桡神经浅支掌背部的临床应用解剖学研究

Clinical Applied Study on Superficial Branch of Radial Nerve at Hand Back

目的:观察桡神经浅支掌背部的解剖结构,为临床掌背部筋膜皮瓣、掌指骨骨折的微创治疗及外科神经修复提供形态学基础。方法:选用福尔马林固定上肢标本42例,应用解剖剥离法,解剖出桡神经浅支及其各分支,观测了桡神经浅支分为内、外侧支的分支点(A点)与桡骨茎突(O点)的距离(AO)和角度(∠A),并测量了其各分支点之间的长度及相应分支点的角度。外侧支分为拇指尺背侧皮神经和第一掌背皮神经处记为B点;桡神经内侧支分为第二、三掌背皮神经处记为C点,第二、三掌背皮神经的夹角记为∠C;第二、三掌背皮神经分为指背皮神经处分别记为D点和E点。结果:42例标本中,38例标本桡神经浅支在桡骨茎突远侧约(3.8±0.6)cm分为内、外侧支,外侧支前行约(1.2±0.3)cm分为拇指尺背侧皮神经和第一掌背皮神经,桡神经内侧支前行(1.1±0.2)cm分为第二、三掌背皮神经,分布于手背部。结论:临床工作中要充分的掌握皮神经的走行数据和体表投影,从而减少损伤和提高手术成功率。

Objective： To observe the location,running and branches of superficial branch of radial nerve at hand back,and then provide morphological bases for fascio-cutaneous flap of hand back,minimally invasive treatment for fracture of phalanx of finger and metacarpus,repairing nerves in clinical.Method： 42 formalin-fixed upper limbs were dissected and the superficial branch of radial nerve and its＇ all branches exposured.The distance（AO） and angle（∠A） between radial malleolus（point O） and the point（point A） where the superficial branch of radial nerve sent medial and lateral branch were observed.The length and angle between each branchpoint were also measured.The point where the lateral branch sent dorsal ulnar cutaneous nerve of thumb and 1st dorsal palmar cutaneous nerve was recorded as point B.The point where the medial branch sent 2nd,3nd dorsal palmar cutaneous nerve was recorded as point C;the angle between these 2 branches was ∠C.The points where the 2nd,3th dorsal palmar cutaneous nerve sent dorsal finger cutaneous nerve were respectively recorded point D and E.Result： In 38 upper limbs,the superficial branch of radial nerve sent medial and lateral branch at distal of radial malleolus,and furthermore sent 1th,2nd,3th dorsal palmar cutaneous nerve that distributed to hand back.Results of measurement： AO=（3.8±0.6）cm,AB=（1.2±0.3）cm,AC=（1.1±0.2）cm,CD=（4.0±0.5）cm,CE=（3.5±0.5）cm.Conclusion： In clinic,clinicians should thoroughly master the running data and projection of cutaneous nerves,so to decrease injuries and elevate achievement ratio of operation.