【作者】 邵岩；

【导师】 顾立强；

【作者基本信息】 南方医科大学 ， 骨外科学， 2007， 博士

【摘要】 手是人类进化的产物,上肢功能的核心就是手内在肌的功能,而拇指的对掌、对指和掌指关节的屈曲和指间关节的伸直是手内肌功能的重要组成部分。通过近百年国内外许多学者的努力,臂丛损伤后的修复,在解决了肩、肘、腕的屈伸功能方面取得了很大的进展,但至今尚未解决手内在肌的功能恢复问题,臂丛损伤的病人虽经长期多次、复杂的手术并没有给他们重建一个灵活实用的手。问题的关键在于缺乏有效的神经纤维再生和手内肌的不可逆性变性、纤维化。随着健侧颈7、丛内神经、丛外神经移位修复臂丛神经的应用,以及神经吻合技术的提高,能够到达手内肌的神经纤维数量逐渐增多起来,但是仍然不能解决神经纤维到达时手内肌已经发生不可逆变性的问题,所以我们的设想是选择合适的替代组织,等到神经移位术后再生的供体神经纤维到达手腕部后再进行组织移植,这样可以替代因为长时间失神经营养而造成的肌肉组织退变,尽快恢复功能。为此我们设计选择适当的吻合血管神经的足内肌移植替代萎缩了的手内肌,从而重建手内在肌的部分功能。神经修复的关键在于为再生的轴突提供正确的通道,使效应器官获得再支配。选择性神经移位术是目前治疗臂丛根性撕脱伤的最为有效的手段之一,而手术成功的关键在于如何正确选择相互匹配的神经(束)支。为应用足内肌修复臂丛神经损伤后手内在肌的功能,必须详细了解足内肌的解剖和组织学特征。为此,本项目以成人尸体标本为研究对象,应用显微解剖和组织化学切片观察的方法对三组足内肌的解剖和组织学特征进行了研究,结合手内肌的解剖和组织学特征进行了手术可行性探讨,以期找出更适合替代鱼际肌的移植供体。希望能指导临床臂丛神经损伤后手内在肌功能恢复的治疗,尤其是臂丛神经根性撕脱伤后手内肌功能的重建提供必要的解剖和组织学依据。目的1.研究足内肌移植重建手内在及功能的解剖学和组织学基础,通过对趾短屈肌、(足母)展肌和(足母)、趾短伸肌的解剖学研究,为手内肌移植找出合适的移植替代肌。2.通过对部分足内肌及相关的神经血管的解剖研究,探讨足内肌带神经血管蒂移植重建手内在肌功能的可能性。3.通过对趾短屈肌、(足母)展肌和(足母)、趾短伸肌的组织学特征的研究,为足内肌移植的神经吻合提供组织学依据。4.为制定手术方案提供相关的客观、科学的依据。材料和方法1.解剖学研究:采用36具近期福尔马林固定,红色乳胶灌注的成人下肢标本上(男性26侧,女性10侧)。解剖过程中在以下位置点测量以下数据:1)肌肉的测量长、宽、厚,以修洁后肌腹最大值为准。2)血管的测量:足内肌动脉汇入上一级动脉前动脉管径和后者管径,如出现两条及以上动脉分别汇入上一级动脉,则不予测量。自血管蒂开始到上一级动脉末端为最大游离长度。3)神经的测量:按照自然分束、醋酸浸滴法逆行显微解剖分离各足内肌束组。当束膜破坏,其它束组与足内肌束组出现纤维交叉时,中止分离。测量足内肌神经束组自然分束中点和最终分离点的直径最大游离长度、计算其面积。2.组织学研究:新鲜尸体标本6具(成年男性),分离三组足内肌神经束支,按上述方法标示、分段,墨汁标记方位后在中点和分离点平面取材,福尔马林固定,常规石蜡包埋,断面切片,厚7um,Loyez髓鞘染色法染色,应用图像分析系统对组织切片定量分析:测算各分支及各神经断面有髓纤维密度、神经纤维截面积和神经干截面积,计算有髓神经纤维数目、神经纤维和结缔组织所占比例。结果1.解剖学研究:(1)趾短屈肌和(足母)、趾短伸肌同属羽状肌,和手内肌同属力量型构筑,并且从长、宽、厚度上比较和手内肌大体相当,适合于作为供体修复手内肌。趾短屈肌测量结果(n=36):肌长:(88.15±5.88)mm,宽度:(27.53±1.65)mm,厚度:(14.89±1.17)mm。(足母)、趾短伸肌测量结果(n=36):肌长:(85.53±8.02)mm,宽度:(42.22±3.8)mm,厚度:(8.54±1.48)mm。(足母)展肌测量结果(n=36):肌长:(119.22±11.09)mm,宽度:(28.58m±2.07)mm,厚度:(17.52±1.66)mm。经统计学处理:(足母)、趾短伸肌和趾短屈肌在长度方面无显著差异,(足母)展肌长度大于趾短伸肌和趾短屈肌的长度。(足母)、趾短伸肌厚度小于趾短屈肌厚度,小于(足母)展肌厚度。(足母)、趾短伸肌宽度小于趾短屈肌宽度,小于(足母)展肌宽度。(2)趾短屈肌、(足母)展肌和(足母)、趾短伸肌都具有各自独立、相对恒定的血管供养,且易于寻找。血管蒂长度、管径可以满足和腕周围血管吻合的需要,从而都能保证移植后的血运及成活。趾短屈肌血供解剖结果:(n=36)趾短屈肌动脉汇入足底内侧动脉前动脉管径:(0.76±0.17)mm趾短屈肌动脉汇入足底内侧动脉时足底内侧动脉的管径:(1.25±0.19)mm自血管蒂开始到足底内侧动脉末端最大游离长度:(46.59±9.62)mm(足母)、趾短伸肌血供解剖结果:(n=36)(足母)、趾短伸肌动脉汇入跗外动脉前动脉管径:(0.65±0.11)mm,(足母)、趾短伸肌动脉汇入跗外动脉时足背动脉的管径:(1.30±0.22)mm自血管蒂开始到足背动脉末端最大游离长度:(20.14±6.79)mm。(足母)展肌血供解剖结果:(n=36)(足母)展肌动脉汇入足底内侧动脉深支前动脉管径:(0.82±0.12)mm(足母)展肌动脉汇入足底内侧动脉时足底内侧动脉的管径:(1.16±0.15)mm自血管蒂开始到足底内侧动脉末端最大游离长度:(61.28±11.32)mm(3)趾短屈肌、(足母)展肌和(足母)、趾短伸肌都具有各自独立且恒定的神经支配,各自具有不同的可游离长度,如果选择正中神经鱼际肌支或尺神经深支作为吻合对象,(足母)、趾短伸肌支在神经截面积和神经纤维密度上具有明显优势,并且以选在神经束的分离点吻合,神经功能恢复的可能性最大。趾短屈肌神经束的巨微解剖测量结果:(n=36)自然分束中点的左右径和前后径分别为:(1.58±0.28)mm和(0.81±0.20)mm神经最大分离点的左右径和前后径分别为:(0.66±0.22)mm和1.42±0.21)mm自然可分离长度:(20.69±2.03)mm,最大可游离长度:(39.03±2.31)mm(足母)、趾短伸肌的神经巨微解剖测量结果:(n=36)自然分束的中点的左右、前后径分别为:(1.08±0.21)mm和(0.35±0.09)mm神经分离点的左右径和前后径分别为:(0.95±0.22)mm和(0.32±0.08)mm自然可分离长度:(26.08±4.65)mm,最大可游离长度:(52.01±6.18)mm(足母)展肌的神经解剖测量结果:(n=36)自然分束的中点的左右、前后径分别为:(1.50±0.17)mm和(1.04±0.20)mm神经分离点的左右径和前后径分别为:(1.23±0.19)mm和(0.83±0.15)mm自然可分离长度:(49.59±7.38)mm,最大可游离长度:(81.55±10.89)mm经统计学处理:(足母)展肌和趾短屈肌在神经束中点的截面积上无显著差异,(足母)、趾短伸肌支截面积小于趾短屈肌支或(足母)展肌支的截面积。(足母)展肌支和趾短屈肌支在神经束分离点的截面积上无显著差异。(足母)、趾短伸肌支分离点的截面积小于趾短屈肌支和(足母)展肌支分离点的截面积。(足母)展肌支可游离长度大于(足母)、趾短伸肌支可游离长度,大于趾短屈肌支可游离长度。趾短屈肌支和(足母)展肌支在神经束中点的截面积上无显著差异,趾短伸肌支截面积小于趾短屈肌或(足母)展肌支的截面积。2、组织学研究:(1)应用Loyez髓鞘染色法显示三组足内肌不同位点有髓神经纤维趾短屈肌、(足母)展肌与(足母)、趾短伸肌神经各束支(组)的不同位点上神经断面经髓鞘染色,有髓神经纤维髓鞘均呈现淡蓝色,轴索不染色,神经纤维周围的结缔组织呈浅灰色,易于辨认。通过显微图像分析系统,可以测算出三组足内肌肌支中点和分离点断面的截面积、神经束截面积以及有髓神经纤维数目等组织学指标,能够为临床臂丛神经损伤重建手内肌功能的手术设计和估计预后提供参考依据。(2)趾短屈肌、(足母)、趾短伸肌、(足母)展肌神经束支有髓神经计数:(n=6)三组足内肌在不同位点上神经支截面积为:趾短屈肌支中点:(5.65±0.62)mm~2,趾短屈肌支分离点:(3.98±0.35)mm~2,(足母)、趾短伸肌支中点:(2.05±0.19)mm~2,(足母)、趾短伸肌支分离点:(1.54±0.24)mm~2,(足母)展肌支中点:(5.83±0.36)mm~2、(足母)展肌支分离点:(3.61±0.24)mm~2。三组足内肌在不同位点上神经束截面积为:趾短屈肌支中点:(3.63±0.42)mm~2,趾短屈肌支分离点:(2.71±0.44)mm~2,(足母)、趾短伸肌支中点:(1.58±0.20)mm~2,(足母)、趾短伸肌支分离点:(1.19±0.13)mm~2,(足母)展肌支中点:(4.04±0.25)mm~2、(足母)展肌支分离点:(3.14±0.19)mm~2。三组足内肌在不同位点上有髓神经纤维数量为:趾短屈肌支中点:(745.33±97.57)根,趾短屈肌支分离点:(826.17±62.41)根,(足母)、趾短伸肌支中点:(505.33±34.02)根,(足母)、趾短伸肌支分离点:(550.00±56.97)根,(足母)展肌支中点:(936.83±90.34)根、(足母)展肌支分离点:(1064.33±141.24)根。经统计学处理:(足母)、趾短伸肌分离点神经纤维数量小于趾短屈肌分离点神经纤维数量,小于(足母)展肌分离点神经纤维数量。在近端神经纤维不足的情况下,(足母)、趾短伸肌移植后更有可能获得有用的神经再支配。趾短屈肌和(足母)展肌中点和分离点有髓神经纤维数量均无显著差异。(足母)、趾短伸肌中点和分离点有髓神经纤维数量有显著差异,(足母)、趾短伸肌分离点有髓神经纤维数量多于神经束中点的有髓神经纤维数量。三组足内肌中点和分离点神经束截面积均有显著差异,三组足内肌中点神经束截面积均大于三组足内肌分离点神经束截面积。(足母)、趾短伸肌中点神经截面积小于趾短屈肌中点神经截面积小于(足母)展肌中点神经截面积。(足母)、趾短伸肌分离点神经截面积小于趾短屈肌分离点神经截面积小于(足母)展肌分离点神经截面积。三组足内肌中点和分离点神经纤维密度均有显著差异,三组足内肌神经束中点神经纤维密度均小于三组足内肌分离点神经束神经纤维密度。(足母)、趾短伸肌中点神经纤维密度大于趾短屈肌中点神经纤维密度大于(足母)展肌中点神经纤维密度。(足母)、趾短伸肌分离点神经纤维密度大于趾短屈肌分离点神经神经纤维密度大于(足母)展肌分离点神经纤维密度。结论1、从解剖和组织学的研究结果分析来看,如果选择正中神经鱼际肌支和尺神经深支作为吻合对象修复鱼际肌功能,(足母)、趾短伸肌无论在组织形状、体积和神经支吻合方面都具有明显的优势。2、为提高神经纤维利用率,应该在手腕部选择运动束支作为足内肌的神经供体。3、神经蒂切取点宜选在分离点,以(足母)、趾短伸肌支和鱼际肌支吻合成功率高。4、为使移植的足内肌恢复3-4级肌力水平,以在足内肌神经束分离点吻合为例,至少需要通过吻合口的有髓神经纤维数目:趾短屈肌需要660.94条;趾短伸肌需要440条;(足母)展肌需要851.46条。更多还原

【Abstract】 BackgroundThe hand is the evolutional product mankind.The function of intrinsic muscle of hand is the key point of function of upper limb and the opposition and digital opposition of thumb,the flection of metacarpophalangeal joint and the straighten of interphalangeal joint are the main composition of the function of intrinsic muscle of hand.Through the efforts of many scholar in about 100 years,the flexion and extend of shoulder,elbow and wrist joints have been achieved big progress relating to the recovery of brachial plexus injury,however,the functional recovery of intrinsic muscle of hand have not been resolved at present..The active and practice hand have not been reconstructed for the patient whose brachial plexus injury through the complicated operation that need long-term and multiple efforts.Our presumption is to select the suitable representative object and transplant to the hand after the nerve fiber of donator have been reached the wrist.In this way,it can avoid the muscle tissue cataplasia because of out of neurotrophy long time and recover the function of hand.So we plan to select the proper intrinsic muscle of foot to replace the atrophy intrinsic muscle of hand and recover the partial function of intrinsic muscle of hang.The key point of nerve recovery is to provid the correct path way for the regenerated axon and gain recontrol for the effector organ.The selected nerve transposition is the one of effective methods to treat the brachial plexus root avulsion at present.The key point of the successful operation is how to correct select nerve branch matching each other.To use the intrinsic muscle of foot to recover the function of intrinsic muscle of hand that suffering the brachial plexus injury,we must understand in detail the anatomy and histologic feature of intrinsic muscle of foot.So this paper using the Chinese adult cadaver and utilizing microanatomy and histochemistry slice method have studied the anatomy and histologic feature of three group intrinsic muscle of foot.We combining the anatomy and histologic feature of intrinsic muscle of hand have researched the probability of operation in order to find the more suitable transplantation donator to replace the muscle of thenar.We hope to guide the functional recovery treatment of intrinsic muscle of hand because of the clinical brachial plexus injury and provide the practice and needed data of anatomy and histology for the functional recovery of intrinsic muscle of hand that suffering the brachial plexus root avulsed wound.ObjectivesWe studied the anatomy of flexor digitorum brevis,abductor hallucis,halluces and extensor digitorum brevis and to find the suitable transplantation vicarious muscle for the transplantation of intrinsic muscle of hand.To provide morphologic data of nerve anastomose of transplantation of intrinsic muscle of hand,we studied the histological feature of flexor digitorum brevis,abductor hallucis,halluces and extensor digitorum brevis.Materials and methodsWe studied the anatomy of flexor digitorum brevis,abductor hallucis,halluces and extensor digitorum brevis and their blood supply and nerve dominant using 36 Chinese adult lower limb specimen(male,26 sides;female 10 sides)that have been fixed by formalin and perfused using red emulsion and assisted by operating microscope.Using 6 fresh cadaver specimen(adult,male),we separated the nerve tract branch of three group intrinsic muscle of foot.According to the above-mentioned methods labeled and segmented the nerve tract,after labeling the aspect using Chinese ink we draw the materials from the middle point and the separated point.We obtained the sectional slice(section thickness,7μm,Loyez myelin staining)after fixed by formalin and using regular paraffin imbedding. Quantitative analysis of histological slice was processed using image analysis system: the density of myelinated fiber of each branch and nervous section,section area of nerve fiber and section area of nerve trunk was measured respectively.The number of myelinated fiber and the ratio of nerve fiber and connective tissue was calculated respectively.ResultsThe flexor digitorum brevis and halluces and extensor digitorum brevis are bipennate muscle and sibling the strength construction as well as the intrinsic muscle of hand.The long,width and thickness of flexor digitorum-brevis,halluces and extensor digitorum brevis are the same with the measurements of intrinsic muscle of hand.So the flexor digitorum brevis,halluces and extensor digitorum brevis are suitable to recover the intrinsic muscle of hand as the donator.The length,width,thickness of flexor digitorum brevis,abductor hallucis, halluces and extensor digitorum brevis is 8.82±0.59cm,2.75±0.17cm,1.49±0.12cm; 11.92±1.11cm,2.86±0.21cm,1.75±0.17cm;8.55±0.80cm,4.22±0.38cm, 0.85±0.15cm respectively.Statistical treatment:there is no significant deviation between the length of halluces and extensor digitorum brevis and flexor digitorum brevis.The length of abductor hallucis is more than the length of halluces and extensor digitorum brevis and flexor digitorum brevis.The width of halluces and extensor digitorum brevis is lesser than extensor digitorum brevis and abductor hallucis.The flexor digitorum brevis,abductor hallucis,halluces and extensor digitorum brevis has the independence and relative permanent blood supply respectively and the blood vessels are easy to seek.The length and caliber of blood vessel stem can be satisfy the need to anastomosis with the peripheral blood vessel of wrist and guarantee the blood transportation and living of the transplanted object.The caliber of artery of flexor digitorum brevis,medial plantar artery and the maximum liberation length is 0.76±0.17mm,1.25±0.19mm and 4.66±0.96mm respectively.The caliber of artery of halluces and extensor digitorum brevis,dorsal artery of foot and the maximum liberation length is 0.65±0.11mm,1.30±0.22mm and 2.01±0.68mm respectively.The caliber of artery of abductor hallucis,medial plantar artery and the maximum liberation length is 0.82±0.12mm,1.16±0.15mm and 6.13±1.13mm respectively.The flexor digitorum brevis,abductor hallucis,halluces and extensor digitorum brevis has the independence and relative permanent innervation respectively and has the different length that can be liberated respectively.If select the thenar muscular branch of median nerve or the deep branch of ulnar nerve as the anastomosis object, the nervous section area and nerve fiber density of the muscular branch of halluces and extensor digitorum brevis have obviously dominance.If selecting the separate point of nerve tract as the site to anastomose,the probability of the functional recovery of nerve is maximum.The left and right diameter and anteroposterior diameter of the middle point nerve tract of flexor digitorum brevis and the maximum liberation point of nerve is 1.58±0.28mm,0.81±0.20mm and 0.66±0.22mm,1.42±0.21mm respectively.The natural liberation length and the maxmum liberation length is 2.07±0.20cm, 3.90±0.23cm respectively.The left and right diameter and anteroposterior diameter of the middle point nerve tract of c and the liberation point of nerve is 1.08±0.21mm,0.35±0.09mm and 0.95±0.22mm,0.32±0.08mm respectively.The natural liberation length and the maxmum liberation length is 2.61±0.47em,5.20±0.62cm respectively.The left and right diameter and anteroposterior diameter of the middle point nerve tract of abductor hallucis and the liberation point of nerve is 1.50±0.17mm, 1.04±0.20mm and 1.23±0.19mm,0.83±0.15mm respectively.The natural liberation length and the maxmum liberation length is 4.96±0.74cm,8.16±1.09cm respectively.Statistical treatment:there is no significant deviation of the section area of middle point of nerve tract between the abductor hallucis and flexor digitorum brevis. The section area of flexor digitorum brevis is lesser than the section area of flexor digitorum brevis and abductor hallucis.There is no significant deviation of the section area of the liberation point of nerve tract between the abductor hallucis and flexor digitorum brevis.The section area of the liberation point of nerve of halluces and extensor digitorum brevis is lesser than the section area of flexor digitorum brevis andc.The liberation length of abductor hallucis is bigger than the liberation length of halluces and extensor digitorum brevis and flexor digitorum brevis.There is no significant deviation of the section area of middle point of nerve tract between flexor digitorum brevis and abductor hallucis.The section area of middle point of nerve tract of flexor digitorum brevis is lesser than that of flexor digitorum brevis and abductor hallucis.Showing the myelinated fiber of different site of three group intrinsic muscle of foot using Loyez myelin staining.The medullary sheath of myelinated fiber was to show light blue,axon no stained and the peripheral connective tissue of nerve fiber showing light grey that was easy to identify on the nerve section of different sit of nerve tract of flexor digitorum brevis,abductor hallucis,halluces and extensor digitorum brevis using myelin staining.The section area of middle point and separated point of muscular branch of three group intrinsic muscles of foot,section area of nerve tract and the number of myelinated fiber can be measured through micro-image analysis system.These histological index can provide reference data for clinical operational design of recovering function of intrinsic muscle of hand that suffering brachial plexus injury and to estimate the prognosis.The counting of myelinated fiber of nerve tract of flexor digitorum brevis, halluces and extensor digitorum brevis and abductor hallucisThe section area of nerve branch at different site of three group intrinsic muscles of foot is to show:the area of middle point and separated point of flexor digitorum brevis is 5.65±0.62 mm~2 and 3.98±0.35 mm~2 respectively.The area of middle point and separated point of halluces and extensor digitorum brevis is 2.05±0.19 mm~2 and 1.54±0.24 mm~2 respectively.The area of middle point and separated point of abductor hallucis is 5.83±0.36 mm~2 and 3.61±0.24 mm~2 respectively.The section area of nerve tract of three group intrinsic muscles of foot at different site is to show:the area of middle point and separated point of flexor digitorum brevis is 3.63±0.42 mm~2 and 2.71±0.44 mm~2 respectively.The area of middle point and separated point of halluces and extensor digitorum brevis is 1.58±0.20mm~2 and 1.19±0.13mm~2 respectively.The area of middle point and separated point of abductor halIucis is 4.04±0.25mm~2 and 3.14±0.19mm~2 respectively.The quantity of myelinated fiber of three group intrinsic muscles of foot at different site are showing:the quantity of middle point and separated point of flexor digitorum brevis is 745.33±97.57 roots and 826.17±62.41 roots respectively.The quantity of middle point and separated point of halluces and extensor digitorum brevis is 505.33±34.02 roots and 550.00±56.97 roots respectively.The quantity of middle point and separated point of abductor hallucis is 936.83±90.34 roots and 1064.33±141.24 roots respectively.Statistical treatment:the quantity of nerve fiber of separated point of halluces and extensor digitorum brevis is lesser than that of flexor digitorum brevis and abductor hallucis.When the proximal nerve fiber is insufficient,the transplantation of halluces and extensor digitorum brevis has the more probability to gain the useful reinnervation.There is no significant deviation between the quantity of myelinated fiber at the middle point of flexor digitorum brevis and that of abductor hallucis and between the quantity of myelinated fiber at the separated point of flexor digitorum brevis and that of abductor hallucis.There is significant deviation between the quantity of myelinated fiber at the middle point and the separated point of halluces and extensor digitorum brevis.The quantity of myelinated fiber at the separated point is bigger than that of the middle point of nerve tract of halluces and extensor digitorum brevis.There is significant deviation between the section area of nerve tract at the middle point and that of separated point in three group intrinsic muscles of foot.The section area of nerve tract at the middle point is bigger than that of separated point in three group intrinsic muscles of foot.The section area of nerve at middle point of halluces and extensor digitorum brevis is lesser than that of extensor digitorum brevis and that of abductor hallucis.The section area of nerve at separated point of halluces and extensor digitorum brevis is lesser that of extensor digitorum brevis and that of abductor hallucis.There is significant deviation between the density of nerve fiber at the middle point and that of separated point in the three group intrinsic muscles of foot.The density of nerve fiber at the middle point of nerve tract is lesser than that separated point in three group intrinsic muscles of foot respectively.The density of nerve fiber at the middle point ofhalluces and extensor digitorum brevis is bigger than that of extensor digitorum brevis and that of abductor hallucis.The density of nerve fiber at the separated point ofhalluces and extensor digitorum brevis is bigger than that of extensor digitorum brevis and that of abductor hallucis.ConclusionsAccording to the anatomic finding,if selecting the thenar muscular branch of median nerve and the deep branch of ulnar nerve as the anastomose object to recover the function of muscle of thenar,the halluces and extensor digitorum brevis has the obviously dominance relating to the hitologic feature,the volume and the anastomose aspect of nervous branch.According to the histological finding,if selecting the thenar muscular branch of median nerve and the deep branch of ulnar nerve as the anastomose object to recover the function of muscle of thenar,the halluces and extensor digitorum brevis has the obviously dominance relating to the section area of nerve tract,the quantity of nerve fiber and the density of nerve fiber.In order to raise the availability of nerve fiber,the motor tract branch at the wrist should be selected as the nerve donator of intrinsic muscles of foot.The cutting point of neural stalk should be selected at the separated point and the succeeding rate is bigger using the branch of nerve tract to anastomose with the branch of thenar muscles.In order to recover the muscle strength level reaching 3-4 grade of the transplanted intrinsic muscles of foot,we selected the separated point of nerve tract of intrinsic muscles of foot as the afiastomose site as example.The quantity of nerve fiber passing through the anastomose aperture at least need:660.94 strips(extensor digitorum brevis),440 strips(halluces and extensor digitorum brevis),851.46 strips(abductor hallucis).This paper selecting the clinical demand relating to the function of intrinsic muscles of hand does not recover after the brachial plexus injury and select the intrinsic muscle of foot and their nerve tract group as the researching object at the first time.This paper selecting selectivity tissue displacement to recover the function of intrinsic muscles of hand as the researching aim,taking the development results of microsurgical technology to the functional recovery of intrinsic muscles of hand that suffering from the brachial plexus injury.According to the histological and anatomic finding of part intrinsic muscles of foot and their neurovascular features,researched the probability of using transplantation of intrinsic muscles of foot having neurovascular stem to recover the function of intrinsic muscles of hand.These results will to provide practice and sciential data for the design of operational plan.更多还原