An anatomical study of the palmar cutaneous branch of the median nerve

We present an anatomical study of the palmar cutaneous branch of the median nerve emphasizing its frequency, origin, perforation point at the transverse carpal ligament, point of emergence in the palm, width, length, divisions and innervation territory. For this purpose, fifty cadaver hands were dissected under a stereomicroscope and/or magnifying glass. The origin of the palmar cutaneous branch (PCB) was on the average 4.56 cm proximal to conventionally named "zero point" on the most distal transverse volar wrist crease. Perforation of the aponeurosis occurred on average 0.79 cm from the mentioned point and its emergence in the palm at 0.76 cm. The nerve had an average length of 5.24 cm. PCB's divisions in the palm resulted in a medial branch in 42%, a lateral branch in 92% and an intermediate branch in 100% of the hands studied. In six specimens PCB presented a deep branch which was directed toward the thenar eminence or made communication with the superficial branch of the palmar digital nerve or still penetrated between the first or second metacarpal. In 4% of the cases there was a communicating branch between the superficial branch of the radial nerve and the PCB. These anatomical results should be considered in the evaluation of the best surgical techniques for decompression of the median nerve in the carpal tunnel.     

正中神经返支和掌皮支血供的显微解剖

目的为修复正中神经返支提供带血管蒂神经桥接的有关数据和掌皮支血供的解剖学资料。方法用体视学方法研究了40侧灌注红色乳胶液的返支和掌皮支的营养血管。观察返支营养血管的来源、长度、外径和进入神经干的方式;观察掌皮支营养血管的来源和进入神经的方式。结果返支营养动脉主要发自掌浅弓凹侧筋膜支(称之来源动脉)。来源动脉起点至“零点”距离(11.62±2.30)mm,外径(0.95±0.10)mm,长度(10.12±1.30)mm。营养动脉主干长度(2.84±0.10)mm,外径(0.42±0.15)mm。营养动脉从返支主干近侧1/3段直入式进入神经者占86.5%;从返支中、远侧段伴入式进入神经者占14.5%;掌皮支营养动脉主要发自尺动脉(占52.5%)和桡动脉(占37.5%),以直式、伴入式和肌支式进入神经。结论返支营养动脉可作为血管蒂神经移植的受体血管。     

Relationships of the palmar cutaneous branch of the median nerve: a morphometric study

Treatment of carpal tunnel syndrome consists in decompression of the median nerve by section of the flexor retinaculum. Usually, this surgery improves the disease with disappearance of the symptoms. However, some painful sequelae may remain such as painful discharges, paresthesiae or permanent anesthesia of the base of the thumb or of the scar related to an injury of the palmar cutaneous branch of the median nerve (PCBm). This study was performed to define the accurate emergence and the anatomic characteristics of this nerve in relation to stable landmarks. Moreover, it assessed the importance of the visual identification of the branch during section of the flexor retinaculum. Thirty-five hands were dissected under macroscopic examination and under magnification of the thinnest branches. Measurements were performed with a caliper and the forearm in supination. Determination of the bistyloid line showed variability in the location of the distal wrist crease. Thus, it could not be used as a landmark to locate the PCBm. The palmar cutaneous branch is the distal collateral branch of the median nerve in the forearm. It emerges on its radial side, on average 44.3 mm before the bistyloid line. It courses in line with the third finger and perforates the antebrachial aponeurosis about 5.7 mm from the bistyloid line. This emergence can be located in the palm, where it can be injured if the incision is performed in line with the third finger. The PCBm usually ends in the palm by division into two or three branches. The lateral branch supplies the skin of the thenar eminence while the medial, usually shorter branch supplies the midline part of the palm. This study has shown the importance of performing the cutaneous incision in line with the fourth finger to avoid injury to the PCBm.     

正中神经掌皮支形态特点及其临床意义

目的：为腕掌部手术避免损伤掌皮支提供解剖学基础。方法：在双目放大镜下对５０侧成人上肢正中神经掌皮支的来源、走行及分支进行解剖和观测。结果：５０侧均存在掌皮支，距离“Ｏ”点即远侧腕横纹４６．０ｍｍ处自正中神经桡侧发出，穿出前臂筋膜处距Ｏ点１９．６ｍｍ；穿出掌腱膜处距Ｏ点８．３ｍｍ。掌皮支长４８．５ｍｍ，起点宽１．２ｍｍ，距舟骨结节垂直距离８．２ｍｍ。掌皮支有３个分支的２８侧（５６．０％）；只有外侧支和中间支的１１侧（２２．０％）；只有内侧支和外侧支的４侧（８．０％）；只有外侧支的４侧（８．０％）；只有中间支的３侧（６．０％）。结论：掌皮支的来源、行程较恒定。腕掌部手术应尽量靠近尺侧，采取纵行切口，免伤掌皮支。     

正中尺动脉型掌浅弓变异1例

作者在解剖1例经红色乳胶灌注的童尸左前臂时发现正中尺动脉型掌浅弓变异，报道如下：     

A connecting branch between the musculocutaneous nerve and the median nerve

We report here a connecting branch between the musculocutaneous and the median nerves in a 42 years old male cadaver. The connecting branch was 8 cm in length and 3 mm in width. One of the brachial veins and the brachial artery were located between the roots of the median nerve and the second brachial vein was present between the connecting branch and the median nerve. These kinds of variations may effect the venous return and may cause edema in the upper extremities. Additionally, variations of these nerves have an importance during operations of this region.     

指掌侧总动脉与指掌侧总神经的关系及其临床意义

目的:探索指掌侧总动脉及其分支是否对指掌侧总神经形成卡压,为临床诊断和治疗提供解剖学基础。方法:选用60侧手,在手掌部解剖,观测指掌侧总动脉的出现率、记录指掌侧总动脉分支出现的数量、分支对指掌侧总神经骑跨的数量、指掌侧总动脉对指掌侧总神经骑跨的数量,及指掌侧总神经被骑跨处的形态学观察,并对数据进行统计学分析。结果:60侧手指掌侧总神经在与指掌侧总动脉及其分支骑跨处有5例发现压痕的形态学改变,占指掌侧总动脉及其分支数量的10.3‰。统计结果为样本P=1.47%,样本标准误Sp=0.65%,卡压率:(1.47±0.65)%,95%的可信区间为(0.20%-2.74%)。结论:指掌侧总动脉可以造成指掌侧总神经的卡压,是导致指掌侧总神经卡压的原因之一。     

Palmar cutaneous branch of the median nerve conduction study

The study of the palmar cutaneous branch of median nerve (PCBMN) was down in the Shohada hospital from september 1st 2002 to june 1st 2004. One hundred fifty healthy adult, 65 men and 85 women, with mean age of 36 year were studied by antidromic stimulation of median nerve 10 cm from the surface recording over the midthenar eminence. The nerve maybe injured by direct trauma or during surgery at the wrist. The latency was 2.07+/-0.22 (range 1.50 to 2.80) and the Amplitude of SNAP was 14.36+/-0.86 (range 12 to 16.2). the study is useful in evaluating lesions of the PCBMN     

Stratification of the flexor retinaculum and the course and distribution of the ulnar, median, and palmar digital nerves: an anatomical study

A gross anatomic study of 169 hands from 94 human adult cadavers was carried out to define the morphology of the flexor retinaculum and the relationship of the flexor retinaculum to the course of the median and ulnar nerves and branching of the palmar digital nerves. The following results were obtained. Three parts of the flexor retinaculum were arranged like overlapping tiles on a roof, and in all cases, the median nerve passed deep to the flexor retinaculum, whereas the ulnar nerve passed through various parts of the flexor retinaculum in 19% of cases irrespective of its proximal form and branching of the palmar digital nerves.     

桡神经肱肌支的解剖学研究

目的：研究桡神经的肱肌支的形态特点。方法：对７２侧固定尸体的桡神经肱肌支进行解剖与测量，并分为三种不同的类型进行比较。结果：桡神经存在肱肌支出现率为５１．４％（３７侧）。肱肌支的出现以单侧多见，与性别、侧别无关。对肱肌支的起始点、入肌点、长度及横径测量结果，将其归分为：上升型、下降型和水平型三种类型。肌支的起始点在Ｈｕｅｔｅｒ＇ｓ线上３．０～９．６ｃｍ，入肌点在Ｈｕｅｔｅｒ＇ｓ线下０．２～线上９．５ｃｍ，肌支长度０．７～９．６ｃｍ，横径为０．４～２．０ｍｍ。结论：桡神经的肱肌支较普遍存在，行上臂、肘部手术时，应对其加以保护，尤其是在肌皮神经已有损伤者更应如此     

肌皮神经与正中神经之间交通支的观测及意义

目的：调查肌皮神经与正中神经之间交通支的出现率并探讨其临床意义。方法：解剖观测56侧成人上肢尸体标本。结果：肌皮神经与正中神经之间交通支的出现率为21．43％，依交通支发出的数量可将其分为两种类型：I型、Ⅱ型，I型又以其发出的部位分为Ia型(高位型)、Ib型(穿喙肱肌型)和Ic型(低位型)三种。结论：肌皮神经和正中神经之间的交通支并不少见，在臂部手术时应对其加以保护。     

A very rare anatomic variation of the right ventricular branch: right ventricular descending branch from the anterior interventricular branch

The anterior interventricular branch of the left coronary artery has the most constant distribution in the human heart and rarely gives off right ventricular branches. Here we report a case with a right ventricular branch which diverged from the anterior interventricular branch and descended on the anterior right ventricular wall parallel to the anterior interventricular sulcus; we termed it the right ventricular descending branch. This artery gave a collateral artery to the occluded anterior interventricular branch at the apex, and had prevented anterior myocardial infarction. The right ventricular descending branch should be precisely identified in order to perform successful myocardial revascularization procedures such as coronary artery bypass grafting and percutaneous coronary intervention, especially in a patient with anterior interventricular branch occlusion.     

肌皮神经并正中神经及尺神经变异1例

在解剖一具老年男性标本时，见左侧肌皮神经并正中神经及尺神经形态变异(附图)。经查有关文献，此类变异较为少见，现报道如下：     

左侧正中神经变异1例

正中神经外侧根起于臂丛外侧束,含第5、6、7颈神经腹侧支纤维;正中神经内侧根起于臂丛内侧束,含第8颈神经和第1胸神经腹侧支纤维,两神经根夹腋动脉第3段,并在腋动脉前外侧汇合形成正中神经[1]。笔者在进行局部解剖学实验教学即尸体标本解剖中发现1例左臂部正中神经变异1例,即臂丛外侧束发出交通支参与正中神经内侧根形成,肌皮神经与正中神经外侧根共干距离较长,正中神经外侧根与内侧根汇合形成正中神经处校正常低,三种变异同时存在较为少见,为丰富国人解剖学资料并为临床提供解剖学依据,现报道如下。     

桡动脉掌浅支皮瓣解剖基础与临床应用进展

目的 总结桡动脉掌浅支皮瓣的解剖基础与临床应用进展。方法 在PubMed、Science Direct、CNKI和万方数据等数据库以“桡动脉掌浅支、鱼际、腕横纹、外科皮瓣、皮肤缺损”为关键词检索2000年1月—2016年11月有关桡动脉掌浅支皮瓣的相关文献,分别对桡动脉掌浅支的解剖研究、皮瓣设计、临床分型、适用范围及优缺点等方面的最新研究进展进行归纳和总结。结果 桡动脉掌浅支可分为鱼际皮支与腕横纹皮支,走行恒定,血供可靠;两个皮支直径均与手指动脉直径相近,有利于与指动脉相吻合。临床上可在鱼际部与腕横纹部分别设计切取岛状皮瓣与游离皮瓣,修复手部中小面积的各种皮肤软组织损伤;对于合并神经、血管的复合损伤,还可切取Flow-through皮瓣或携带神经、肌腱的嵌合皮瓣,完成一期创面覆盖与功能重建。桡动脉掌浅支皮瓣优点颇多,但对于皮瓣的切取面积范围及具体神经支配情况尚未有统一意见。结论 以桡动脉掌浅支供血的皮瓣切取方式多,修复效果好,适用范围广,临床值得推广,但现有报道中对于皮瓣切取面积及神经支配情况未有详细证据,需进一步研究探讨。