合谷穴与尺神经深支的位置关系

Positional relationship between Acupoint Hegu(LI4) and deep branch of ulnar nerve

目的:探讨合谷穴与尺神经深支的位置关系。方法:在100只成人手标本上解剖观测合谷穴局部。结果:拇指呈伸位,合谷穴直刺进针时,针体经手背合谷穴皮肤至拇收肌掌面的组织厚度是(2.38±0.34c)m,该厚度均超过合谷穴手背至手掌面皮肤组织厚度的一半。皮肤进针点与尺神经深支终末段穿拇收肌处的距离是(3.53±0.24)cm。尺神经深支终末段穿拇收肌横头与拇收肌斜头之间入拇收肌后间隙,并在此间隙内发出各分支,其中拇收肌横头支行向外下方,拇收肌斜头支行向前外上,第一骨间背侧肌支水平向外下后方,拇短屈肌支水平向外。结论:合谷穴针刺时,拇指应呈伸位,直刺进针,深度以不超过患者皮肤进针点至手掌面皮肤组织厚度的一半为宜。尺神经深支终末段的分支走行方向,可能与临床上针刺合谷穴时向不同方向进针有不同的疗效和针感具有一定的关系。

Objective：To explore the positional relationship between Acupoint Hegu（LI4） and deep branch of ulnar nerve. Methods： One hundred cadaveric hands were perfused with formalin, Acupoint Hegu（LI4） and deep branch of ulnar nerve were meticulously dissected along their course layer by layer. Results： Acupoint Hegu （LI4） was located at the volar surface of the adductor pollicis muscle, the thickness from the dorsal skin to the volar surface of the adductor pollicis muscle was （2.38±0.34）cm, when the thumb was in extensional position. This distance preponderated over half of the thickness from the dorsal hand to the volar. The depth from the inserted point of the skin to the point where the terminal segment of deep branch of ulnar nerve penetrated through the adductor pollicis muscle, was（3.53±0.24）cm. The terminal segment of deep branch of ulnar nerve penetrated between the transverse head and oblique head of adductor pollicis muscle, and then into the posterior space of adductor pollicis muscle and sent off several branches. The branches of transverse head ran inferolaterally： The branch of the oblique head ran antero-latero-superiorly; The branches to the 1st dorsal interosseal muscle horizontally ran latero-infero-posteriorly, and the branches to the Flexor pollicis brevis muscle horizontally went laterally. Conclusions： When Acupoint Hegu （LI4） was punctured, thumb should be extended,the needle should be inserted perpendicularly and the depth should be no more than half of the thickness from the inserting surface of the dorsal skin to the voiar surface of the palm. The direction of the branches of the terminal segment of deep branch of ulnar nerve may have some relation to the different curative effect and needling sensation at the time of puncturing Hegu （LI4）.