指固有神经背侧支的应用解剖学研究

Applied anatomy of the dorsal branch of the proper digital nerve

目的 为指固有神经背侧支的临床应用提供解剖学基础。方法 观测 12只新鲜成人手标本 48个手指指固有神经背侧支的出现率、直径、走向及分支。结果 示、中、环指及小指桡侧指固有神经发出的单一分支形成背侧支者占 92 .86% (78/84侧 ) ,背侧支缺如者占 7.14 % (6/84侧 )。各指背侧支均在近节手指近、中 1/3平面发出 ,并从指侧面斜向指背远端走行。在近指间关节桡背 (或尺背 )侧向背面及中节指背发出 2～ 5条分支。除小指外 ,2～ 4指指桡、尺侧背侧支的直径粗细均有显著性差异(P <0 .0 5 ) ,桡侧 >尺侧。小指尺侧无指固有神经背侧支。结论 示、中、环及小指的桡侧指固有神经背侧支走向恒定 ,可包含在同指逆行岛状皮瓣内 ,适用于修复指腹软组织缺损。

Objective To provide anatomic basis for the clinic application of the dorsal branch of the proper digital nerve. Methods 48 fingers of 12 hands of adult cadavers were dissected. The dorsal branch of the proper digital nerve were observed and measured about the rate of appearance, diameter, course and branches.Results The dorsal branch of the proper digital nerve was seen originating from the proper digital nerve on both sides of the index, middle and ring fingers and from the nerve on radial side of the little finger in 92.86 % of the specimens (78/84 sides). The absent rate of the dorsal side of the little finger in 92.86 % of the specimens (78/84 sides). The absent rate of the dorsal branch was 7.14 % (6/84 sides). The dorsal branch began at the level of proximal - mid third of the proximal phalanx of the finger. It coursed obliquely and distally from lateral aspect of the finger to the dorsal aspect. At dorsal - radial margin or dorsal - ulnar margin of PIP joint, 2 to 5 branches were sent off to the dorsum of the middle phalanx. Except the little finger, the diameter of the radial dorsal branch and the ulnar dorsal branch had significant difference, the former being thicker than the latter. The ulnar dorsal branch of the little finger was absent. Conclusions The sourse of the dorsal branch of the proper digital nerve of index, middle and ring fingers on both sides, and that of the little finger on the radial side is constant. It can be harvested with the reverse digital island flap to repair finger pulp defect.