Substitute forearm extensor surgery

The sacral nerve injury varies with the location of the sacral nerve. The muscles of the forearm radial nerve injury include: the extension of the total muscle, the extension of the longus muscle, the extension of the shortbone muscle, the radial extension of the wrist, the ulnar extension of the wrist muscle, the abductor longus muscle, the intrinsic extension of the little finger muscle and the intrinsic extension. The finger muscles are shown, and as a result, the back extension of the wrist is weakened, the thumb extension and abduction disappear, and the stretching force of each finger disappears. The sacral nerve injury in the middle part of the humerus is in addition to the above muscle group, as well as the triceps and the iliac crest. Therefore, the forearm extension force also disappears, causing the wrist to sag. The sacral nerve injury may be partial or total damage due to its different nature of injury (such as sacral nerve injury is a complete injury, traction or sacral contusion may be partial or most damage), and the muscles of the sputum are also Not the same. For the forearm extensor surgery, the tendon should be transferred according to the muscles of the tendon. The method of tendon metastasis is as follows: 1. Use the radial flexor carpi muscle (median innervation) to transfer to the tendon of the thumb, short muscles and abductor longus muscles to restore the function of abduction and back extension. 2. Transfer the ulnar flexor carpimus (the ulnar nerve) to the extremity finger, the intrinsic extension finger and the little finger tendon, and restore the function of the back extension finger. 3. For example, the radial nerve injury above the elbow joint, the long side of the wrist and the long tendon of the wrist, that is, the wrist is drooping. The pronated round muscle (median innervation) is transferred to the temporal extension of the wrist and the short tendon to restore the function of the back extension wrist. Treatment of diseases: radial nerve injury Indication 1. Unrepairable radial nerve injury. 2. The sacral nerve injury that has not recovered after 6 months of repair. 3. Forearm extensor tendon is not recovered by non-surgical treatment. Preoperative preparation 1. Carefully check the muscles of the tendon before surgery to determine the surgical design of the tendon transplant. At the same time, it is necessary to determine the function of the pronated round muscle and the ulnar and ulnar flexor carotid muscles, which are dominated by the ulnar nerve and the median nerve, and the wrist and the rotating forearm are powerful. 2. In order to facilitate the fixation after surgery, the forearm plaster support from the elbow to the fingertip can be pre-operatively preoperatively, and the wrist can be stretched 45°, the thumb abduction and extension, and the other 4 fingers can be stretched. application. Surgical procedure 1. Position: In the supine position, the limbs are abducted on a small operating table next to the operating table. 2. Incision: A total of 6 incisions were made. Incision 1: A transverse incision was made on the temporal side of the distal wrist of the diseased limb, 1.5 cm long, showing the sacral tendon of the radial flexor tendon. Incision 2: A transverse incision was made on the ulnar side of the distal wrist transverse pattern and the proximal side of the pea bone, and the length was 1.5 cm, and the ulnar wrist flexor tendon was exposed. Incision 3: In the middle of the forearm, the volar side of the volar muscle of the radial flexor muscle was made as a longitudinal incision, 6 cm long, showing the flexor carpi radial muscle. When the incision is made, the radial flexor tendon can be gently pulled at the incision 1 to identify the correct position of the muscle abdomen. Incision 4: An incision was made in the volar side of the mid-forearm and the ulnar flexor carpi muscle. The length was 6 cm, and the ulnar flexor carpi muscle was exposed. Incision 5: On the medial side of the dorsal forearm, a longitudinal incision from the wrist joint, 5 cm long, revealing the abductor hallucis longus, the buckling short muscles and the long thumb. Incision 6: The forearm is placed in the neutral position, and a longitudinal incision is made in the middle and upper 1/3 of the humerus, which is about 5-6 cm long to reveal the stopping point of the pronated round muscle on the tibia. 3. Separation, metastasis, ulnar flexion of the wrist muscle: the incision 1 is cut off the iliac crest muscle tendon stop point, and the muscle abdomen is exposed and isolated in the incision 3, and the tendon is extracted. The ulnar flexor tendon is then severed in the incision 2, and the tendon is also withdrawn from the incision 4. The ulnar artery and nerve are placed under the ulnar flexor carpal muscle, taking care to avoid injury. There are many muscle fibers attached to the ulnar flexor tendon, which should be partially separated to expose the tendon. Then, a subcutaneous tunnel is made to the incision 3 and the incision 4 in the incision 5, respectively, and the radial flexor tendon and the ulnar flexor tendon are extracted from the incision 5. 4. Transfer the pronated round muscle: Place the forearm in the neutral position and pull the incision 6 to reveal the diaphragm. Pulling the muscle to the dorsal side, looking for the midpoint of the lateral aspect of the humerus, you can find a thin layer of tendon from the inside to the lower side, that is, the stop point of the pronator on the tibia. Together with the periosteum, the pronator is cut, and then the sacral longissimus dorsi and the temporally extensor brachial muscle are exposed on the deep side of the diaphragm; the muscle can be pulled and determined if the wrist is stretched. If local anesthesia is used, the pronated round tendon can be temporarily sutured on the two tendons under the extension of the wrist. The patient is flexed and extended, and the patient is allowed to maintain the functional position of the wrist and balance with the antagonistic muscle. At the suture site, a buttonhole was perforated on the two tendons with a mosquito-type hemostatic forceps tip, and then the pronated round tendon was sutured to the buttonhole at a position where there was no distortion and tightness. Thereafter, there should be a person who keeps the wrist stretched (or fixed on the lead plate) to protect the suture. 5. Fixed iliac crest and ulnar flexion of the wrist: Place the thumb in the functional position, and make a buttonhole at the intersection of the abductor longus muscle, the buckling short muscles, and the extension of the longissimus dorsi tendon and the iliac crest tendon. The radial flexor carpi muscle was sutured in the buttonhole of the above 3 muscles without distortion and tightness. Keep the wrist and knuckle in the functional position, and make the buttonhole at the intersection of the extension finger muscle, the intrinsic extension index finger muscle and the intrinsic extension of the small finger tendon and the ulnar flexor tendon, and the ulnar flexor carpi muscle without distortion. It is sutured in the above 3 buttonholes in a moderately tight condition. If local anesthesia is available, the appropriate site can be selected as described above. After the tendon suture is completed, the thumb and fingers should not sag. Stitch all the incisions.