Kim Y S
Department of Orthopaedics, Ohta General Hospital, 1-50 Nisshincho, Kawasaki, Kanagawa 210-0024, Japan.
Kaibogaku Zasshi. 2001 Jun;76(3):313-22.
Using 131 fingers for the metacarpophalangeal (MP) joint and 124 fingers for the distal interphalangeal (DIP) joint obtained from 30 hands of human cadavers, the innervation of the MP and DIP joints was investigated anatomically in detail. Two articular branches developing from a dorsal branch of the ulnar nerve and a superficial branch of the radial nerve, and entering the dorsal side of the MP joint from the ulnar side and radial side, respectively, were found in every finger. In addition, articular branches from the deep branch of the ulnar nerve were found in every middle, ring and little finger. However, articular branches from the proper palmar digital nerve were found to exist in 62.7% of the fingers. Articular branches developing from the proper palmar digital nerve and going towards the DIP joint were found in every case, and 97.3% of 244 branches developed directly from the proper palmar digital nerve, while some of the remaining branches were from a dorsal branch of the proper palmar digital nerve and others developed neural loop penetration. Articular branches ran parallel to the distal transverse artery and entered the joint, and some of them went towards the volar plate, dorsal joint capsule, and tendon sheath. Many nerve endings existed in the surface layer of the articular capsule and arthrosynovial membranes in the form of Pacinian corpuscles and corpuscles of Ruffini. The existence of a neural loop in the finger should be taken notice of during somatoscopy in patients with neurovascular symptoms in the fingertip or surgical operation on a vascular pedicular island flap. Further, it was suggested that injury of the articular branch of the DIP joint could induce Heberden nodes due to its anatomical characteristics.
利用从30具人类尸体的手部获取的131根手指用于掌指(MP)关节和124根手指用于远侧指间(DIP)关节,对MP和DIP关节的神经支配进行了详细的解剖学研究。在每个手指中均发现有两支关节支,分别由尺神经的背侧支和桡神经的浅支发出,分别从尺侧和桡侧进入MP关节的背侧。此外,在每个中指、环指和小指中均发现有来自尺神经深支的关节支。然而,发现来自指掌侧固有神经的关节支存在于62.7%的手指中。在每种情况下均发现有从指掌侧固有神经发出并走向DIP关节的关节支,244支关节支中的97.3%直接由指掌侧固有神经发出,其余一些分支来自指掌侧固有神经的背侧支,还有一些形成神经袢穿入。关节支与远侧横行动脉平行走行并进入关节,其中一些走向掌侧板、背侧关节囊和腱鞘。在关节囊和关节滑膜的表层以Pacinian小体和Ruffini小体的形式存在许多神经末梢。在对指尖有神经血管症状的患者进行体格检查或对血管蒂岛状皮瓣进行手术操作时,应注意手指中神经袢的存在。此外,由于其解剖学特征,提示DIP关节的关节支损伤可能诱发Heberden结节。