摘要
目的:应用组织学方法观察鉴别尺神经内的手内肌功能束组在断面上的分布,为选择性修复提供依据。方法:实验于2001-12/2002-04在广州第一军医大学临床解剖学研究所完成。新鲜成年男性尸体上肢标本6具,左右各半,为脑死亡病人捐献遗体。分离尺神经及其分支,墨汁标记方位后在各个分段平面取材,冰冻切片机横断面切片后进行Karnovsky-roots乙酰胆碱酯酶组织化学染色以区分运动和感觉神经纤维。根据染色结果,结合显微解剖结果和各分支自神经干分出的先后位置,观察判断手内肌功能束组在断面上的分布情况。结果:①运动束染色特点:高倍镜下见多数纤维染色呈现中等强度阳性反应,酶染色局限于轴索,髓鞘不染色,低倍镜下见只有少量稀疏的块状酶染区。②感觉束染色特点:高倍镜下所能分辨的有髓纤维,酶反应阴性,但是其间有大量强阳性的群块状酶染区(无髓纤维分布区),低倍镜下呈密集的团块状,均匀分布于神经束内。③混合束染色特点:可见上述两类来源神经纤维酶染色特点。刚开始混合的束内,两类来源的纤维各占一方;而后相互交错,但是神经纤维的两类来源,根据其酶染特征,还是清晰可辩;最后两类纤维充分混合,散布在整个束内,低倍镜下整个束内有较感觉束稀疏的块状酶染区。整个混合过程一般经过一两个节段就会完全混合。④各断面中功能束组分布的判断:在深支汇入平面,深支(手内肌)束组表现为运动束染色特点,浅支束组表现为感觉束染色特点,两束组间间隔明显;到前臂6/16平面,手内肌束组和浅支束组完全混合。从前臂13/16～16/6平面在神经干断面的感觉束是腕背支束组,混合束是包含手内肌神经纤维的混合束组,运动束是前臂屈肌束组,根据位置可以判断出其功能,在前臂15/16腕背支束组与混合束组有了初步的纤维交错,上臂1/8平面腕背支束组、尺侧腕屈肌束组与混合束组完全混合,上臂3/8平面指深屈肌束组与手内肌束组混合,3/8平面以上功能束完全混合。结论:应用乙酰胆碱酯酶组织化学染色方法结合显微解剖结果,能够在组织断面上判断出手内肌功能束组的分布位置和范围。在手术中结合应用该方法,将有助于手内肌功能束组的判断和保证选择性修复定位的准确性。
AIM： To observe the distribution of the fascicular groups in the ulnar nerve trunk on different cross-section stained by histological technique, in order to provide anatomical evidence for selective repair.
METHODS： The experiment was performed at the Institute of Clinical Anatomy, Guangzhou First Military Medical University from December 2001 to April 2002. Totally 6 fresh cadaveric upper extremitiers were obtained from male adults, left and right （half and half）. The mortal remains were donated from patients with brain death. The ulnar nerve and its branches were isolated. Specimens were got fromeach divided segment and marked direction by ink. After all specimens were cut into crossing sections by cryoultramicrotome, all slides were stained according to the AchE histochemical technique of Karnovsky-roots to distinguish motor nerve fibers and sensory nerve fibers. According to the staining combined with the micredissection result and the order of different branches branching off the nerve trunk, distribution of the fascicular groups to the intrinsic muscles were observed on each crossing sections.
RESULTS： ①Staining feature of motor tract： Under high power lens it was shown that most fibers were moderate intensity positive reaction, enzyme staining limited at neuraxis, no staining at myelin sheath, Under low power lens only a few sparse block-shape enzyme staining regions were shown.②Staining feature of sensory tract： Under high power lens enzyme reaction of resoluble myelinated fiber was negative, but in it there was a mass of strong positive block-shape enzyme staining region （nonmyelinated fiber region）. Under low power lens the fibers showed confertim clumping shape and evenly distributed in nerve tract. ③Staining feature of mixed beam： It was thus evident the staining characteristics of above-mentioned two sources of nerve fiber enzyme. At the beginning the two kinds of fibers occupied their place, and then interlocked. But the two kinds of nerve fibers could be seen clearly based on their enzyme staining feature. At last the fibers mixed fully, dispersed in the tract. There was sparse block-shape enzyme staining region as compared with the sensory tract in the tract under low power lens. They could combined completely after one or two segments. ④Decision of distribution of functional fascicular group of each section： At the level of deep branch mixing into the trunk, the fascicular group of deep branch （to the intrinsic muscles） showed the staining character of motor tract, while the superficial branch showed the staining character of sensory fascicular on the cross-section. They were separated obviously. At the level of 6/16 forearm, the fascicular groups of deep and superficial branches mixed completely. From the level 13/16 to 16/6 of forearm, the sensory tract on the cross-sections consisted the group of dosal cutaneous branch. The mixed tract was the fasciculars group of deep and superficial branches. The motor tract was the tract to flexors of forearm. Its function could be determined based on their position. At the level of 15/16 of forearm, there was initial fibers-cross between the fascicular groups of dosal cutaneous branch and the mixed fascicular group. At the level of ann 1/8, fascicular groups of dorsal cutaneous branch, flexor carpi ulnaris （FCU） and the mixed fascicular group mixed completely. At the level of arm 3/8, the fascicular group of flexor digitorum profundus （FDP） mixed with the fascicular group of the mixed fascicular group that contained the fibers to the intrinsic muscles of hand. On the proximal level of arm 3/8, all the functional fascicular groups mixed completely.
CONCLUSION： The localization and distribution range of the fascicular groups to the intrinsic muscles on each crossing sections can be known and outlined by using AchE histochemical staining combined with microanatomy results. Used in the operation, this method will contribute to judge the fascicular groups to .the intrinsic muscles and ensure the accuracy of selective repairing.
出处
《中国临床康复》
CSCD
北大核心
2006年第24期117-119,i0002,共4页
Chinese Journal of Clinical Rehabilitation
