正中神经掌皮支的局部解剖与临床意义  

Regional anatomy of median nerve palmar cutaneous branch and its clinical significance

作　　者：丁洁[1] 粱炳生[1] 贾英伟[1] 达志峰[1] 朱志祥[1] 

机构地区：[1]山西医科大学附属第二医院骨科,太原030001

出　　处：《中华手外科杂志》2013年第4期205-207,共3页Chinese Journal of Hand Surgery

摘　　要：目的为避免腕、掌部手术切口损伤正中神经掌皮支提供解剖学资料。方法对52例成人上肢标本正中神经掌皮支的来源、走行、分支、分布、血管显微解剖等进行解剖测量。结果52例标本均有掌皮支，50例自正中神经桡侧发出，2例自尺侧发出，走行在掌长肌腱和桡侧腕屈肌腱之间的深层。发出点距离0点（远侧腕横纹中点）为（45．2±21．2）mm，穿出前臂深筋膜处距离0点（19．8±12．3）mm，穿出掌腱膜处距离0点（8．2±4．3）mm，掌皮支主干长（49．2±24．2）mm，起点处宽（1．2．4±0．7）mm，掌皮支与舟骨结节中点的垂直距离为（8．3±2．8）mm。掌皮支分3支者31例（占59．6％），分2支者15例（占28．9％），1支者6例（占11．5％）。掌皮支主要分布于鱼际区和掌中区，以直入式、伴人式和肌支式进入神经。结论掌皮支的来源、行程均较恒定。为避免伤及正中神经掌皮支及其营养血管，在腕部手术切口应选在尺侧半（环指纵轴的尺侧），在掌部应靠近第四掌骨作纵切口。Objective To provide anatomic data for avoiding injury of the palmar cutaneous branch （PCB） of the median nerve during operation around the wrist and palm. Methods The origin, course, branching, distribution and blood supply of the PCB of the median nerve were observed and measured in dissections of 52 adult cadaver upper extremity specimens. Results PCB existed in all 52 specimens originating from the radial side of the median nerve in 50 and from the ulnar side in 2. PCB ran in the deep side between the palmaris longus and flexor carpi radialis tendon. The distance from PCB origin to the zero point （the midpoint of the distal wrist crease） was （45.2 ± 21.2） nun. The point where PCB piercing the forearm deep fascia was （19.8 ±12.3） mm from the zero point, while the point where PCB piercing the palm aponeumsis was （8.2 ± 4.3） mm from the zero point. The length of PCB before branching was （49.2 ± 24.2） mm, while the width at its beginning was （1.2± 0.7） mm. The vertical distance of PCB to the scaphoid tubercle midpoint was （8.3 ± 2.8） mm. 3 branches of PCB were found in 31 specimens （59.6%）, 2 branches in 15 specimens （28.9%） and 1 branch in 6 specimens （11.5%）. Distribution of the PCB was mainly in the thenar and mid- palm area. Palmar cutaneous branch nutritional artery either entered the PCB directly, accompanying it or by way of muscular branch. Conclusion The origin and course of PCB is relatively constant. Surgical incisions at the wrist or palm should be ulnar to the longitudinal axis of the ring finger and close to the fourth metacarpal, to avoid inadvertent injury of the median nerve PCB and its nutrient vessels.

关 键 词：正中神经 掌皮支 应用解剖 血管 

分 类 号：R322.8[医药卫生—人体解剖和组织胚胎学]