尺神经运动支的束间解剖：一项尸体研究

Interfascicular Anatomy of the Motor Branch of the Ulnar Nerve: A Cadaveric Study.

作者信息

Chambers Spencer B, Wu Kitty Yuechuan, Smith Corey, Potra Robert, Ferreira Louis M, Gillis Joshua

机构信息

Division of Plastic and Reconstructive Surgery, University of Western Ontario, Roth McFarlane Hand and Upper Limb Center, St. Joseph's Health Care, London, Ontario, Canada.

Surgical Mechatronics Research Laboratory, Roth McFarlane Hand and Upper Limb Center, St. Joseph's Health Care, London, Ontario, Canada; Department of Mechanical and Materials Engineering, Western University, London, Ontario, Canada.

出版信息

J Hand Surg Am. 2023 Mar;48(3):309.e1-309.e6. doi: 10.1016/j.jhsa.2021.10.012. Epub 2021 Dec 20.

DOI:10.1016/j.jhsa.2021.10.012

PMID:34949481

Abstract

PURPOSE

The motor branch of the ulnar nerve contains fascicles that innervate the intrinsic musculature of the hand. This cadaveric study aimed to describe the organization and consistency of the internal topography of the motor branch of the ulnar nerve.

METHODS

Five fresh-frozen cadaveric specimens with an average age of 74 years (range, 65-88 years) were dissected. The ulnar nerve was exposed and transfixed to the underlying tissues to maintain its orientation throughout the dissection. The dorsal cutaneous branch (DCB) and the volar sensory branch were identified and reflected to expose the motor branch. The fascicles to the first dorsal interosseus (FDI), flexor pollicis brevis, and abductor digiti minimi (ADM) were identified. Internal neurolysis was performed distal to proximal to identify the interfascicular arrangement of these fascicles within the motor branch. The organization of these fascicles was noted, and the branch points of the DCB, FDI, and ADM were measured relative to the pisiform using a handheld electronic caliper.

RESULTS

The internal topography of the motor branch was consistent among all specimens. Proximal to the pisiform, the arrangement from radial to ulnar was as follows: volar sensory branch, flexor pollicis brevis, FDI/intrinsic muscles, ADM, and DCB. The position of these branches remained consistent as the deep motor branch curved radially within the palm and traveled to the terminal musculature. The locations of the average branch points of the FDI, ADM, and DCB with respect to the pisiform were as follows: FDI, 4.6 cm distal (range, 4.1-4.9 cm), 4.5 cm radial (range, 4.1-4.9 cm); ADM, 0.65 cm distal (range, 0.3-1.1 cm), 0.7 cm radial (range, 0.3-1.1 cm), DCB, 7.7 cm proximal (range, 4.2-10.1 cm), and 0.4 cm ulnar (range, 0.3-0.8 cm).

CONCLUSIONS

The internal topography of the ulnar nerve motor branch was consistent among the specimens studied. The topography of the motor branches was maintained as the motor branch turns radially within the palm.

CLINICAL RELEVANCE

This study provides further understanding of the internal topography of the ulnar nerve motor branch at the wrist level.

摘要

目的

尺神经运动支包含支配手部固有肌肉组织的束支。本尸体研究旨在描述尺神经运动支内部局部解剖结构的组织情况及一致性。

方法

解剖了5例平均年龄74岁（范围65 - 88岁）的新鲜冷冻尸体标本。暴露尺神经并将其固定于下方组织，以便在整个解剖过程中保持其方向。识别并翻开背侧皮支（DCB）和掌侧感觉支，以暴露运动支。识别出至第一背侧骨间肌（FDI）、拇短屈肌和小指展肌（ADM）的束支。从远端向近端进行内部神经松解，以确定这些束支在运动支内的束间排列。记录这些束支的组织情况，并用手持式电子卡尺测量DCB、FDI和ADM的分支点相对于豌豆骨的距离。

结果

所有标本中尺神经运动支的内部局部解剖结构一致。在豌豆骨近端，从桡侧向尺侧的排列顺序如下：掌侧感觉支、拇短屈肌、FDI/固有肌、ADM和DCB。随着深运动支在手掌内径向弯曲并走向终末肌肉组织，这些分支的位置保持一致。FDI、ADM和DCB的平均分支点相对于豌豆骨的位置如下：FDI，远端4.6 cm（范围4.1 - 4.9 cm），桡侧4.5 cm（范围4.1 - 4.9 cm）；ADM，远端0.65 cm（范围0.3 - 1.1 cm），桡侧0.7 cm（范围0.3 - 1.1 cm）；DCB，近端7.7 cm（范围4.2 - 10.1 cm），尺侧0.4 cm（范围0.3 - 0.8 cm）。