Caetano Edie Benedito, Vieira Luiz Ângelo, Sprovieri Fábio Antonio Anversa, Petta Guilherme Camargo, Nakasone Maurício Tadeu, Serafim Bárbara Lívia Correa
Pontifícia Universidade Católica de São Paulo, Faculdade de Ciências Médicas e da Saúde, Disciplina de Ortopedia e Traumatologia, Sorocaba, SP, Brazil.
Rev Bras Ortop. 2017 Mar 2;52(2):169-175. doi: 10.1016/j.rboe.2017.02.003. eCollection 2017 Mar-Apr.
To assess the anatomical variations of the pronator teres muscle (PTM) and its implication in the compression of the median nerve, which passes through the humeral and ulnar heads of the PTM.
For the present study, 100 upper limbs from human cadavers from the anatomy laboratory were dissected. Forty-six specimens were male and four, female, whose aged ranged from 28 to 77 years; 27 were white and 23, non-white. A pilot study consisting of six hands from three fresh cadaver dissections was conducted to familiarize the authors with the local anatomy; these were not included in the present study.
The humeral and ulnar heads of PTM were present in 86 limbs. In 72 out of the 86 limbs, the median nerve was positioned between the two heads of the PTM; in 11, it passed through the muscle belly of ulnar head of the PTM, and in three, posteriorly to both heads of the PTM. When both heads were present, the median nerve was not observed as passing through the muscle belly of the humeral head of PTM. In 14 out of the 100 dissected limbs, the ulnar head of the PTM was not observed; in this situation, the median nerve was positioned posteriorly to the humeral head in 11 limbs, and passed through the humeral head in three. In 17 limbs, the ulnar head of PTM was little developed, with a fibrous band originating from the ulnar coronoid process, associated with a distal muscle component near the union with the humeral head. In four limbs, the ulnar head of the MPR was represented by a fibrous band. In both limbs of one cadaver, a fibrous band was observed between the supinator muscle and the humeral head of the PTM, passing over median nerve.
The results suggest that these anatomical variations in relationship median nerve and PTM are potential factors for median nerve compression, as they narrow the space through which the median nerve passes.
评估旋前圆肌（PTM）的解剖变异及其对正中神经压迫的影响，正中神经穿过PTM的肱骨头和尺骨头。
在本研究中，解剖了来自解剖实验室的100例人体尸体的上肢。46例标本为男性，4例为女性，年龄在28至77岁之间；27例为白人，23例为非白人。进行了一项由来自三个新鲜尸体解剖的六只手组成的初步研究，以使作者熟悉局部解剖结构；这些未纳入本研究。
86例上肢存在PTM的肱骨头和尺骨头。在86例上肢中的72例中，正中神经位于PTM的两个头之间；11例中，它穿过PTM尺骨头的肌腹，3例中，它位于PTM两个头的后方。当两个头都存在时，未观察到正中神经穿过PTM肱骨头的肌腹。在100例解剖的上肢中，有14例未观察到PTM的尺骨头；在这种情况下，11例上肢的正中神经位于肱骨头后方，3例穿过肱骨头。在17例上肢中，PTM的尺骨头发育不良，有一条纤维带起自尺骨冠状突，与靠近与肱骨头结合处的远端肌肉成分相连。在4例上肢中，MPR的尺骨头由一条纤维带代表。在一具尸体的双上肢中，在旋后肌和PTM的肱骨头之间观察到一条纤维带，越过正中神经。
结果表明，正中神经与PTM关系的这些解剖变异是正中神经受压的潜在因素，因为它们缩小了正中神经通过的空间。
