Stecco Carla, Macchi Veronica, Barbieri Alessandro, Tiengo Cesare, Porzionato Andrea, De Caro Raffaele
Anatomy Institute, Department of Neuroscience, University of Padova, via Gabelli 65, Padova, 35121, Italy.
Clinic of Plastic surgery, Department of Neuroscience, University of Padova, via Giustiniani 2, Padova, 35121, Italy.
Clin Anat. 2018 Jul;31(5):677-683. doi: 10.1002/ca.23076. Epub 2018 Apr 14.
There are few data in the scientific literature about the innervation of fasciae of the hand. The present study first elucidates the density and location of nervous structures in the palmar aponeurosis and, for comparison, in the flexor retinaculum (both can be considered specializations of the deep fascia of the upper limbs). Second, it compares nonpathological with pathological palmar aponeurosis. Samples of nonpathological fascia were taken from the flexor retinaculum and palmar aponeurosis of 16 upper limbs of unembalmed cadavers. Samples of pathological palmar aponeurosis were taken from seven patients with Dupuytren's disease. All samples were stained immunohistochemically with anti-S100 and anti-tubulin antibodies, and analyzed quantitatively and qualitatively by microscopy. The palmar aponeurosis showed higher median density than the retinacula of free nerve endings (22 and 20 elements/cm , respectively), Pacinian corpuscles (2 and 0 elements/cm ) and Golgi-Mazzoni corpuscles (1.0 and 0.5 element/cm ). Some corpuscles were located at the intersections of the fibers in the three directions. Free nerve endings were denser in pathological palmar aponeurosis (38 elements/cm ). The results indicate that the palmar aponeurosis is central to proprioception of the hand and that surgery should therefore avoid injuring it. The higher density of free nerve endings in pathological samples indicates that the nervous structures are implicated in the amplified fibrosis of Dupuytren's disease. Clin. Anat. 31:677-683, 2018. © 2018 Wiley Periodicals, Inc.
科学文献中关于手部筋膜神经支配的资料很少。本研究首先阐明了掌腱膜以及（作为比较）屈肌支持带（二者均可视为上肢深筋膜的特殊结构）中神经结构的密度和位置。其次，对非病理性掌腱膜与病理性掌腱膜进行了比较。非病理性筋膜样本取自16具未防腐尸体上肢的屈肌支持带和掌腱膜。病理性掌腱膜样本取自7例掌腱膜挛缩症患者。所有样本均用抗S100和抗微管蛋白抗体进行免疫组织化学染色，并通过显微镜进行定量和定性分析。掌腱膜显示出比屈肌支持带更高的游离神经末梢（分别为22和20个/厘米）、环层小体（2和0个/厘米）和高尔基-马佐尼小体（1.0和0.5个/厘米）的中位密度。一些小体位于三个方向纤维的交叉处。病理性掌腱膜中的游离神经末梢更密集（38个/厘米）。结果表明掌腱膜在手的本体感觉中起核心作用，因此手术应避免损伤它。病理性样本中游离神经末梢的较高密度表明神经结构与掌腱膜挛缩症的纤维化加剧有关。《临床解剖学》2018年第31卷：677 - 683页。© 2018威利期刊公司。
