Ozcanli Haluk, Coskun Nigar Keles, Cengiz Menekşe, Oguz Nurettin, Sindel Muzaffer
Department of Orthopedics, Akdeniz University Faculty of Medicine, 07059, Antalya, Turkey.
Surg Radiol Anat. 2010 Mar;32(3):203-6. doi: 10.1007/s00276-009-0498-7. Epub 2009 Apr 1.
Carpal tunnel decompression is one of the most common surgical procedures in hand surgery. Cutaneous innervation of the palm by median and ulnar nerves was evaluated to find a suitable incision preserving cutaneous nerves. A morphometric study was designed to define the safe-zone for mini-open carpal tunnel release. Sixteen fresh-frozen (8 right, 8 left) and 14 formalin-fixed (8 right, 6 left) cadaveric hands were dissected. Anatomy of the palmar cutaneous branch of the median and the ulnar nerve, motor branch of the median nerve, superficial palmar arch were evaluated relative to the surgical incision. We also identified the motor branch of the median nerve. Detailed measurements of the whole palmar region are reported in this study. The motor branch of the median nerve was extraligamentous as 60%, subligamentous as 34%, transligamentous as 6%. The palmar cutaneous branches of the median and the ulnar nerves in the palmar region were classified as Type A (34%), Type B (13%), Type C (13%), Type D (none), Type E (40%) according to forms of palmar cutaneous innervation originating from the ulnar and median nerves. Injury to the palmar cutaneous branch of the median nerve (PCBMN) is the most common complication of the carpal tunnel surgery. Various techniques were described to decrease post-operative morbidity. Based on these anatomic findings mini incision between the superficial palmar arch and the most distal part of the PCBMN in the palmar region is the safe-zone for carpal tunnel surgery.
腕管减压术是手部外科最常见的手术之一。评估正中神经和尺神经对手掌的皮肤神经支配情况，以找到一个合适的保留皮神经的切口。设计了一项形态学研究来确定小切口腕管松解术的安全区域。解剖了16只新鲜冷冻（8只右侧，8只左侧）和14只福尔马林固定（8只右侧，6只左侧）的尸体手。评估了正中神经掌皮支、尺神经掌皮支、正中神经运动支、掌浅弓相对于手术切口的解剖结构。我们还确定了正中神经的运动支。本研究报告了整个手掌区域的详细测量数据。正中神经运动支位于韧带外的占60%，位于韧带下的占34%，穿过韧带的占6%。根据来自尺神经和正中神经的手掌皮肤神经支配形式，手掌区域正中神经和尺神经的掌皮支分为A型（34%）、B型（13%）、C型（13%）、D型（无）、E型（40%）。正中神经掌皮支损伤是腕管手术最常见的并发症。已描述了各种技术以降低术后发病率。基于这些解剖学发现，在掌浅弓和手掌区域正中神经掌皮支最远端之间的小切口是腕管手术的安全区域。
