骨间前神经卡压的解剖学研究及临床分析

Anatomic study and clinical analysis of anterior interosseous nerve compression syndrome

目的探讨骨间前神经卡压的解剖学因素及临床疗效。方法对12侧新鲜尸体上肢标本进行解剖学研究，观察骨间前神经在走行过程中存在的卡压因素。1997年5月-2007年12月，对15例骨间前神经卡压者进行治疗。其中1例行保守治疗；14例行骨间前神经松解，并切除对其形成卡压的腱性组织，其中7例同时结扎卡压在骨间前神经上的血管。15例获得6个月至4年的随访。结果12侧解剖学研究发现，旋前圆肌深头的腱性组织出现率为91．7％（11侧），骨间前神经几乎均被旋前圆肌两头骑跨；示、中指指浅屈肌腱腱弓出现率为41．7％（5侧）；拇长屈肌副头出现率为58．3％（7侧）；骑跨于正中神经和骨间前神经之上的异常血管出现率为66．7％（8侧）。14例手术者中，7例同时行血管结扎者，术后疗效优于单纯松解骨间前神经和切断腱性组织者。结论骨间前神经卡压是多因素共同作用的结果，手术彻底解除其走行路径的全部卡压因素是获得满意疗效的关键。

Objective To investigate the anatomic factors that cause anterior interosseous nerve entrapment and analyze the clinical results of decompression. Methods Twelve fresh cadaver upper limb specimens were dissected. The anatomic characteristics of the anterior interosseous nerve and the possible compression factors along its course were observed. Fifteen cases of anterior interosseous nerve compression syndrome were treated between May 1997 and December 2007. One underwent conservative treatment and 114 had surgical decompression of the anterior interosseous nerve. The tendinous structures that compressed the nerve were resected. In 7 cases the vessels that run across the nerve were ligated. Postoperative follow up time ranged from 6 months to 4 years. Results Anatomic studies in the dissected 12 specimens showed 91.7 % occurrence （11 specimens） of tendinous structures of the deep head of pronator teres. The anterinor interesseous nerve was almost always sandwiched between the two heads of pronator teres. The tendinous arch of flexor digitorum superficialis of the index and middle fingers occurred in 41.7% （5 specimens）. Accessory head of flexor pollicis longus occurred in 58.3% （7 specimens）. The incidence of abnormal vessels across the median nerve and the anterior interosseous nerve was 66.7% （8 specimens）. The 7 cases treated with additional hgation of the abnormal vessels running across the anterior interosseous nerve had better results than those treated only with nerve decompression and resection of the tendinous or fibrous structures. Conclusion Anterior interosseous nerve compression syndrome is the result of multiple factors. All the structures that can cause entrapment of the nerve on its anatomic course should be released in order to achieve satisfactory results.