis.2. Histological studies: musculocutaneous nerve biceps musclebranch myelinated nerve fibers number of 737±310 roots, theulnar nerve of a bouquet of single-myelinated nerve fibers of 1 986±545 roots.Ulnar nerve single-myelinated fibers with a bouquet ofadequate number, has provided the driving force nerve big andpowerful source. 3. The ulnar nerve with a bouquet of single-shiftrepair muscle nerve biceps muscle branch of the resumption of theelbow flexion the operation, in the clinical application of the sevencases of typical patients, all with the surgery in the mouth, easy tooperate, after all seven cases were followed up biceps musclerestore reached M4, satisfied with the recovery of motor function,forearm, hand and foot in the area of motor and sensory function,preoperative and postoperative has not been significantly affected. Use of the elbow flexion resume operation simple and reliable,has important clinical value. The procedure applicable to thebrachial plexus on the stem and root avulsion musculocutaneousnerve serious injury of patients.