正中神经掌皮支的应用解剖

Applied anatomy of the palmar cutaneous branch of the median nerve

目的 为腕掌部手术避免损伤掌皮支提供解剖学基础。方法 对 5 0侧成人上肢标本的掌皮支来源、走行、分支、分布及其营养动脉等进行解剖学观测。结果 掌皮支在腕远横纹的“0”点近端(4 4 .9± 2 1.6)mm处发自正中神经桡侧 ,在该点近端 (18.6± 11.5 )mm处穿出前臂深筋膜后 ,紧贴深筋膜和屈肌支持韧带浅面 ,越豆、舟顶间线的中、外 1/3交点至手掌。在“0”点远端 (8.2± 3 .4)mm处穿出掌腱膜。掌皮支干长 (4 9.7± 2 5 .2 )mm ,起点处宽 (1.2± 0 .9)mm。掌皮支主要分支有 3支者占 5 2 %(2 6侧 ) ,2支者 3 4% (17侧 ) ,1支者 14 % (7侧 ) ,它主要分布于手掌的大鱼际区和掌中区。桡、尺动脉发出营养支 (84.69% )与掌皮支干伴行后进入神经 ,掌浅弓发出营养支 (89.62 % )直接进入掌皮支的手掌部分支。

Objective To provide anatomic data for avoiding injury of the palmar cutaneous branch(PCB)of median nerve during operation at the wrist and palmar. Methods The origin, course, branches and nutrient arteries of the PCB were dissected and measured in 50 sides of adult cadavers of upper extremity. Results PCB originated from the radial side of median nerve(44.9 ± 21.6) mm to the zero point(the distal wrist crease),perforated the antebrachial aponeurosis (18.6± 11.5) mm to the zero point, crossed intercept of middle 1/3 and external 1/3 of commissure line of the tip of scaphoid bone and pisiform bone, went to the palm of hand on surface of the flexor retinaculum, and emerged off the palmar facia (8.2± 3.4) mm to the zero point. The length of the PCB was (49.7 ± 25.2) mm, and its width (1.2 ± 0.9) mm at its origin. 3 branches of PCB were found in 26 specimen(52 %), 2 branches in 17 (34 %) and 1 branch in 7 (14 %).The innervation areas included greater thenar and the middle palmar. The trophic arteries of the PCB which originated from the radial artery and ulnar artery went with and came into the nerve (84.69 %).The trophic arteries of the PCB which originated from the superficial palmar arch directly came into the nerve (89.62 %). Conclusions A longitudinal incision which located on the ulnar side of the wrist and palm is designed to avoid injury of PCB.