正中神经返支空间分布的解剖学研究及临床意义

Anatomy study and clinical significance about the spatial distribution of the recurrent branch of median nerve

目的为避免腕掌部鱼际区近端手术切口损伤正中神经返支提供解剖学资料。方法对30例成人上肢标本(16例为甲醛固定标本,14例为新鲜冷冻标本)进行解剖,测量正中神经返支起点的位置、返支与正中神经主干纵轴的夹角、返支第一分叉点位置、浅支和深支分支分布,并观察其与大鱼际区近、中、远三个区域的位置关系。结果46.7%的正中神经返支主干的发出点位于鱼际区近1/3区域,52.3%位于鱼际区中1/3区域,正中神经返支从正中神经主干发出后,以与正中神经主干平均48.6°(20°-70°)的角度向近橈侧行进,56.7%的正中神经返支在近1/3区域发出深、浅两个分支,43.3%在中1/3区域发出深、浅分支;96.7%的深支及其分支和56.7%的浅支及其分支分布在近1/3区域内。结论正中神经返支及其终末分支主要分布于鱼际区近1/3区域,任何在此区域的手术操作都要注意避免损伤。

Objective To provide anatomical data for avoiding the injury of the recurrent branch of median nerve (RBMN) through the proximal operative incision of the carpal thenar region. Methods Thirty adult upper limb specimens (16 formaldehyde fixed specimens and 14 fresh frozen specimens) were dissected. The origin of the RBMN, the angle between the RBMN and the longitudinal axis of the median nerve main trunk, the location of the first bifurcation point of the RBMN, the distribution of the superficial branch and the deep branch of the RBMN were measured, and the relationship between the RBMN and the proximal, middle and distal regions of the thenar was observed. Results The origin of the trunk of the RBMN located in the proximal and middle third of the thenar area account for 46.7% and 52.3%, respectively. After the RBMN originated from the main trunk of the median nerve, it moved towards the radial side at an average angle of 48.6°(range, 20° to 70°). The first bifurcation point of RBMN located in the proximal and middle third of the thenar area account for 56.7% and 43.3%, respectively. 96.7% deep branch and 56.7% superficial branch were located in the proximal third of the thenar area. Conclusion The RBMN and its terminal branches were mostly located in the proximal third of the thenar area, and any operation in this area should pay attention to avoiding injury.