骨间后神经的应用解剖学研究
发布时间：2018-12-15 23:30
【摘要】：目的： 通过骨间后神经(Posterior interosseous nerve)的解剖学研究寻找一种防止神经损伤的新方法,探索一种更为安全的手术入路,从而指导临床前臂手术,进一步增强手术的安全性。 材料与方法： 1.福尔马林固定的成人上肢尸体标本20例,左右各10例,新鲜成年上肢标本8例,左右各4例。 2.对防腐标本进行大体解剖,显露旋后肌及骨间后神经,观察神经的走行及位置,分别测量：L1(神经发出点与桡骨小头的距离)、L2(神经发出点与进入旋后肌点的距离)、L3(神经穿出旋后肌的部位与桡骨小头的距离)、L4(桡骨茎突与桡骨小头的距离)、L5(神经穿出旋后肌的部位与肱骨外上髁和Lister结节连线的水平距离)、L6(神经从旋后肌穿出点至尺骨内缘的水平距离)、L7(神经与桡骨颈外侧中线交叉点至桡骨小头的距离)和R(神经旋后肌出入点连线和桡髁线的夹角)。 3.将前臂置于旋前位,以肱骨外上髁(A)、尺骨茎突(D)、桡骨Lister结节(E)三点连成一个三角形,再将A点与DE连线的中点(F)连接起来,观察骨间后神经各肌支与ADE三角、AF线的关系。 4.暴露骨间后神经前臂各肌支,仔细分离出各肌支及其入肌点,显露并观察各肌支的走行和分布情况,测量各肌支发出点和入肌点至肱骨外上髁的距离及肌支数目。 结果： 1.骨间后神经主干测量结果单位：mm (x±s, n左侧=14,n右侧=14) L1左14.74±0.24,右15.82±0.56；L2左31.76±0.32,右30.52±0.48；L3左65.70±0.92,右63.26±0.31；L4左230.26±0.23,右232.34±0.54；L5左6.22±0.34,右6.86±0.26；L6左25.34±0.53,右24.82±0.67；L7左42.74±0.62,右43.58±0.28。 2.骨间后神经旋后肌出入点连线和桡髁线的夹角R左30.0°±0.2°,右32.0°±0.1°(x±s,n左侧=14,n右侧=14) 3.骨间后神经各肌支发出点和入肌点至肱骨外上髁的距离和入肌支数单位：mm(x±s,n=28) 肱桡肌支39.44±0.15,11.78±0.32,1.9±0.2；桡侧腕长伸肌支35.52±0.16,10.94±0.36,1.8±0.1;桡侧腕短伸肌支45.92±0.32,66.92±0.12,2.6±0.1；旋后肌支61.94±0.57,67.92±0.14,1.6±0.3；指伸肌支69.82±0.36,93.98±0.02,4.9±0.2；尺侧腕伸肌支76.92±0.58,92.94±0.37,2.9±0.4；小指伸肌支78.82±0.48,95.76±0.12,1.3±0.2；拇长展肌支96.74±0.18,125.92±0.36,1.1±0.1；拇短伸肌支103.22±0.52,144.52±0.12,1.5±0.3；拇长伸肌支102.92±0.64,130.36±0.82,1.0±0.1；示指伸肌支130.98±0.74,148.46±0.48,1.0±0.2;肘肌支101.38±0.58,10.18±0.78,1.1±0.2。 4.骨间后神经主干位于AF线上者占78.6%(22例),位于AF线桡侧者占10.7%(3例),尺侧者占10.7%(3例)。 结论： 1.区域定位和线性定位相结合是一种更为准确的骨间后神经的定位方法。 2.旋后肌穿出点可作为骨间后神经一个重要的定位标志。
[Abstract]:Objective: to find a new method to prevent nerve injury through anatomical study of posterior interosseous nerve (Posterior interosseous nerve), and to explore a more safe surgical approach to guide clinical forearm operation and further enhance the safety of operation. Materials and methods: 1. 20 adult cadavers were fixed with formalin, 10 cases were left and right, 8 cases were fresh adult upper limbs, 4 cases were left and right. 2. The antiseptic specimens were dissected and exposed to the reflex muscle and the posterior interosseous nerve. The route and position of the nerve were observed and measured: L1 (distance between the nerve emitting point and the radial head), L2 (the distance between the nerve emitting point and the point entering the pronation muscle), L3 (distance between the nerve passing through the pronator muscle and the head of the radius), L4 (the distance between the styloid process of the radius and the capitulum of the radius), L5 (the horizontal distance between the location of the nerve passing through the pronator muscle and the line between the lateral epicondyle of the humerus and the Lister nodule), L6 (horizontal distance from the point of exiting the pronator muscle to the inner margin of the ulna), L7 (the distance between the nerve and the lateral midline of the radial neck and the radial head) and R (the angle between the entry and exit point of the pronator muscle and the radial condyle line). 3. The forearm was placed in the pronation position and was triangulated by the Lister node (E) of the ulna styloid process (D), of the lateral epicondyle of the humerus (E), and then the A point was connected with the midpoint (F) of the DE line. The relationship between muscle branches of posterior interosseous nerve and ADE triangle and AF line was observed. 4. The muscle branches of the forearm of the posterior interosseous nerve were exposed, the muscle branches and their entry points were carefully separated, the movement and distribution of the muscle branches were observed and the distance between the origin and entry points of the muscle branches to the external epicondyle of the humerus and the number of the muscle branches were measured. Results: 1. The main trunk of posterior interosseous nerve was measured in units of: mm (x 卤s, n left = 14n right = 14) L1 left 14.74 卤0.24, right 15.82 卤0.56L 2, left 31.76 卤0.32, right 30.52 卤0.48 L 3, left 65.70 卤0.92, right 63.26 卤0.31; L4 left 230.26 卤0.23, right 232.34 卤0.54L 5 left 6.22 卤0.34, right 6.86 卤0.26L 6 left 25.34 卤0.53, right 24.82 卤0.67L 7 left 42.74 卤0.62, right 43.58 卤0.28. 2. The angle between the line and the radial condyle was 30.0 掳卤0.2 掳left and 32.0 掳卤0.1 掳right (x 卤stin left = 14 n, right side = 14 掳). The distance between the muscular branches of the posterior interosseous nerve and the lateral epicondyle of the humerus and the number of branches in the muscle of the posterior interosseous nerve were 39.44 卤0.1511.78 卤0.321.9 卤0.2; The branch of extensor Carpi longus radialis was 35.52 卤0.16 卤10.94 卤0.36 卤1.8 卤0.1, the branch of extensor Carpi brevis was 45.92 卤0.32 卤0.122.62 卤0.1, the branch of pronator muscle was 61.94 卤0.57 卤0.47 卤0.147.92 卤0.147.92 卤0.14 卤0.3, the branch of extensor Carpi longus radialis was 45.92 卤0.32 卤0.12 卤0.1; The branches of extensor digitorum musculi 69.82 卤0.3693.98 卤0.02fl. 9 卤0.2, extensor carpi ulnaris 76.92 卤0.58l92.94 卤0.372.94 卤0.44,78.82 卤0.482 卤0.125.76 卤0.121.3 卤0.2, branch of abductor pollicis longus 96.74 卤0.18125.92 卤0.365.92 卤0.1. The branches of extensor pollicis brevis were 103.22 卤0.52144.52 卤0.121.51.5 卤0.3, the branches of extensor pollicis longus 102.92 卤0.64130.36 卤0.821.0 卤0.1, the branches of extensor digitorum 130.98 卤0.74148.46 卤0.481 卤0.2, and the branches of elbow muscle 101.38 卤0.5810.18 卤0.781.1 卤0.2. 4. The posterior interosseous nerve trunk was located on the AF line in 22 cases (78.6%), in the radial side of the AF line in 3 cases (10.7%), and in the ulnar side in 3 cases (10.7%). Conclusion: 1. The combination of regional location and linear location is a more accurate method for locating posterior interosseous nerve. 2. The perforating point of pronator muscle can be used as an important localization marker of posterior interosseous nerve.
【学位授予单位】：南华大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R322
本文编号：2381464
[Abstract]:Objective: to find a new method to prevent nerve injury through anatomical study of posterior interosseous nerve (Posterior interosseous nerve), and to explore a more safe surgical approach to guide clinical forearm operation and further enhance the safety of operation. Materials and methods: 1. 20 adult cadavers were fixed with formalin, 10 cases were left and right, 8 cases were fresh adult upper limbs, 4 cases were left and right. 2. The antiseptic specimens were dissected and exposed to the reflex muscle and the posterior interosseous nerve. The route and position of the nerve were observed and measured: L1 (distance between the nerve emitting point and the radial head), L2 (the distance between the nerve emitting point and the point entering the pronation muscle), L3 (distance between the nerve passing through the pronator muscle and the head of the radius), L4 (the distance between the styloid process of the radius and the capitulum of the radius), L5 (the horizontal distance between the location of the nerve passing through the pronator muscle and the line between the lateral epicondyle of the humerus and the Lister nodule), L6 (horizontal distance from the point of exiting the pronator muscle to the inner margin of the ulna), L7 (the distance between the nerve and the lateral midline of the radial neck and the radial head) and R (the angle between the entry and exit point of the pronator muscle and the radial condyle line). 3. The forearm was placed in the pronation position and was triangulated by the Lister node (E) of the ulna styloid process (D), of the lateral epicondyle of the humerus (E), and then the A point was connected with the midpoint (F) of the DE line. The relationship between muscle branches of posterior interosseous nerve and ADE triangle and AF line was observed. 4. The muscle branches of the forearm of the posterior interosseous nerve were exposed, the muscle branches and their entry points were carefully separated, the movement and distribution of the muscle branches were observed and the distance between the origin and entry points of the muscle branches to the external epicondyle of the humerus and the number of the muscle branches were measured. Results: 1. The main trunk of posterior interosseous nerve was measured in units of: mm (x 卤s, n left = 14n right = 14) L1 left 14.74 卤0.24, right 15.82 卤0.56L 2, left 31.76 卤0.32, right 30.52 卤0.48 L 3, left 65.70 卤0.92, right 63.26 卤0.31; L4 left 230.26 卤0.23, right 232.34 卤0.54L 5 left 6.22 卤0.34, right 6.86 卤0.26L 6 left 25.34 卤0.53, right 24.82 卤0.67L 7 left 42.74 卤0.62, right 43.58 卤0.28. 2. The angle between the line and the radial condyle was 30.0 掳卤0.2 掳left and 32.0 掳卤0.1 掳right (x 卤stin left = 14 n, right side = 14 掳). The distance between the muscular branches of the posterior interosseous nerve and the lateral epicondyle of the humerus and the number of branches in the muscle of the posterior interosseous nerve were 39.44 卤0.1511.78 卤0.321.9 卤0.2; The branch of extensor Carpi longus radialis was 35.52 卤0.16 卤10.94 卤0.36 卤1.8 卤0.1, the branch of extensor Carpi brevis was 45.92 卤0.32 卤0.122.62 卤0.1, the branch of pronator muscle was 61.94 卤0.57 卤0.47 卤0.147.92 卤0.147.92 卤0.14 卤0.3, the branch of extensor Carpi longus radialis was 45.92 卤0.32 卤0.12 卤0.1; The branches of extensor digitorum musculi 69.82 卤0.3693.98 卤0.02fl. 9 卤0.2, extensor carpi ulnaris 76.92 卤0.58l92.94 卤0.372.94 卤0.44,78.82 卤0.482 卤0.125.76 卤0.121.3 卤0.2, branch of abductor pollicis longus 96.74 卤0.18125.92 卤0.365.92 卤0.1. The branches of extensor pollicis brevis were 103.22 卤0.52144.52 卤0.121.51.5 卤0.3, the branches of extensor pollicis longus 102.92 卤0.64130.36 卤0.821.0 卤0.1, the branches of extensor digitorum 130.98 卤0.74148.46 卤0.481 卤0.2, and the branches of elbow muscle 101.38 卤0.5810.18 卤0.781.1 卤0.2. 4. The posterior interosseous nerve trunk was located on the AF line in 22 cases (78.6%), in the radial side of the AF line in 3 cases (10.7%), and in the ulnar side in 3 cases (10.7%). Conclusion: 1. The combination of regional location and linear location is a more accurate method for locating posterior interosseous nerve. 2. The perforating point of pronator muscle can be used as an important localization marker of posterior interosseous nerve.
【学位授予单位】：南华大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R322
【参考文献】
相关期刊论文 前10条
1 李桂成;张安生;熊波;;不同镇痛方式对带蒂皮瓣移植术患者血液流变学的影响[J];湘南学院学报(医学版);2007年01期
2 姜恒,单忠林,单建林,郭光金,张天飞;桡神经深支的体表定位应用解剖学研究[J];第三军医大学学报;2004年10期
3 蒋克平,潘玮;皮瓣移植术后高压氧治疗效果观察[J];华夏医学;2004年06期
4 陈刚;江华;党瑞山;姜会庆;胡心宝;洪志坚;;桡神经前臂伸肌支分布的解剖学研究[J];医学研究生学报;2007年06期
5 姚志喜;;桡神经深支损伤漏诊8例[J];解剖与临床;2006年02期
6 王立峰,岳学军,智红;盐酸罂粟碱在断指再植中的应用体会[J];中国交通医学杂志;2005年02期
7 张东方,亓建华;皮瓣移植失败原因分析[J];临床误诊误治;2000年06期
8 马显杰,夏炜,鲁开化,艾玉峰,郭树忠,韩岩;撕脱皮瓣血运判断及治疗原则[J];中国美容医学;2003年05期
9 刁立君;仇树林;;皮瓣缺血再灌注损伤与细胞凋亡的研究进展[J];中国美容医学;2008年08期
10 于如山,曲方,史雪颖,冯扬;骨间后神经综合征的临床及肌电图研究[J];临床神经电生理学杂志;2001年01期
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