Department of Anaesthesiology and General Intensive Care Medicine, Austria.
Department of Anaesthesiology and General Intensive Care Medicine, Austria.
Br J Anaesth. 2018 Apr;120(4):836-845. doi: 10.1016/j.bja.2017.09.008. Epub 2017 Nov 24.
Many clinicians require a solid understanding of the anatomical areas supplied by specific peripheral nerves. Virtually all pertinent medical textbooks claim that the entire (palmar and dorsal) surface of the hand is supplied by three (median, radial, and ulnar) nerves and that each of these covers a well-defined area. This study was designed to evaluate the sensory-distribution pattern of peripheral nerves in the hand.
Twelve volunteers were enrolled and randomly allocated to have median, ulnar, or radial nerve blocks to each hand on three successive days. All blocks were performed using ultrasound guidance. A neurologist carried out pinprick testing to define the sensory-distribution area of each procedure. The hand surface was then scanned, and the sensory-distribution area of the blocked nerve was traced, measured, and quantified in relation to the entire hand surface for descriptive and comparative statistical analyses.
The sensory-distribution areas of the three nerves revealed a high degree of inter-individual and intra-individual variabilities. Sizeable areas were not covered by any of the three nerves, again involving great variability. Conversely, 15 of the 24 hands showed areas of overlapping supply from more than one nerve.
Our findings suggest that the anatomical areas supplied by peripheral nerves are characterised by much greater variability than is routinely claimed.
DRKS00010707.
许多临床医生需要对特定周围神经供应的解剖区域有扎实的了解。几乎所有相关的医学教科书都声称，手部的整个（手掌和手背）表面都由三根（正中、桡和尺）神经供应，并且这些神经都覆盖着明确界定的区域。本研究旨在评估手部周围神经的感觉分布模式。
招募了 12 名志愿者，并在连续三天内随机将正中、尺或桡神经阻滞分配到每只手上。所有阻滞均采用超声引导进行。神经科医生进行刺痛测试，以确定每个程序的感觉分布区域。然后对手面进行扫描，并追踪、测量和量化被阻滞神经的感觉分布区域，与整个手面进行描述性和比较性统计分析。
三根神经的感觉分布区域显示出高度的个体间和个体内变异性。相当大的区域没有被三根神经中的任何一根覆盖，这也涉及到很大的变异性。相反，24 只手中有 15 只显示出来自不止一根神经的重叠供应区域。
我们的发现表明，周围神经供应的解剖区域的变异性比通常所声称的要大得多。
DRKS00010707。
