成人前臂前群肌的神经入肌点定位及意义

Localization and significance of nerve entry points of the anterior forearm muscles in adults

目的准确定位成人前臂前群肌神经入肌点(NEP)的体表位置和深度。方法成人尸体12具,仰卧。紧贴皮肤连接肱骨外上髁和内上髁间的曲线为横向参考线(H),肱骨外上髁和桡骨茎突间的曲线为纵向参考线(L)。解剖暴露NEP,硫酸钡标记,螺旋CT扫描与三维重建。将NEP在体表上的投影点记为P点,P点通过NEP后投射至前臂后体表上的点为P’点。P点投射到H线与L线上的位置分别记为PH和PL。Syngo系统下确定PH和PL在H和L线上的位置及NEP的深度。结果旋前圆肌、桡侧腕屈肌、掌长肌、尺侧腕屈肌、指浅屈肌、拇长屈肌、指深屈肌(正中神经支)、指深屈肌(尺神经支)、旋前方肌NEP的PH分别位于H线上的58.08%、64.17%、75.14%、61.14%、62.26%、52.07%、50.81%、63.38%和51.37%处;PL分别位于L线上的9.79%、3.97%、16.37%、4.42%、17.88%、34.17%、30.27%、11.48%和75.32%处;穿刺深度分别位于PP’线的26.80%、25.06%、27.68%、28.13%、37.30%、39.85%、49.26%、70.86%和44.25%处。以上数据均为平均值。结论这些NEP的体表穿刺位置与深度的界定可为提高前臂前群肌痉挛肌外神经溶解术靶点阻滞的效率、手术切断神经肌支治疗肌痉挛的微创切口设计、作为供肌的功能评估、以及肌移植术中对神经的保护等提供形态学指导。

Objective To accurately localize the body surface position and depth of nerve entry points(NEPs)of the adult anterior forearm muscles.Methods Twelve adult cadavers were used in the supine position.The curve close to the skin connecting the lateral epicondyle and the medial epicondyle of humerus was designed as the horizontal reference line(H),and the curve between the lateral epicondyle and the radius styloid process was designed as the longitudinal reference line(L).The NEPs ware exposed by dissection and marked with barium sulfate,then spiral CT scan and three-dimensional reconstruction were performed.The projection point of NEP on the body surface was denoted as P point,and the point P through NEP projecting onto the posterior surface of the forearm was denoted as P’point.The position of P point projected on H line and L line was denoted as PHand PLrespectively.The positions of PHand PLon H and L lines and the depth of NEPs were determined under Syngo system.Results The PHfor the NEPs of the pronator teres,flexor carpi radialis,palmaris longus,flexor carpi ulnaris,flexor digitorum superficialis,flexor pollicis longus,flexor digitorum profundus(median nerve branch),flexor digitorum profundus(ulnar nerve branch),and pronator quadratus muscles were located at 58.08%,64.17%,75.14%,61.14%,62.26%,52.07%,50.81%,63.38%and51.37%on the H line,respectively.The PLwere at 9.79%,3.97%,16.37%,4.42%,17.88%,34.17%,30.27%,11.48%and 75.32%of the L line,respectively.The puncture depth were located at 26.80%,25.06%,27.68%,28.13%,37.30%,39.85%,49.26%,70.86%and 44.25%of the PP’line,respectively.The above data were the average value.Conclusions The definition of the body surface location and depth of these NEPs can provide morphological guidance for improving the efficiency of target block of extra-muscular neurolysis,the design of minimally invasive incision for the treatment of muscle spasticity by surgical transection the neuromuscular branches,the evaluation of the function of the donor muscle,and the protection of nerves in muscle transplantation.