针刀治疗桡骨茎突狭窄性腱鞘炎安全区域的解剖学研究

Anatomical study on the safe zone of knife needle in treatment of stenosing tendovaginitis of radial styloid

目的:探讨针刀治疗桡骨茎突狭窄性腱鞘炎的安全区域。方法:选取20具成人尸体上肢标本(左侧8例,右侧12例),剥离以桡骨茎突为中心的长10 cm、宽5 cm的皮肤,仔细分离桡神经浅支、血管和腱鞘,找到桡骨茎突掌、背侧骨嵴最高点。观测桡骨茎突周围桡神经浅支和桡动脉的走行分布,并以桡骨茎突掌、背侧骨嵴及其最高点为标志,分别在桡骨茎突外侧腱鞘浅面和桡骨茎突外侧面骨沟处各划定1个安全治疗区域,测量并比较这2个安全治疗区域的面积。结果:(1)桡骨茎突周围桡神经浅支的走行分布。在桡骨茎突根部,桡神经浅支斜行于桡骨茎突外侧腱鞘浅面,其主要分支数量为1~2支,且走行于桡骨茎突掌、背侧骨嵴形成的骨沟之外,仅有部分细小分支覆盖于桡骨茎突腱鞘浅面。20具标本中,19具有2支桡神经浅支分支走行于桡骨茎突掌、背侧骨嵴形成的骨沟之外,1具有1支桡神经浅支分支走行于桡骨茎突背侧骨嵴之外。(2)桡骨茎突周围桡动脉的走行分布。桡动脉在桡骨茎突根部沿着桡骨茎突掌侧骨嵴的掌侧面走行,到达桡骨茎突掌侧骨嵴最高点,以30°±5°角折向拇短伸肌和拇长展肌腱鞘的内侧,并斜行至手背。(3)安全治疗区域。桡骨茎突腱鞘浅面安全治疗区的面积大于桡骨茎突外侧面骨沟安全治疗区的面积[(303.04±38.63)mm^2,(134.29±24.37)mm^2,t=2.286,P=0.023]。结论:桡骨茎突掌、背侧2条骨嵴之间,掌、背侧骨嵴最高点连线以上,距离两骨嵴最高点1 cm以内,是针刀治疗桡骨茎突狭窄性腱鞘炎的安全区域。

Objective:To explore the safe zone of knife needle in treatment of stenosing tendovaginitis of radial styloid.Methods:The cadaveric upper limb specimens(8 on the left and 12 on the right)of 20 adults were selected.A 10×5 cm skin centered on radial styloid was stripped and superficial branch of radial nerve,blood vessels and tendon sheath were separated to find out the highest points of palmar and dorsal bony crest of vadial styloid.The orientation and the distribution of superficial branch of radial nerve and radial artery around radial styloid were observed.The safe zones for treatment were delineated on the surface of lateral tendon sheath of vadial styloid and in the lateral bone groove of vadial styloid respectively by taking vadial styloid palmar,dorsal bone crest and their highest points as the anatomic landmark.The areas of the two safe zones for treatment were measured and compared with each other.Results:At the root of radial styloid,the superficial branch of radial nerve passed by the surface of lateral tendon sheath of radial styloid obliquely and its main 1-2 branchs ran outside the bone groove formed by palmar and dorsal bony crest of radial styloid,and only a few small branches passed by the surface of tendon sheath of radial styloid.Two subbranches of superficial branch of radial nerve in 19 specimens ran outside the bone groove formed by palmar and dorsal bony crest of radial styloid,and one subbranch of superficial branch of radial nerve in 1 specimen ran outside the dorsal bony crest of radial styloid.At the root of radial styloid,the radial artery ran along the palmar surface of palmar bony crest of radial styloid and reached the highest point of palmar bony crest of radial styloid,and then turned to the medial side of tendon sheath of extensor pollicis brevis and abductor pollicis longus at an angle of 30+/-5 degree and ran slantly until the opisthenar.The area of safe zone for treatment was larger on the surface of tendon sheath of radial styloid compared to lateral bone groove of radial styloid(303.04+/-38.63 vs 134.29+/-24.37 mm(2),t=2.286,P=0.023).Conclusion:The zone between palmar bony crest and dorsal bony crest of radial styloid,above the line from the highest point of palmar bony crest to the highest point of dorsal bony crest,and within 1 cm to the highest point of the two bony crests,was the safe zone for treatment of stenosing tendovaginitis of radial styloid by using knife needle.