“点线角距离法”在小趾展肌神经卡压综合征中的体表定位诊断研究

Study on body surface localization diagnosis of“point-line-angular distance method”in nerve entrapment syndrome of the abductor digiti minimi muscle

目的探究小趾展肌神经卡压综合征的简易体表定位诊断方法。方法对10具尸体标本20侧足踝在踝关节90°功能位,以内踝尖的最下缘为A点,以跟骨结节的内侧突为B点,以第一跖骨头内侧的最突点为C点,以小趾展肌神经穿出踇展肌深筋膜腱弓处为D点,测量小趾展肌神经在穿过踇展肌深筋膜腱弓处D点的直径,测量D点与B点的距离L1、A点与BC点连线的垂直距离L2,测量AB点连线与BD点连线所成角度、BC点连线与BD点连线所成角度,得到D点与体表标志的相对关系,分析不同性别标本D点的体表投影简易定位。结果20侧足踝尸体标本中,18侧小趾展肌神经来自跖外侧神经,2侧直接发源于胫神经。小趾展肌神经在穿过踇展肌深筋膜腱弓处D点的直径成年男性平均为(1.87±0.30)mm,成年女性平均为(1.85±0.25)mm。小趾展肌神经通过跟骨前方时与跟骨垂直距离成年男性平均为(20.86±1.38)mm,成年女性平均为(20.06±1.16)mm。A点与BC点连线的垂直距离L2成年男性平均为(71.10±2.17)mm,成年女性平均为(67.31±2.93)mm。AB点连线与BD点连线所成角度为(43.71±2.96)°,BC点连线与BD点连线所成角度为(40.61±2.53)°。结论跟骨结节内侧突斜前上40°~43°的40 mm处可以作为小趾展肌神经穿出踇展肌深筋膜腱弓的简易体表定位点。

Objective To explore a simple body surface localization method for the diagnosis of nerve entrapment syndrome of the abductor digiti minimi muscle.Methods With the 20 ankle specimens of 10 cadavers at 90°functional position,regard the lowest edge of the medial malleolus tip as point A,regard the medial process of the calcaneal tubercle as point B,regard the most abrupt point on the medial side of the first metatarsal bone as point C,and regard the point where the abductor digiti minimi muscle nerve passed through the deep fascia arch of abductor muscle as point D.The diameter of abductor digiti minimi muscle nerve at point D,the distance L1 between point D and point B,the vertical distance L2 from point A to the connection between point B and point C,the angle formed by the connection between AB and BD,and the angle formed by the connection between BC and BD were measured.The relative relationship between point D and body surface marks was obtained,and the projection of point D on body surface of different gender was analyzed.Results Among the 20 ankle specimens,the abductor digiti minimi muscle nerve derived from the lateral plantar nerve in 18 cases,and the abductor digiti minimi muscle nerve derived directly from the tibial nerve in 2 cases.The diameter of abductor digiti minimi muscle nerve at point D was(1.87±0.30)mm in adult males,while it was(1.85±0.25)mm in adult females.The vertical distance between the abductor digiti minimi muscle nerve and calcaneus was(20.86±1.38)mm in adult males,while it was(20.06±1.16)mm in adult females.The vertical distance L2 from point A to the connection between point B and point C was(71.10±2.17)mm in adult males,while it was(67.31±2.93)mm in adult females.The angle formed by the connection between AB and BD was(43.71±2.96)°,and the angle formed by the connection between BC and BD was(40.61±2.53)°.Conclusion The point which 40 mm at 40°to 43°front half upward the medial process of the calcaneal tubercle can be used as a simple body surface location for the abductor digiti minimi muscle nerve passed through the deep fascia arch of abductor muscle.