Loréa P, Berthe J V, De Mey A, Coessens B C, Rooze M, Foucher G
Laboratoire de chirurgie plastique expérimentale, fondation médicale Reine Elisabeth, CHU Brugmann, place Van Gehuchten, 4, 1020 Bruxelles, Belgique.
Chir Main. 2001 Aug;20(4):257-62. doi: 10.1016/s1297-3203(01)00044-0.
Denervation has been proposed successfully for chronic wrist pain. This procedure is not commonly performed for degenerative osteoarthritis of the trapeziometacarpal joint. According to the classic anatomical descriptions of the wrist innervation, it seems that the thenar branch of the median nerve (TBMN) is the only nerve of the wrist for which no articular branches are clearly defined. The aim of this study is to complete the few anatomical descriptions of the trapeziometacarpal joint innervation with microdissections of the TBMN.
Ten wrist and hand specimens from fresh cadavers were dissected by the same operator under magnification (3.5-12x). The TBMN was identified at its origin from the median nerve and followed in the thenar muscles. All the divisions of the TBMN were identified and followed to their terminal branches.
The TBMN divided in at least two main branches, one each to the opponens and to the abductor pollicis brevis. In all but one specimen, the branch to the opponens pollicis muscle passed over or into its medial aspect to spread on the palmar side of the trapezium. Each dissected articular branches were histologically confirmed.
Our results show a clear participation of the TBMN in the innervation of the trapeziometacarpal joint. The lack of knowledge of this anatomical feature may explain the inconstant results obtained with selective denervation of the trapeziometacarpal joint.
已有人成功提出将去神经支配术用于治疗慢性腕部疼痛。但该手术并不常用于治疗大多角骨-第一掌骨关节的退行性骨关节炎。根据腕部神经支配的经典解剖学描述，正中神经的鱼际支（TBMN）似乎是腕部唯一没有明确界定关节支的神经。本研究的目的是通过对TBMN进行显微解剖，完善关于大多角骨-第一掌骨关节神经支配的少量解剖学描述。
由同一名操作者在放大倍数为3.5 - 12倍的条件下，对10个新鲜尸体的腕部和手部标本进行解剖。在TBMN从正中神经发出的起始处进行识别，并追踪其在鱼际肌中的走行。识别TBMN的所有分支，并追踪至其终末分支。
TBMN至少分为两个主要分支，分别支配对掌肌和拇短展肌。除一个标本外，在所有标本中，支配拇对掌肌的分支越过或进入其内侧，在大多角骨掌侧分布。每个解剖出的关节支均经组织学证实。
我们的结果表明TBMN明显参与了大多角骨-第一掌骨关节的神经支配。对这一解剖特征缺乏了解可能解释了选择性去神经支配术治疗大多角骨-第一掌骨关节时效果不一的原因。
