成人桡侧腕伸肌神经入肌点定位

Localization of the nerve entry points of extensor carpi radialis muscle

目的准确定位成人桡侧腕伸肌神经入肌点(NEP)的位置。方法 12具成人尸体,仰卧。紧贴皮肤连接肩峰与肱骨外上髁间的曲线为桡侧腕长伸肌NEP的纵向参考线(L1),肱骨外上髁至桡骨茎突间的曲线为桡侧腕短伸肌NEP的纵向参考线(L_2);肱骨外上髁至内上髁间的曲线为共用的横向参考线(H)。解剖暴露NEP,硫酸钡标记,螺旋CT扫描,三维重建图像。NEP在体表上的投影点定为P点,P点通过NEP后投射至相反侧体表上的点为P'点。经P点垂于H线的直线与H线、平行于H线的直线与L线的交点分别记为P_H点和P_L点。Syngo系统下确定P_H点和_PL点在H线和L线上的百分位置及NEP深度。结果桡神经桡侧腕长伸肌支NEP的P_(1H)点和桡侧腕短伸肌支NEP的P_(2H)点分别位于H线上的(33. 83±0. 96)%和(35. 11±0. 90)%处; P_(1L)点和P_(2L)点分别位于L_1和L_2线上的(95. 01±2. 36)%和(19. 34±0. 78)%处; NEP_1和NEP_2的穿刺深度分别位于PP'线的(32. 94±0. 89)%和(29. 08±0. 93)%处。结论这些NEP位置的准确定位可为提高桡侧腕伸肌神经阻滞的效率与疗效提供解剖学指导。

Objective To identify the precise location of nerve entry points(NEP)of adult extensor carpi radialis muscles.Methods Twelve Chinese adult cadavers were used in the supine position.A curved line on the skin surface joining the acromion to the lateral epicondyle of humerus was designated as the longitudinal reference line(L1)for the NEP of extensor carpi radialislongus muscle,the curved line joining the lateral epicondyle of humerus to styloid process of radius was designated as the longitudinal reference line(L2)for the NEP of extensor carpi radialisbrevis muscle;The curved line joining the lateral and medial epicondyle of the humerus was the common horizontal reference line(H).Following dissection,NEPs were exposed and labeled with barium sulfate,and then,spiral computed tomography(CT)scanning and 3D reconstruction were performed.The projection points of NEP on the body surface were determined as P,P by the NEP projecting on opposite surface of upper limb was designated as P′.The intersection points that the straight line perpendicular to H line through P and the H and the straight line parallel to H line through P and the L line were designated as PH point and PL point,respectively;The location of PH point and PL point on the H line and L line and the depth of NEP were measured under Syngo system.Results The P1H point of NEP of extensor carpi radialislongus muscular branch and the P2H point of NEP of extensor carpi radialisbrevis muscular branch were located at(33.83±0.96)%and(35.11±0.90)%of the H line,respectively;The P1L point and P2L point were located at(95.01±2.36)%and(19.34±0.78)%of the L1 line and the L2 line,respectively.The depth of NEP1 and NEP2 were located at(32.94±0.89)%and(29.08±0.93)%of the PP′line,respectively.Conclusion The precise localization of these NEP should provide anatomical guidance for improving the efficiency and efficacy of nerve block of extensor carpi radialis muscule.