三圆交汇定位联合神经分段法在骨间背侧神经体表定位中的临床应用

Clinical application of tri-cyclic mutual crosses localization combined with nerve segmentation in the localization of dorsal interosseous nerve on the body surface

目的 解剖国人骨间背侧神经及其肌支,探讨三圆交汇定位法联合神经分段法在骨间背侧神经体表定位中的临床应用。方法对35具成人防腐尸体的70侧上肢标本进行精细解剖,观察骨间背侧神经及其肌支的行程与神经各分叉点,提出用“三圆交汇定位法”及“神经分段法”来确定骨间背侧神经的体表位置。选择30例骨间背侧神经损伤手术的成年患者,通过三圆交汇定位联合神经分段法进行体表定位,术中观察定位结果的准确度。结果本组30例患者,27例获得准确定位,3例未获得准确定位,其中1例为指伸肌支,2例为示指伸肌支。骨间背侧神经的4个分叉点(O、O1、O2、O3)对于体表定位的分区及分段有较为重要的指导意义,三圆交汇定位可更为精确地定位神经,但指伸肌支及示指伸肌支的变异较大,该二肌支采用三圆交汇定位的准确性较差。结论三圆交汇定位联合神经分段法,可相对精确地定位骨间背侧神经及其肌支,明确神经损伤的位置。

Objective To make further exploration of the clinical application of tri-cyclic mutual crosses localization combined with nerve segmentation in the localization of dorsal interosseous nerve on the body surface through anatomical study of the dorsal interosseous nerve and its muscle branch.Methods Seventy upper limb specimens of thirty-five adult cadavers were dissected precisely to reveal the courses of dorsal interosseous nerve and its muscle branch and each bifurcation point.Determined the body surface position of the dorsal interosseous nerve through the"tri-cyclic mutual crosses localization method"and the"nerve segmentation method".Thirty adult patients with dorsal interosseous nerve injury were selected and located with tri-cyclic mutual crosses combined with nerve segmentation on the body surface,and the accuracy of the results was observed during the operation.Results Among the 30 patients,27 cases obtained accurate location and the other 3 cases failed,including 1 case of extensor digitorum branch and 2 cases of extensor indicis branch.The four bifurcation points of the dorsal interosseous nerve(O,O1,O2,O3)have important guiding significance for the subarea and segmentation of the body surface.The tri-cyclic mutual crosses localization could be more accurate.But there were large variation in extensor digitorum branch and extensor indicis branch,thus the accuracy of tri-cyclic mutual crosses localization is poor.Conclusion According to the tri-cyclic mutual crosses localization combined with nerve segmentation,the localization of dorsal interosseous nerve and its muscular branches could be more accurate,and the location of nerve injury could be identified.