Department of Orthopedic Surgery, Governador Celso Ramos Hospital, Florianópolis, SC, Brazil.
Plastic Surgery and Hand Surgery Superspeciality Clinic. Jalna Road, Aurangadab, Maharashtra, India.
J Hand Surg Am. 2024 Mar;49(3):278.e1-278.e7. doi: 10.1016/j.jhsa.2022.06.025. Epub 2022 Aug 12.
Dissection of the radial nerve in the axilla and upper portion of and posterior aspect of arm may be necessary for brachial plexus reconstruction, in axillary nerve paralysis, and in radial nerve injuries. The radial nerve is in intimate contact with the profunda brachial artery (PBA). The authors sought to describe the relationship of the PBA with the radial nerve.
We dissected the PBA and the radial nerve bilaterally in 20 upper limbs from 10 fresh cadavers after subclavian artery injection with green latex. We studied the relationship of the PBA with the radial nerve, its branching patterns, and its diameters. In addition, we performed surgery on 5 patients with brachial plexus, radial, or axillary nerve injury in whom we dissected the PBA.
The PBA was present in all dissections, originating from the brachial artery (n = 19 specimens) close to the latissimus dorsi tendon or from the subscapular artery (n = 1 specimen). In 15 dissections, the PBA bifurcated into an anterior (AB) and a posterior (PB) branch. In one dissection, the AB was absent. The AB traveled toward the triceps medial head. The PB flanked the radial nerve posteriorly and traveled around the humerus, with the radial nerve passing between the medial and the lateral head of the triceps. The AB and PB were longer than the PBA and measured on average 53 mm (SD ± 33 mm) and 39 mm (SD ± 26 mm), respectively. Intraoperatively, the radial nerve could be exposed in the upper arm by pulling the triceps medial head anteriorly together with the AB. The PB was lateral to the radial nerve in the posterior arm approach.
In the upper arm, the radial nerve was not flanked by a single branch as postulated in anatomical textbooks but by 2 branches resulting from the bifurcation of the PBA.
Awareness of PBA anatomy is essential during radial nerve dissection from the anterior or posterior arm approach.
在臂丛重建、腋神经麻痹和桡神经损伤时，可能需要在腋窝和上臂的后外侧解剖桡神经。桡神经与肱深动脉（PBA）密切接触。作者试图描述 PBA 与桡神经的关系。
我们在 10 具尸体上肢中，经锁骨下动脉注入绿色乳胶后，双侧解剖了 20 个 PBA 和桡神经。我们研究了 PBA 与桡神经的关系、分支模式及其直径。此外，我们对 5 例臂丛、桡神经或腋神经损伤患者进行了手术，解剖了 PBA。
所有解剖均显示 PBA 存在，起源于肱动脉（n=19 标本），靠近背阔肌腱或肩胛下动脉（n=1 标本）。在 15 次解剖中，PBA 分为前支（AB）和后支（PB）。在一次解剖中，AB 不存在。AB 向三头肌内侧头方向走行。PB 位于桡神经后方，绕过肱骨，桡神经位于三头肌内侧头和外侧头之间。AB 和 PB 比 PBA 长，平均长度分别为 53mm（SD±33mm）和 39mm（SD±26mm）。术中，通过将三头肌内侧头与 AB 一起向前牵拉，可以在前臂显露桡神经。在肱后入路中，PB 位于桡神经外侧。
在上臂，桡神经并非像解剖学教科书中假设的那样由单一分支（即 PBA）侧翼包裹，而是由 PBA 的分支形成的 2 个分支包裹。
在从前臂或肱后入路解剖桡神经时，了解 PBA 的解剖结构非常重要。
