Ortiz Ricardo, Westenberg Ritsaart F, Langhammer Christopher G, Knaus William J, Chen Neal C, Eberlin Kyle R
Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, Mass.
Department of Orthopedic Surgery, Massachusetts General Hospital, Boston, Mass.
Plast Reconstr Surg Glob Open. 2019 Mar 13;7(3):e2155. doi: 10.1097/GOX.0000000000002155. eCollection 2019 Mar.
Nerve injuries in the hand are common and often pose a challenge for the upper extremity surgeon. A range of reconstructive options exist for nerve repair, but proper matching of nerve diameter is important for many of these techniques. The purposes of this study were to (1) describe the nerve diameters of the hand and their relative differences and (2) investigate whether there is a relationship between nerve diameter and external hand dimensions or body mass index.
We utilized 18 freshly frozen cadaveric hands from adult donors aged 20-86 of both sexes for this study. Two independent observers measured each nerve diameter to the nearest 0.1 mm using a digital caliper.
Using the flexor zones as boundaries, a total of 33 nerve measurements were performed for each cadaveric hand. Nerve diameter increased from the distal to the proximal flexor zones. The internal common digital nerves in flexor zone 3 were larger than the external digital nerves. The median nerve was found to be nearly 2 times larger than the ulnar nerve at 2 locations within the wrist. There was a positive correlation between body mass index, hand span, hand width, and nerve diameter at several measured locations.
This study provides reference values for nerve diameters of the hand and wrist and describes their relative differences. It is important for surgeons to be aware of these differences and to consider this information as we advance our efforts to reconstruct the hand and develop technologies for nerve repair.
手部神经损伤很常见，常常给上肢外科医生带来挑战。神经修复有一系列重建选择，但对于其中许多技术而言，神经直径的恰当匹配很重要。本研究的目的是：（1）描述手部神经直径及其相对差异；（2）研究神经直径与手部外部尺寸或体重指数之间是否存在关联。
我们使用了18只来自年龄在20 - 86岁的成年男女供体的新鲜冷冻尸体手进行本研究。两名独立观察者使用数字卡尺将每条神经直径测量至最接近的0.1毫米。
以屈肌区为边界，每只尸体手共进行了33次神经测量。神经直径从远端屈肌区向近端屈肌区增大。屈肌区3的指总神经内侧支比指神经外侧支粗。在腕部的2个位置发现正中神经比尺神经粗近2倍。在几个测量位置，体重指数、手跨度、手宽度与神经直径之间存在正相关。
本研究提供了手部和腕部神经直径的参考值，并描述了它们的相对差异。外科医生了解这些差异并在推进手部重建和神经修复技术研发工作时考虑这些信息很重要。
