Bertelli Jayme A, Goklani Mayur Sureshlal, Patel Neehar, Duarte Elisa Cristiana Winkelmann
1Department of Orthopedic Surgery, Governador Celso Ramos Hospital, Florianópolis, Santa Catarina, Brazil.
2Department of Plastic Surgery, Bombay Hospital Institute of Medical Sciences, New Marine Lines, Mumbai, Maharashtra, India.
J Neurosurg. 2021 Oct 8;136(5):1424-1433. doi: 10.3171/2021.4.JNS2169. Print 2022 May 1.
The authors sought to describe the anatomy of the radial nerve and its branches when exposed through an axillary anterior arm approach.
Bilateral upper limbs of 10 fresh cadavers were dissected after dyed latex was injected into the axillary artery.
Via the anterior arm approach, all triceps muscle heads could be dissected and individualized. The radial nerve overlaid the latissimus dorsi tendon, bounded by the axillar artery on its superior surface, then passed around the humerus, together with the lower lateral arm and posterior antebrachial cutaneous nerve, between the lateral and medial heads of the triceps. No triceps motor branch accompanied the radial nerve's trajectory. Over the latissimus dorsi tendon, an antero-inferior bundle, containing all radial nerve branches to the triceps, was consistently observed. In the majority of the dissections, a single branch to the long head and dual innervations for the lateral and medial heads were observed. The triceps long and proximal lateral head branches entered the triceps muscle close to the latissimus dorsi tendon. The second branch to the lateral head stemmed from the triceps lower head motor branch. The triceps medial head was innervated by the upper medial head motor branch, which followed the ulnar nerve to enter the medial head on its anterior surface. The distal branch to the triceps medial head also originated near the distal border of the latissimus dorsi tendon. After a short trajectory, a branch went out that penetrated the medial head on its posterior surface. The triceps lower medial head motor branch ended in the anconeus muscle, after traveling inside the triceps medial head. The lower lateral arm and posterior antebrachial cutaneous nerve followed the radial nerve within the torsion canal. The lower lateral brachial cutaneous nerve innervated the skin over the biceps, while the posterior antebrachial cutaneous nerve innervated the skin over the lateral epicondyle and posterior surface of the forearm. The average numbers of myelinated fibers were 926 in the long and 439 in the upper lateral head and 658 in the upper and 1137 in the lower medial head motor branches.
The new understanding of radial nerve anatomy delineated in this study should aid surgeons during reconstructive surgery to treat upper-limb paralysis.
作者试图描述通过腋窝前上臂入路暴露时桡神经及其分支的解剖结构。
在将染色乳胶注入腋动脉后，对10具新鲜尸体的双侧上肢进行解剖。
通过前上臂入路，可以解剖并区分所有三头肌头。桡神经覆盖背阔肌腱，其上表面以腋动脉为界，然后与下外侧臂和前臂后皮神经一起绕过肱骨，位于三头肌外侧头和内侧头之间。没有三头肌运动支伴随桡神经走行。在背阔肌腱上方，始终观察到一个包含所有桡神经至三头肌分支的前下束。在大多数解剖中，观察到一根至长头的分支以及外侧头和内侧头的双重神经支配。三头肌长头和近端外侧头分支在靠近背阔肌腱处进入三头肌。至外侧头的第二分支起源于三头肌下头运动支。三头肌内侧头由上内侧头运动支支配，该运动支沿尺神经走行并在其前表面进入内侧头。至三头肌内侧头的远端分支也起源于背阔肌腱远端边界附近。经过短距离走行后，发出一个分支穿透内侧头的后表面。三头肌下内侧头运动支在三头肌内侧头内走行后止于肘肌。下外侧臂和前臂后皮神经在扭转管内跟随桡神经走行。下外侧臂皮神经支配肱二头肌上方的皮肤，而前臂后皮神经支配肱骨外侧髁和前臂后表面的皮肤。长头运动支的有髓纤维平均数量为926条，上外侧头为439条，上内侧头为658条，下内侧头运动支为1137条。
本研究中对桡神经解剖结构的新认识应有助于外科医生在治疗上肢瘫痪的重建手术中。
