正中神经返支卡压及易损伤部位的解剖学基础

目的：探讨腕管综合征术后大鱼际功能恢复不良的原因与返支易损伤部位。方法：对20侧成人新鲜上肢标本进行显微解剖，观测正中神经返支走行中存在的卡压因素以及易损伤部位。结果：(1)拇短屈肌浅头尺侧存在腱弓及腱纤维束结构，对正中神经返支形成卡压；(2)住屈肌支持带远侧返支与掌腱膜关系密切，在此部位掌腱膜可对返支形成卡压或术中易误伤返支；(3)走行中返支与拇长屈肌腱和示指屈肌腱存在交叉走行关系。结论：(1)返支走行中存在易卡压因素，治疗腕管综合征时应常规探查松解返支；(2)涉及拇长屈肌腱，示指屈肌腱和掌腱膜手术时，应注意防止损伤返支。

Anatomical study on the position susceptible to entrapment and damage of the recurrent branch of median nerve

Objective: To explore the reasons for malfunction of thenar muscle after operation of the carpal tunnel syndrome and study the position susceptible to entrapment and damage of the recurrent branch of median nerve. Methods: 20 fresh upper limb specimens were dissected under the loupe. The entrapment factors and positions along the course of the median nerve were observed. Results: (1) Tendinous arch and tendinous band ulnar to the superficial head of flexor pollicis brevis would compress the recurrent branch. (2) Palmar aponeurosis near flexor retinaculum was easy to compress the recurrent branch. (3) The recurrent branch passed through the flexor pollicis longus and the flexor tendon of index finger during its course. Conclusions: (1) In operation of carpal tunnel syndrome, the recurrent branch entrapped by other structures need to be released routinely. (2)The recurrent branch should be protected during the operation of the flexor pollix longus,the flexor tendon of index finger and palmar aponeurosis.