骨间后神经的解剖学研究及其临床意义

Anatomic Study and its Clinical Significance for the Posterior Interosseous Nerve

目的研究骨间后神经的起源、行程、受卡压原因,并为外科手术治疗提供解剖学基础。方法解剖40侧成人尸体上肢,将骨间后神经分为3段(见附图):桡管段为从起点到旋后肌入口的距离,旋后肌管段为入口到出口的距离,旋后肌管后段为出旋后肌管以后的分支。观察骨间后神经的起源、行程、分支,旋后肌管入口、出口的形态和结构特点。用游标卡尺测量桡管段和旋后肌管段长度,旋后肌管入、出口的宽度。结果骨间后神经桡管段和旋后肌管段长度分别为(36.1±10.7)mm(均数±标准差,下同)和(39.7±0.89)mm。旋后肌管入口宽度为(12.4±0.29)mm,腱性结构占65%(26例),膜性结构占20%(8例),肌性结构为15%(6例)。出口位于拇长展肌上缘上方(15.3±0.68)mm,宽度(12.9±0.55)mm,肌性结构占52.5%(21例),腱性结构占40%(16例),膜性结构占7.5%(3例)。结论桡管和旋后肌管的解剖结构有时可导致骨间后神经受卡压,本文资料对外科手术治疗具有重要参考价值。

Objective To study the course, the origin and the possible compression sites of the posterior interosseous nerves at the region of the supinator muscles and to＇provide anatomic base for surgical treatment. Methods On 40 Chinese adults cadaver upper limbs, the posterior interosseous nerves were dissected. It was divided into three parts： the radial tunnel part, the distance from origin to entering supinator muscles entrances, supinator tunnel part, the distance from supinator muscle entrances to the exit. The origin, the course, the branches and the structure of entering with outing of the supinator muscle entrances and exit were observed and measured. The length of the radial tunnel with supinator tunnel and the widths of entering with outing of the supinator muscle entrances and exit were measured. Results The length of the radial tunnel and the supinator tunnel are（36.1 ± 1.07）mm （average ± standard deviation） and （ 39.7 ± 0.89） mm, respectively. The widths of the entrances and the exit are （ 12.4 ± 0.29） mm and （ 12.9 ± 0.55 ） mm, respectively. The entrances of the entering supirator were tendinous, membranous, and muscular in 65% , 20% , 15 % , respectively. The exit out of supinator was muscular membranous and tedious in 52.5% ,40% ,7.5% ,respectively. The distance from outing of supinator exit to the superior border of the abductor policies longus were（ 15.3 ±0.68 ） mm. Conclusion Some anatomic structure at the radial tunnel and the supinator tunnel may result in the compression of the posterior interosseous nerves. The data may provide the knowledge for surgical treatment.