Department of Neuroscience and Anatomy, Erasmus MC, Rotterdam, The Netherlands; Department of Plastic and Reconstructive Surgery and Hand Surgery, Erasmus MC, Rotterdam, The Netherlands.
Department of Plastic Surgery, RadboudUMC, Nijmegen, The Netherlands.
J Plast Reconstr Aesthet Surg. 2015 Feb;68(2):237-42. doi: 10.1016/j.bjps.2014.10.010. Epub 2014 Oct 16.
The superficial branch of the radial nerve (SBRN) is known for developing neuropathic pain syndromes after trauma. These pain syndromes can be hard to treat due to the involvement of other nerves in the forearm. When a nerve is cut, the Schwann cells, and also other cells in the distal segment of the transected nerve, produce the nerve growth factor (NGF) in the entire distal segment. If two nerves overlap anatomically, similar to the lateral antebrachial cutaneous nerve (LACN) and SBRN, the increase in secretion of NGF, which is mediated by the injured nerve, results in binding to the high-affinity NGF receptor, tyrosine kinase A (TrkA). This in turn leads to possible sprouting and morphological changes of uninjured fibers, which ultimately causes neuropathic pain. The aim of this study was to map the level of overlap between the SBRN and LACN. Twenty arms (five left and 15 right) were thoroughly dissected. Using a new analysis tool called CASAM (Computer Assisted Surgical Anatomy Mapping), the course of the SBRN and LACN could be compared visually. The distance between both nerves was measured at 5-mm increments, and the number of times they intersected was documented. In 81% of measurements, the distance between the nerves was >10 mm, and in 49% the distance was even <5 mm. In 95% of the dissected arms, the SBRN and LACN intersected. On average, they intersected 2.25 times. The close (anatomical) relationship between the LACN and the SBRN can be seen as a factor in the explanation of persistent neuropathic pain in patients with traumatic or iatrogenic lesion of the SBRN or the LACN.
桡神经浅支（SBRN）在创伤后易发生神经病理性疼痛综合征。由于前臂其他神经的参与，这些疼痛综合征难以治疗。当神经被切断时，施万细胞和神经横断远段的其他细胞会在整个远段产生神经生长因子（NGF）。如果两条神经在解剖上重叠，类似于前臂外侧皮神经（LACN）和 SBRN，受伤神经介导的 NGF 分泌增加会导致与高亲和力 NGF 受体酪氨酸激酶 A（TrkA）结合。这反过来又导致未受伤纤维的可能发芽和形态变化，最终导致神经病理性疼痛。本研究旨在描绘 SBRN 和 LACN 之间重叠的程度。彻底解剖了 20 只手臂（5 只左手和 15 只右手）。使用一种称为 CASAM（计算机辅助手术解剖图）的新分析工具，可以直观地比较 SBRN 和 LACN 的行程。测量两条神经之间的距离，每隔 5 毫米增加一次，并记录它们交叉的次数。在 81%的测量中，两条神经之间的距离>10mm，而在 49%的测量中，距离甚至<5mm。在 95%的解剖手臂中，SBRN 和 LACN 交叉。平均而言，它们交叉 2.25 次。LACN 和 SBRN 之间的密切（解剖）关系可以被视为解释创伤性或医源性 SBRN 或 LACN 损伤患者持续性神经病理性疼痛的一个因素。
