尺神经解剖及临床

Click to edit Master title style,*,*,Edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,*,Edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,Edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,Click to edit Master title style,Edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,Click to edit Master title style,Edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,Click to edit Master title style,Edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,Edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,Click to edit Master title style,Edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,THANKS,Click to edit Master title style,Edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,Edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,Click to edit Master title style,Edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,Click to edit Master title style,Edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,Click to edit Master title style,Edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,Edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,Click to edit Master title style,Edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,THANKS,Click to edit Master title style,Edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,Edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Click to edit Master title style,Edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,尺神经解剖与临床,太钢总医院康复科,尺神经解剖及临床,第1页,尺神经解剖,损伤及临床表现,治疗,主要内容,尺神经解剖及临床,第2页,尺神经解剖,/01,3,尺神经解剖及临床,第3页,尺神经起源及走行,尺神经在腋部由臂丛内侧束形成。,臂丛,：颈,5,8,与胸,1,前支,颈,5+,颈,6,：臂丛上干,;,颈,7,：单独组成中干,;,颈,8+,胸,1,：共同组成下干。,这三干又各分为前支与后支。,外侧束,:,上、中两干前支,;,后束,:,上、中、下三干后支,内侧束,:,下干前支,尺神经解剖及临床,第4页,尺神经,发自臂丛内侧束，在肱二头肌内侧沟伴行于肱动脉内侧至臂中部，,转至臂后区内侧，继而行至肱骨内上髁上方尺神经沟。,再向下穿尺侧腕屈肌至前臂内侧，伴随尺动脉，于尺侧腕屈肌和指深屈肌之间下降抵达腕部。,在腕部，尺神经于腕骨外侧穿屈肌支持带浅面和掌腱膜深面进入手掌。,尺神经解剖及临床,第5页,尺神经解剖,尺神经起自内侧束，沿肱二头肌内侧随肱动脉下降至臂中部，离开肱动脉后转向后下,尺神经解剖及临床,第6页,经肱骨内上髁后方尺神经沟,尺神经解剖及临床,第7页,尺神经解剖及临床,第8页,Section Header Here,Supporting text here.,When you copy&paste,choose keep text only option.,/01,9,尺神经解剖及临床,第9页,尺神经,主干,豌豆骨桡侧,手背支,桡腕关节上方,手背尺侧半及,尺侧二个半指皮肤,深支：,浅支,前臂：,肌支,小鱼际皮肤和,尺侧一个半指皮肤,尺侧腕屈肌和,指深屈肌尺侧半,小鱼际肌，拇收肌，,全部骨间肌及,第三，四蚓状肌,尺神经解剖及临床,第10页,Section Header Here,Supporting text here.,When you copy&paste,choose keep text only option.,/01,11,U,尺神经,R,桡神经,手掌尺侧、小指全部和环指尺侧半；手背尺侧半及尺侧二个半指皮肤,(,第,3,4,指相邻侧只分布于近节后面皮肤,),尺神经解剖及临床,第11页,尺神经损伤及临床表现,/02,12,尺神经解剖及临床,第12页,损伤原因及部位,：,腕部,：,A,在尺管综合征时，神经在豌豆骨和钩骨沟之间受压。,B,腕关节，尤其是因伤口、职业性损伤和腱鞘囊肿造成。,C,肘关节远端,：经过尺侧腕屈肌两头之间时受到压迫。,D,内上髁层面,：如尺神经炎，继发于局部摩擦、压力和牵 拉；肘外翻，骨关节炎。,E,腋部,：外伤或其它原因损伤所致。,尺神经解剖及临床,第13页,Section Header Here,Supporting text here.,When you copy&paste,choose keep text only option.,/01,14,尺神经解剖及临床,第14页,临床表现及诊疗,1,、,运动功效障碍,：,肘上损伤时，曲腕力减弱，环指和小指远节指关节不能屈曲，小鱼际肌和骨间肌萎缩，拇指不能内收，各指不能不能内收外展，,Froment,征,（,+,），夹纸试验（,+,），各掌指关节过伸，出现,爪形手,。,腕部受损：骨间肌运动障碍,尺神经解剖及临床,第15页,检验：,夹纸试验：,（1）骨间肌测试,：让患者环指和小指夹一张纸，手指必须完全伸直，夹紧纸并给予逐步加强反抗力，若所以夹持纸片很易抽出，该试验为阳性。,（2）测试拇收肌（froment试验）：,要求患者由拇指和示指侧面捏紧一张纸，检验者试图将纸抽出，假如患者拇收肌麻痹就会出现拇指在指间关节处弯曲，与健侧相比更易觉察。,尺神经解剖及临床,第16页,2,、感觉功效障碍：,手掌尺侧、小指全部和环指尺侧半；手背尺侧半及尺侧二个半指皮肤,(,第,3,4,指相邻侧只分布于近节后面皮肤,),感觉消失。,若在豌豆骨处损伤，因为手感觉支早已发出，手皮肤感觉不受影响。,尺神经解剖及临床,第17页,治疗：,标准：正确诊疗，尽早修复,（一）闭合性神经损伤或因其它伤病手术挫伤，拉伤,（神经传导障碍或轴突断裂）,保守治疗非手术治疗（,3,月）,理疗，局部按摩。,电针刺激。,自我“意念性”训练,神经营养及生长因子应用,3,月,仍无恢复或恢复不佳,外松解,神经松解,手术探查 内松解,改进神经周围条件（环境）,尺神经解剖及临床,第18页,（二）开放性神经损伤（完全断裂）,1,、一期修复：即时,2,、延期修复：,1,3,周内,3,、二期修复：,1,2,个月,4,、晚期修复：单纯修复神经疗效问题,肌肉、肌腱移植，关节手术（矫形）,（三）神经修复手术方式,1,、神经缝合术,对接：外膜（鞘膜）法，束膜法,端侧缝合,2,、神经松解,3,、神经移植,尺神经解剖及临床,第19页,康复治疗,目标：为神经和肢体功效恢复创造条件，预防肌肉萎缩、纤维化和关节僵硬、促进神经再生。,方法：,1.,理疗 蜡疗、超声波、冷疗、中频等,2.,手法治疗 瘢痕松解、关节松动及牵伸,3.,运动疗法及作业疗法 肌力，协调，脱敏疗法,尺神经解剖及临床,第20页,尺神经解剖及临床,第21页,