尺神经手背支的解剖关系及分支模式。
Anatomical relationships and branching patterns of the dorsal cutaneous branch of the ulnar nerve.
作者信息
Root Cassie G, London Daniel A, Schroeder Nicole S, Calfee Ryan P
机构信息
Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO63110, USA.
出版信息
J Hand Surg Am. 2013 Jun;38(6):1131-6. doi: 10.1016/j.jhsa.2013.03.016.
PURPOSE
To describe the variable branching patterns of the dorsal cutaneous branch of the ulnar nerve (DCBUN) relative to identifiable anatomical landmarks on the ulnar side of the wrist.
METHODS
We dissected the ulnar nerve in 28 unmatched fresh-frozen cadavers to identify the DCBUN and its branches from its origin to the level of the metacarpophalangeal joints. The number and location of branches of the DCBUN were recorded relative to the distal ulnar articular surface. Relationships to the subcutaneous border of the ulna, the pisotriquetral joint, and the extensor carpi ulnaris tendon were defined in the pronated wrist.
RESULTS
On average, 2 branches of the DCBUN were present at the level of the distal ulnar articular surface (range, 1-4). On average, 2.2 branches were present 2 cm distal to the ulnar articular surface (range, 1-4). At least 1 longitudinal branch crossed dorsal to the extensor carpi ulnaris tendon prior to its insertion at the base of the fifth metacarpal in 23 of 28 specimens (82%). In 27 of 28 specimens (96%), all longitudinal branches of the DCBUN coursed between the dorsal-volar midpoint of the subcutaneous border of the ulna and the pisotriquetral joint. In 20 of 28 specimens (71%), a transverse branch of the DCBUN to the distal radioulnar joint was present.
CONCLUSIONS
During exposure of the dorsal and ulnar areas of the wrist, identification and protection of just a single branch of the DCBUN are unlikely to ensure safe dissection because multiple branches normally are present. The 6U, 6R, and ulnar midcarpal arthroscopy portals may place these branches at risk. In the pronated forearm, the area between the DCBUN and the pisotriquetral joint contained all longitudinal branches of the DCBUN in 96% of specimens.
CLINICAL RELEVANCE
During surgery involving the dorsal and ulnar areas of the wrist, multiple longitudinal branches and a transverse branch of the DCBUN are normally present and must be respected.
目的
描述尺神经手背支（DCBUN）相对于腕部尺侧可识别解剖标志的可变分支模式。
方法
我们在28具未配对的新鲜冷冻尸体上解剖尺神经，以识别DCBUN及其从起源到掌指关节水平的分支。记录DCBUN分支的数量和位置相对于尺骨远端关节面的情况。在旋前位的腕关节中确定其与尺骨皮下边界、豌豆三角骨联合和尺侧腕伸肌腱的关系。
结果
在尺骨远端关节面水平，DCBUN平均有2个分支（范围为1 - 4个）。在尺骨关节面远侧2 cm处，平均有2.2个分支（范围为1 - 4个）。在28个标本中的23个（82%）中，至少有1条纵向分支在尺侧腕伸肌腱插入第五掌骨基部之前越过其背侧。在28个标本中的27个（96%）中，DCBUN的所有纵向分支走行于尺骨皮下边界的背掌中点与豌豆三角骨联合之间。在28个标本中的20个（71%）中，存在DCBUN至远侧桡尺关节的横向分支。
结论
在显露腕部背侧和尺侧区域时，仅识别和保护DCBUN的单一分支不太可能确保安全解剖，因为通常存在多个分支。6U、6R和尺侧腕中关节镜入路可能使这些分支处于危险之中。在旋前位的前臂中，96%的标本中DCBUN与豌豆三角骨联合之间的区域包含DCBUN的所有纵向分支。
临床意义
在涉及腕部背侧和尺侧区域的手术中，DCBUN通常存在多个纵向分支和一个横向分支，必须予以重视。
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