成人手中间群肌肌内神经整体分布模式及意义

Overall distribution pattern and its significance of intramuscular nerve in the intermediate group muscles of the hand in adults

目的研究成人手中间群肌的肌内神经整体分布模式,并分析其意义。方法经福尔马林固定的中国成人尸体16具。解剖观察蚓状肌、骨间掌侧肌和骨间背侧肌的神经入肌位置后,取下肌块行Sihler’s染色,显示肌内神经整体分布模式,划分神经肌亚部,用Photoshop软件测量与确定肌内神经密集区在肌腹长上的百分位置。结果蚓状肌的神经支从肌的近侧1/3浅面入肌,骨间掌侧肌与骨间背侧肌的神经支均从肌近端浅面入肌。蚓状肌不能分出神经肌亚部,第2骨间掌侧肌和4块骨间背侧肌可分为内侧和外侧2个神经肌亚部。第1~4蚓状肌的肌内神经密集区均仅有1个,其密集区中心点分别位于肌腹长的40.8%、46.4%、40.2%和51.5%处;第1~3骨间掌侧肌的肌内神经密集区数量分别为1、2和1个,其中心点分别位于肌腹长的41.6%、51.0%和36.1%、58.9%处;第1~4骨间背侧肌的肌内神经密集区均为2个,其中心点分别位于肌腹长的41%和67.60%、23.9%和63.9%、35.6%和42.3%、40.9%和57.5%处。结论成人手不同中间群肌间的神经分布存在差异,可为手外科免于神经损伤、亚部肌移植的取材设计以及注射肉毒毒素A治疗手肌痉挛提供形态学指导依据。

Objective To study the overall distribution pattern of intramuscular nerve in the intermediate group muscles of the hand in adults and explore its significance.Methods Sixteen Chinese adult cadavers fixed with formalin were used.After dissecting and observing the nerve entry position of lumbricales,palmar interossei and dorsal interossei,these muscles were removed for Sihler’s staining to show the overall distribution pattern of intramuscular nerve,and then divided them into different neuromuscular compartments.Furthermore,the percentage position of intramuscular nerve dense region on the muscle belly length was measured and determined by Photoshop software.Results The nerve branches of lumbricales entered the muscle from the superficial surface of the proximal 1/3,and the nerve branches of palmar interossei and dorsal interossei entered the muscle from the superficial surface of the proximal end of the muscle.Lumbricales could not be divided into neuromuscular compartments.The second palmar interosseous muscle and four dorsal interossei could be divided into medial and lateral neuromuscular compartments.There was only one intramuscular nerve dense region in the first to fourth lumbrical muscle,and the central points of the dense region were located at 40.8%,46.4%,40.2%and 51.5%of the muscle belly length;The number of intramuscular nerve dense regions of the first to third palmar interosseous muscle was 1,2 and 1 respectively;Meanwhile,the central points were located at 41.6%,51.0%and 36.1%,and 58.9%of the muscle belly length,respectively;There were two intramuscular nerve dense regions in the first to fourth dorsal interosseous muscles,of which the central points were located at 41%and 67.60%,23.9%and 63.9%,35.6%and 42.3%,40.9%and 57.5%of the muscle belly length,respectively.All the aforementioned percentage values were shown as means.Conclusion There are differences in the nerve distribution among the distinct intermediate group muscles of the hand in adults,which might provide morphological guidance for avoiding nerve injury in hand surgery,the material design of compartmental transplantation and the treatment of hand muscle spasticty by botulinum toxin A injection.