正中神经前臂段浅层肌支的应用解剖

目的测量正中神经前臂段浅层肌支的解剖学数据,为正中神经的创伤修复提供形态学依据。方法采用解剖剥离测量方法,对30侧10%甲醛固定的成人上肢标本正中神经发出的前臂段浅层肌支进行解剖学观察。结果正中神经前臂段浅层肌支的分支类型有1支型、2支型、3支型和4支型。其中,旋前圆肌支以3支型(87%),指浅屈肌支(90%)以4支型,桡侧腕屈肌支(96.7%)和掌长肌支(96.7%)以1支型出现率最多。正中神经前臂段浅层肌支主要集中于前臂的4%～65%。结论确定了正中神经前臂段浅层肌支在前臂的危险区间;讨论了有利于开展带神经血管蒂肌瓣移植的肌支类型。     

前臂后群伸肌的神经分布及意义

目的　探讨前臂后群肌内的桡神经走行及分布,为临床自体骨骼肌移植提供解剖学基础。 方法　在5 具新鲜成人尸体标本上,完整取下桡侧腕长伸肌、指伸肌、拇长展肌和拇长伸肌,观测肌外神经来源,并采用改良Sihler’s 肌内神经染色法观察肌内神经的分支、分布。 结果　采用Sihler’s 染色后的肌肉标本,呈透明或半透明状态,肌内神经分支被染成紫黑色,其在肌肉内的分布及走行清晰可见。 结论　根据染色结果可将桡侧腕长伸肌、指伸肌、拇长展肌和拇长伸肌分为不同的肌亚部,为临床肌移植设计有指导意义。     

Anatomical study of the motor branches of the median nerve to the forearm and guidelines for selective neurectomy

Purpose

The median nerve is responsible for the motor innervation of most of the muscles usually involved in upper limb spasticity. Selective neurectomy is one of the treatments utilized to reduce spasticity. The purpose of this study was to describe the variations of the motor branches of the median nerve in the forearm and draw recommendations for an appropriate planning of selective neurectomy.

Materials and methods

The median nerve was dissected in the forearm of 20 fresh cadaver upper limbs. Measurements included number, origin, division, and entry point of each motor branch into the muscles.

Results

One branch for the pronator teres was the most common pattern. In 9/20 cases, it arose as a common trunk with other branches. A single trunk innervated the flexor carpi radialis with a common origin with other branches in 17/20 cases. Two, three or four branches innervated the flexor digitorum superficialis, the first one frequently through a common trunk with other branches. They were very difficult to identify unless insertions of pronator teres and flexor digitorum superficialis were detached. The flexor digitorum profundus received one to five branches and flexor pollicis longus one to two branches from the anterior interosseous nerve.

Conclusions

There is no regular pattern of the motor branches of the median nerve in the forearm. Our findings differ in many points from the classical literature. Because of the frequency of common trunks for different muscles, we recommend the use of peroperative electrical stimulation. Selective neurotomy of flexor digitorum superficialis is technically difficult, because the entry point of some of their terminal branches occurs just below the arch and deep to the muscle belly.

     

A split and conjoined median nerve in the forearm

We observed a variation of the median nerve that split into two divisions in the proximal forearm and conjoined into a single cord in the distal forearm before entering the carpal tunnel. The medial division was larger than the lateral division. An aberrant muscular slip from the flexor digitorum superficialis ran over the medial division of the split median nerve. The muscular slip over the medial division might have caused an entrapment syndrome of this nerve due to several muscular and cutaneous branches originating from the medial division. This variation of the median nerve has not been reported to our knowledge and may affect diagnosis and treatment of any neuropathy of the median nerve.     

Topographical anatomy of the radial nerve and its muscular branches related to surface landmarks

Understanding of the anatomy of the radial nerve and its branches is vital to the treatment of humeral fracture or the restoration of upper extremity function. In this study, we dissected 40 upper extremities from adult cadavers to locate the course of the radial nerve and the origins and insertions of the branches of the radial nerve using surface landmarks. The radial nerve reached and left the radial groove and pierced the lateral intermuscular septum, at the levels of 46.7, 60.5, and 66.8% from the acromion to the transepicondylar line, respectively. Branches to the long head of the triceps brachii originated in the axilla, and branches to the medial and lateral heads originated in the axilla or in the arm. The muscular attachments to the long, medial, and lateral heads were on average 34.0 mm proximal, 16.4 mm distal, and 19.3 mm proximal to the level of inferior end of the deltoid muscle, respectively. The radial nerve innervated 65.0% of the brachialis muscles. Branches to the brachioradialis and those to the extensor carpi radialis longus arose from the radial nerve above the transepicondylar line. Branches to the extensor carpi radialis brevis usually arose from the deep branch of radial nerve (67.5%); however, in some cases, branches to the extensor carpi radialis brevis arose from either the radial nerve (20.0%) or the superficial branch of the radial nerve (12.5%). Using these data, the course of the radial nerve can be estimated by observing the surface of the arm. Clin. Anat. 26:862–869, 2013. © 2012 Wiley Periodicals, Inc.     

骨间后神经及其拇示指肌支的解剖学特征

目的　观察前臂骨间后神经及其拇示指肌支的解剖学特征。 方法　解剖43具尸体的86侧上肢部桡神经深支及其分支到腕背部,观测骨间后神经的行程与投影及其拇示指肌支起始部位横径、长度和骨性标志线与神经干间夹角关系等参数。 结果　骨间后神经及其各分支均呈扁薄的窄带状神经束,其主干和多数肌支都走行在前臂后面中2/4段浅、深层肌之间,终末支止于腕背侧的梭形膨大部;主干起始处横径为（3.79±0.64）mm,各分支在起始部的平均横径（除指伸肌支约2.0 mm外）均小于1.0 mm;在旋后位,它呈向桡侧开放的弓形线段投影在肱骨外上髁至尺骨茎突连线的尺侧,半旋前位时则投影于该连线上或其桡侧。 结论　前臂后面中2/4段是骨间后神经主干及其大多数拇示指肌支在临床上易被损伤、误伤发生的高风险区域。     

Vascular branches from cutaneous nerve of the forearm and hand: Application to better understanding raynaud's disease

Cutaneous nerves have branches called vascular branches (VBs) that reach arteries. VBs are thought to be involved in arterial constriction, and this is the rationale for periarterial sympathectomy as a treatment option for Raynaud's disease. However, the branching patterns and distribution areas of the VBs remain largely unclear. The aim of the present study was to investigate the anatomical structures of the VBs of the cutaneous nerves. Forty hands and forearms were examined to assess the branching patterns and distribution areas of the VBs of the superficial branch of the radial nerve (SBRN), the lateral antebrachial cutaneous nerve (LACN), the medial antebrachial cutaneous nerve (MACN), and the palmar cutaneous branch of the ulnar nerve (PCUN). VBs reaching the radial and ulnar arteries were observed in all specimens. The branching patterns were classified into six types. The mean distance between the radial styloid process and the point where the VBs reached the radial artery was 34.3 ± 4.8 mm in the SBRN and 38.5 ± 15.8 mm in the LACN. The mean distance between the ulnar styloid process and the point where the VBs reached the ulnar artery was 60.3 ± 25.9 mm in the MACN and 43.8 ± 26.0 mm in the PCUN. This study showed that the VBs of the cutaneous nerves have diverse branching patterns. The VBs of the SBRN had a more limited distribution areas than those of the other nerves. Clin. Anat. 31:734–741, 2018. © 2017 Wiley Periodicals, Inc.     

肌皮神经肌支的定位及临床意义

目的探讨肌皮神经肌支的分支类型及其精确的体表定位方法.方法上肢标本58侧,仔细解剖观测肌皮神经走行、分支的横径和长度等.结果(1)肌皮神经穿过喙肱肌的位置距肩峰为(5.95±1.03)cm;(2)肱二头肌支起始处距肩峰距离男(12.02±1.68)cm,女(10.35±1.88)cm,分别为肩峰-外上髁长度的(41.12±4.46)%和(36.91±6.55)%;起始点横径男(1.27±0.37)mm,女(1.43±0.42)mm.短头肌支的长男(3.66±13.7)cm,女(5.07±2.05)cm,长头肌支的长男(4.27±1.37)cm,女(5.25±1.95)cm;(3)肱肌支起始处距肩峰距离为男(15.27±2.76)cm,女(12.72±2.01)cm,分别为肩峰-外上髁长度的(52.50±9.60)%和(45.42±6.97)%.起始点横径(1.35±0.40)mm,长为(5.88±2.19)cm.结论将肱二头肌支和肱肌支在肌皮神经发出点定位表达以肩峰与外上髁距离的百分比,可避免因个体差异而对肌支起点定位产生的误差,为临床提供更为便捷、可靠、实用的解剖依据.     

Surgical anatomy of the radial nerve branches to triceps muscle

The objectives of the study are to demonstrate the innervation patterns of the triceps muscles and the most suitable branch of the radial nerve for nerve transfer to restore the motor function of the deltoid muscle in patients with complete C5–C6 root injury. Seventy‐nine arms (40 left arms and 39 right arms) from 46 embalmed cadavers (24 male and 22 female) were included in the study. The nerves to the triceps were dissected from the triceps muscles (long head, lateral head, and medial head). The lengths of the branches were measured from the main trunk. The distance from the inferior margin of the teres major muscle to the origin of the nerve to the long head, lateral head, and medial head of the triceps were recorded as well. The first branch was the nerve to the long head of the triceps in 79 arms (100%). The second branch was the nerve to the upper medial head in 30 arms (38%), nerve to the medial head in 8 arms (10.1%), nerve to the upper lateral head in 35 arms (44.3%) and nerve to the lateral head in 6 arms (7.6%). The patterns of branches to the triceps were classified according to our dissections. The nerve to the long head of the triceps was constant as the first branch of the nerve to the triceps branch of the radial nerve in the vicinity of the inferior margin of the teres major muscle. Clin. Anat. 2013. © 2012 Wiley Periodicals, Inc.     

股神经和闭孔神经肌支转位的解剖学测量和神经纤维定量

目的　探索股神经肌支转位修复闭孔神经损伤与闭孔神经肌支修复股神经损伤的应用解剖。 方法　游标卡尺测量20具成人尸体股神经和闭孔神经肌支的长度;6具死亡3~10 h内尸体,其股神经和闭孔神经的肌支经Karnovsky-Roots法染色后,图像分析仪测量它们的横切面积和神经纤维数量。 结果　股神经肌支中股内侧肌长支最长,近端横断面积最大;闭孔神经肌支中股薄肌支最长,大收肌支近端横切面积最大。每条肌支内均以躯体运动纤维含量最高,股神经肌支中股内侧肌长支躯体运动纤维数量最多,而闭孔神经肌支中大收肌支最多,其次是股薄肌支。各肌支中γ-薄髓神经纤维的含量,股神经的肌支中以股内侧肌短支和股直肌支较高;而闭孔神经肌支中短收肌支含量最高。 结论　基于各肌支长度、近端横断面积和神经纤维数量的综合考虑,股神经和闭孔神经损伤修复中,股内侧肌长支和股薄肌支宜为供体神经;股内侧肌短支和股直肌支以及大收肌支宜为受体神经。     

人胫神经及其肌支功能束的定位与纤维定量

目的:探索人胫神经及其肌支功能束的定位与定量情况. 方法:取20侧成人胫神经及其肌支,采用Karnovsky-Roots乙酰胆碱酯酶组织化学法进行染色,对其功能束进行定位、定量与定性分析. 结果:胫神经腘窝段功能束为(18.33±2.61)束.切片内能区分躯体感觉、躯体运动、γ-薄髓和交感节后无髓4种神经纤维.躯体感觉束主要位于神经断面的后内侧;躯体运动束主要位于前外侧.胫神经肌支2支型占66%～70%.小腿后群浅层肌支中各种神经纤维数量总和比深层肌支多1～2倍.支配深层3块肌的神经支中,躯体运动纤维和γ-薄髓神经纤维在胫骨后肌支中含量最高. 结论:胫神经及分支内感觉纤维与运动纤维相互混合,且存在同种纤维分区聚集现象.各神经支中每种纤维的数量不同.     

用旋前方肌肌桥修复正中神经缺损的应用解剖

在30侧成人上肢标本上,观测了旋前方肌的形态和血供.旋前方肌血供来自骨间前动脉、桡动脉和尺动脉的旋前方肌肌支.肌的血供主要来自骨间前动脉,以骨间前血管为蒂,依据神经损伤平面的不同,可设计以旋前方肌上、中、下不同部位的肌桥为桥接体、     

肘部及前臂上段正中神经卡压综合征的临床解剖学研究

目的 探讨肘部正中神经卡压综合征的解剖学基础。方法 解剖观察５０侧上肢标本,结果 肱二头肌腱膜与正中神经的关系有非覆盖４０例（８０％）,部分覆盖型６侧（１２％）和完全覆盖型４侧（８％）。旋前圆肌纤维桥斜过正中神经前方３２侧（６４％）。旋前圆肌肱骨头肌内有腱束８例（成人,占１８．６％）,尺骨头汪岙较厚筋膜４７侧（９４％）。指浅屈肌起始结构有联合腱弓型４４侧（８８％）,纤维情怀２侧型（４％）和腱束型（     

正中神经在肘部及前臂上段卡压综合征的解剖基础

目的：探讨正中神经在肘部及前臂上段卡压综合征的解剖学基础。方法；在50例上肢标本上解剖观察正中神经受压的解剖因素。结果：肱二头肌腱膜与正中神经的关系；非覆盖型80％（40侧），部分覆盖型12％（6侧）和全覆盖型4侧（8％）。64％（32侧）反转筋膜斜过正中神经前方。18．6％（8侧）旋前圆肌肱骨头肌内有明显腱束，94％（47侧）尺骨头浅面有增厚腱膜。指浅屈肌起始两头间的形态结构：88％（44侧）联合腱弓型，4％（2侧）纤维弓，8％（4侧）指浅屈肌腱束。结论：正中神经通过前臂上段及肘部时，肱二头肌腱膜，旋前圆肌肱骨头的反转筋膜和肌内腱束，尺骨头浅面的腱膜，指浅屈肌起始部的联合腱弓和纤维弓等可能是导致其受压的解剖学因素。     

前臂近中段Thompson入路中桡神经深支医源性损伤的解剖学因素及对策

目的　探讨前臂近中段Thompson入路中容易发生桡神经深支损伤的解剖学因素并提出对策。 方法　教学用成人尸体标本48具,按照Thompson入路显露,观察前臂伸肌与桡神经深支及其肌支的位置关系;测量桡神经深支穿出旋后肌的位置距离桡侧腕短伸肌的横向距离;观察指伸肌和桡侧腕短伸肌在前臂近段的愈着情况,测量二者在肱桡关节线以远的愈着长度。 结果　指伸肌和桡侧腕短伸肌在前臂近段相愈着,愈着长度在肱桡关节以远(7.1±2.1)cm;桡神经深支在旋后肌下缘的穿出点与桡侧腕短伸肌尺侧缘的水平距离为(1.3±0.3) cm,与肱桡关节线距离为(6.1±1.8) cm。 结论　前臂近中段Thompson入路中容易发生桡神经深支损伤存在着解剖学因素,了解桡神经深支的解剖特点及其与前臂伸肌的位置关系可以避免桡神经深支损伤。     

Topographic anatomy of the lingual nerve and variations in communication pattern of the mandibular nerve branches

We made a thorough observation of the morphology and course of the lingual nerve (LN) and inferior alveolar nerve (IAN) to clarify their topographical relationships in the infratemporal fossa and in the paralingual area. Thirty-two Korean hemi-sectioned heads were dissected macroscopically and microscopically from a clinical viewpoint. On the 32 tracings on the radiograph, the average distance between the retromolar portion and the LN was 7.8 mm, and no case was found where the LN ran above the alveolar crest as passing along the mandibular lingual plate. The bifurcation of the LN and IAN was located around the mandibular notch, inferior to the otic ganglion in 66% of the cases, and a plexiform branching pattern of the mandibular nerve was observed in only two cases. The bifurcation spot of the LN and IAN was located 14.3 mm inferior to the foramen ovale and 16.5 mm superior to the tip of hamulus. Collateral nerve twigs from the LN to the retromolar area were observed in 26 cases (81.2%), with an average of one nerve twig. We observed four types of variations in terms of communication pattern. In four specimens, the mylohyoid nerve passed through the mylohyoid muscle and connected with the LN. In other four specimens, the IAN communicated with the auriculotemporal nerve. We also observed another type of variational communication between the IAN and the nerve to the lateral pterygoid (LPt); this was observed in only one specimen, and it could be predicted that motor innervation from the nerve to the LPt was transmitted via the mental nerve to the depressor anguli oris. Another type was observed where the IAN divided into two branches with the posterior branch being partially entrapped by the LPt muscle fibers.