The Research Of The Muscular Branches Of Flexor Digitorum Superiicialis Muscle From Median Nerve To Repair The Motor Branch Of Ulnar Nerve

Objective: Based on the anatomy of the muscular branches of flexor digitorum superiicialis muscle from median nerve to repair the motor branch of ulnar nerve, we carried out operations for the qualified volunteers who had high injury of ulnar nerve and then provided clinical basis for the high injury of ulnar nerve. The patients who had high ulnar nerve injury and low brachial plexus injury had claw hand deformity because of paralysis of intrinsic muscles in denervation which could cause metacarpophalangeal joint hyperextension and interphalangeal joint flexion. The treatment of claw hand deformity and intrinsic muscle atrophy caused by high ulnar nerve injury is a world problem. Recently, there are many researches about intrinsic muscles atrophy, but all are limited and only for animal research. Meanwhile, there are many ways to treat intrinsic muscle atrophy which are also poor. While for the treatment of intrinsic muscle atrophy is also a lot, but the effect is also poor. Through the anatomy of the muscular branches of flexor digitorum superiicialis muscle from median nerve and the motor branch of ulnar nerve, the muscular branches are proved to be used to repair the motor branch of ulnar nerve in anatomical level. We carried out operations for the qualified volunteers. Through regular followed-up of the patients, we got the results of the muscle atrophy, intrinsic muscle strength and sensorimotor recovery which are available to provide theoretical and clinical basis for the research of the muscular branches of flexor digitorum superiicialis muscle from median nerve to repair the motor branch of ulnar nerve and functional restoration of intrinsic muscles.Method:1 Anatomic basis: through anatomic research we got the results: it is "(48.4± 2.4)" mm from the issued point of the forth muscular branch from median nerve to the attachment of the radial styloid process and ulnar styloid., the horizontal diameter is "(1.2±0.2) "mm, and the long diameter is (0.7±0.1) "mm. The separation length between the sensory branch and the motor branch of ulnar nerve without damage is " (7.1±0.70) "cm. The number of myelinated nerve fibers is "(1378.9±107.9)". And the number of fibers of the motor branch of ulnar nerve (deep branch) is 3600 at most. According to matching rate, the account of nerve fibers which could be used to repair the motor branch of ulnar nerve is 1440. Thus we can conclude that the forth muscular branch from median nerve could provide enough nerve fibers to repair the motor branch of ulnar nerve which dominates hand intrinsic muscles.2 Surgical methods:2.1 The choice of cases: 1) high ulnar nerve injury 2) patients who understand high ulnar nerve injury and various surgical methods to be operated this way voluntarily 3) aged between 18 and 60 4) patients without diabetes, Renault disease and other diseases.2.2 Surgical Anatomy: firstly repair the cut ends of high ulnar nerve and suture the perineurium. We made Longitudinal incision at the forearm distal to the wrist stripes and proximal to the wrist of about 10cm. Cut open the skin, musculus flexordigitorum superficialis and musculus flexor carpi ulnaris could be seen. Find out ulnar nerve at the deep side of musculus flexor carpi ulnaris and the farthest branch of median nerve at the deep side of musculus flexor digitorum superficialis. For this section, the motor branch locates in the inferior and rear side of ulnar nerve. Carefully, distinguish the forth muscular branch from median nerve and the motor branch of ulnar nerve. Then separate the forth muscular branch from median nerve and the motor branch of ulnar nerve to the distal side as much as possible and suture with 8-0 microsutures.2.3 Postoperative care: dress change every 2-3 days and take out stitches 12 days postoperative. Fix the waist in flexion position with plaster. And 4 weeks later, remove the plaster and strengthen functional exercises of hand intrinsic and external muscles. 2.4 Follow up the patients every month and record hand intrinsic muscle strength, two- point discrimination changes and so on.Results:1 Intraoperative findings: the forth muscular branch of flexor digitorum superiicialis muscle from median nerve issued about 5cm to the wrist, and it is still in the deep side of the musculus flexor digitorum sublimis. The occurrence rate of the forth muscular branch is steady.2 The Separation length between the sensory branch and the motor branch of ulnar nerve without damage is about 7cm.3 Postoperative functional exercise can effectively slow down the intrinsic muscles and thenar muscle atrophy.4 Ulnar nerve repair of the injury point is the basis for sensory function recovery of one and a half fingers of the hand ulnar side. The pinkie finger sensory recovery time is about 1.5 years, and two-point discrimination test showed that the wounded hand's sensory recovered effectively, but was significantly worse than the healthy side .5 Seven months later, the motion relevant to ulnar nerve began to recover, firstly: little finger adduction and abduction functions; followed: ring, middle and index finger exercises of hand intrinsic muscles. Finally: functions of adductor muscle. Hand motor function recovery of the patients: 1.5 years later, the intrinsic muscle strength grade is about 2-4, jam experiment (-), Froment (±), no claw hand deformity.6 Patients are satisfied with sensory and motor function of the hand.Conclusion:1 Based on anatomical and neural matching rate, the muscular branches of flexor digitorum superiicialis muscle from median nerve can be used to repair the motor branch of ulnar nerve in theory, and muscle strength could recover partly.2 For the high ulnar nerve injury patients, the sensory can be effectively restored 1.5 years postoperative.3 Postoperative functional exercise can effectively slow down the intrinsic muscles and thenar muscle atrophy. And claw hand deformity could be avoided.4 Hand intrinsic muscle function can be effectively restored postoperative of the muscular branches of flexor digitorum superiicialis muscle from median nerve to repair the motor branch of ulnar nerve. The muscular branches of flexor digitorum superiicialis muscle from median nerve can be used to repair the ulnar nerve motor branch which is an effective treatment for high ulnar nerve injury.5 The function of flexor digitorum superiicialis muscle was not injured if one branch of median nerve was sacrificed.