尺神经手背支尺侧支皮神经的体表投影及临床应用  

Surface projection and clinical application of cutaneous nerve of ulnar collateral branch of dorsal branch of ulnar nerve

作　　者：吴迪[1] 利春叶[1] 陈金仁[1] 贾赛雄[1] 龙海泉[1] 颜卓杰 Wu Di;Li Chunye;Chen Jinren;Jia Saixiong;Long Haiquan;Yan Zhuojie(Department of Hand Surgery,Shenzhen Bao′an District People′s Hospital,Shenzhen No.8 People′s Hospital,Guangdong 518101,China)

机构地区：[1]深圳市宝安区人民医院(深圳市第八人民医院)手外科,广东518101

出　　处：《中华手外科杂志》2020年第3期206-209,共4页Chinese Journal of Hand Surgery

摘　　要：目的通过对尺神经手背支尺侧支皮神经体表投影的解剖研究来指导临床应用。方法自2017年4月至2019年9月,我院通过标本解剖及术中观察,研究发现尺神经手背支尺侧支自尺骨茎突背侧走行至第五掌指关节尺背侧,其走行的体表投影为手掌背部尺背侧掌-背侧皮纹交界处,利用此特点指导5例尺神经手背支尺侧支营养血管皮瓣的精准设计与切取,同时在19例微创第五掌骨颈骨折闭合复位单根克氏针内固定中,有效地避免该神经的损伤。结果皮瓣全部存活,色泽质地良好,外形满意;第五掌骨颈骨折闭合复位单根克氏针内固定患者均随访1.5~3.0个月,骨折均获解剖复位,达到骨性愈合,无一例伴有尺神经手背支损伤所致的麻木及浅感觉消失的症状;第五掌骨颈骨折术后按照按中华医学会手外科学会上肢功能评定试用标准评定:优18例,良1例。结论通过手掌尺背侧的掌-背侧皮纹交界处定位,发现恒定走行的尺神经手背支尺侧支体表投影,从而在微创第五掌骨颈骨折闭合复位单根克氏针内固定中有效避免神经的损伤;指导尺神经手背支尺侧支营养血管皮瓣达到术前精准设计、术中精细切取,是一种简单实用、值得推广的方法。Objective To research the anatomy of the surface projection of cutaneous nerve of ulnar collateral branch of dorsal branch of ulnar nerve so as to guide clinical application.Methods From April 2017 to September 2019, through specimen anatomy and intraoperative observation, it was found that the ulnar collateral branch of dorsal branch of ulnar nerve went from the dorsal styloid process of ulna to the dorsal ulnar side of the fifth metacarpophalangeal joint. The surface projection was the junction of palms and dorsalis on the back of the palm. Utilizing this feature, the accurate design and resection of 5 cases of nutrient vessel flap with the ulnar collateral branch of dorsal branch of ulnar nerve were guided. Meanwhile, in 19 cases of the fifth metacarpal neck fracture, treated by minimally invasive closed reduction and single Kirschner wire internal fixation, the injury of the nerve was effectively avoided.Results All the flaps survived with good color and texture and satisfactory appearance. The patients with the fifth metacarpal neck fracture with closed reduction and single Kirschner wire internal fixation were follow-up for 1.5 to 3.0 months. All the fractures were anatomically reduced to achieve bony healing. None of them had numbness and superficial sensation disappearance caused by the injury of the dorsal branch of the ulnar nerve. After the fifth metacarpal neck fractures were treated, according to the evaluation criteria of upper limb function of Hand Surgery Society of Chinese Medical Association, 18 cases were excellent and 1 case was good.Conclusion Through the location of the junction of palms and dorsalis on the back of the palm, it was found that the surface projection of the ulnar collateral branch of dorsal branch of ulnar nerve was constant, which effectively avoided the nerve injury in the minimally invasive closed reduction and a single Kirschner wire internal fixation of the fifth metacarpal neck fracture. It was a simple and practical method to guide the accurate design of nutrient vessel

关 键 词：尺神经 解剖学 体表投影 临床应用 

分 类 号：R658.2[医药卫生—外科学]