Caetano Edie Benedito, Vieira Luiz Angelo, Sabongi Neto João José, Caetano Maurício Benedito Ferreira, Sabongi Rodrigo Guerra
Pontifícia Universidade Católica de São Paulo (PUC-SP), Faculdade de Ciências Médicas e da Saúde (FCMS), Sorocaba, SP, Brazil.
Conjunto Hospitalar de Sorocaba (CHS), Serviço de Cirurgia da Mão, Sorocaba, SP, Brazil.
Rev Bras Ortop. 2018 Aug 2;53(5):575-581. doi: 10.1016/j.rboe.2018.07.010. eCollection 2018 Sep-Oct.
The goal of this study was to describe anatomical variations and clinical implications of anterior interosseous nerve. In complete anterior interosseous nerve palsy, the patient is unable to flex the distal phalanx of the thumb and index finger; in incomplete anterior interosseous nerve palsy, there is less axonal damage, and either the thumb or the index finger are affected.
This study was based on the dissection of 50 limbs of 25 cadavers, 22 were male and three, female. Age ranged from 28 to 77 years, 14 were white and 11 were non-white; 18 were prepared by intra-arterial injection of a solution of 10% glycerol and formaldehyde, and seven were freshly dissected cadavers.
The anterior interosseous nerve arose from the median nerve, an average of 5.2 cm distal to the intercondylar line. In 29 limbs, it originated from the nerve fascicles of the posterior region of the median nerve and in 21 limbs, of the posterolateral fascicles. In 41 limbs, the anterior interosseous nerve positioned between the humeral and ulnar head of the pronator teres muscle. In two limbs, anterior interosseous nerve duplication was observed. In all members, it was observed that the anterior interosseous nerve arose from the median nerve proximal to the arch of the flexor digitorum superficialis muscle. In 24 limbs, the branches of the anterior interosseous nerve occurred proximal to the arch and in 26, distal to it.
The fibrous arches formed by the humeral and ulnar heads of the pronator teres muscle, the fibrous arch of the flexor digitorum superficialis muscle, and the Gantzer muscle (when hypertrophied and positioned anterior to the anterior interosseous nerve), can compress the nerve against deep structures, altering its normal course, by narrowing its space, causing alterations longus and flexor digitorum profundus muscles.
本研究旨在描述骨间前神经的解剖变异及临床意义。在完全性骨间前神经麻痹中，患者无法屈曲拇指和示指的远节指骨；在不完全性骨间前神经麻痹中，轴突损伤较少，拇指或示指其中之一受到影响。
本研究基于对25具尸体的50条肢体进行解剖，其中男性22具，女性3具。年龄范围为28至77岁，14人为白人，11人为非白人；18具通过动脉内注射10%甘油和甲醛溶液制备，7具为新鲜解剖的尸体。
骨间前神经起自正中神经，平均位于髁间线远侧5.2厘米处。在29条肢体中，它起自正中神经后部区域的神经束，在21条肢体中，起自后外侧束。在41条肢体中，骨间前神经位于旋前圆肌的肱骨头和尺骨头之间。在2条肢体中，观察到骨间前神经重复。在所有标本中，均观察到骨间前神经起自指浅屈肌弓近端的正中神经。在24条肢体中，骨间前神经的分支位于弓的近端，在26条肢体中，位于弓的远端。
由旋前圆肌的肱骨头和尺骨头形成的纤维弓、指浅屈肌的纤维弓以及Gantzer肌（当肥大并位于骨间前神经前方时），可将神经压向深部结构，通过缩小其空间改变其正常走行，导致拇长屈肌和指深屈肌发生改变。
