用户:Heihaheihaha/尺神经

尺神经(Ulnar nerve
点击放大图片-尺神经见于左下角
左上肢的神经(尺神经见于前臂,图中左侧)
基本信息
来源C8, T1 (内侧束的分支)
支配尺侧腕屈肌
指深屈肌尺侧半
小鱼际肌
第三和第四蚓状肌
[[[小指短屈肌(手)|小指屈肌]]
]骨间背侧肌
骨间掌侧肌
拇内收肌
标识字符
拉丁文nervus ulnaris
神经解剖学术语英语Anatomical terms of neuroanatomy

在人体解剖学中,尺神经行走于尺骨旁的一根神经,肘关节尺侧副韧带与尺神经有关。该神经是人体最大的不受骨和肌肉保护的神经,其损伤较为常见。[1]该神经直接连接到小拇指无名指的尺侧半(与小拇指相邻的半侧),支配这些神经的掌侧、指尖的前部和后部,可能远至甲床。

在弯曲手臂的情况下撞击肱骨内侧髁可能刺激该神经并引起类似电击的短暂疼痛。[2]

走行

手臂

尺神经起自脊神经C8-T1的神经根(有时也包含来自外侧索的C7的纤维)。[3][4]然后成为臂丛的内侧束的一部分,沿着肱动脉内侧下降至肱二头肌肌腱附着点(肱骨内侧边中间5厘米处)。之后,它穿过内侧肌间隔膜进入臂后区内侧,伴尺神经旁血管在肱骨的后内侧走行,由尺神经沟经过内上髁穿过桡侧腕屈肌起点至前臂内侧份,可用手触及。[5]

前臂

The ulnar nerve is not a content of the cubital fossa. It enters the anterior (flexor) compartment of the forearm between the two heads of flexor carpi ulnaris,[4] and lies along the lateral border of the flexor carpi ulnaris.[4] The ulnar nerve runs between the flexor digitorum superficialis (laterally) and flexor digitorum profundus medially. Near the wrist, it courses superficial to the flexor retinaculum of hand, but covered by volar carpal ligament to enter the hand.[5]

In the forearm it gives off the following branches:[6]:700

  • 肌支——供应一块半肌肉(尺侧腕屈肌趾深屈肌的内侧半)[5]
  • 掌支——起自前臂中部并供应小鱼际隆起处的皮肤[5]
  • 背支——起自距腕关节上方7.5厘米处,向后绕行,供应尺侧一个半手指的近端皮肤及手指间相邻区域的皮肤。[4][5]
  • 关节支——至肘关节。[5]

 
尺神经在手部的分支

Ulnar nerve enters the palm of the hand via the Guyon's canal, superficial to the flexor retinaculum and lateral to the pisiform bone.[5]

在前臂,尺神经发出以下分支:[6]

功能

尺神经也被称为“音乐家的神经”,因为它控制着手指的精细运动。[5]

感觉

 
右上肢的皮肤神经支配。浅蓝色的区域受尺神经支配

尺神经还为第五指和第四指的内侧半部分及相应的手掌部分提供感觉神经支配:

  • 掌支——为前部皮肤和指甲提供皮肤神经支配。
  • 背侧皮支——为手背内侧和内侧1.5个手指的背侧提供皮神经支配。

运动

尺神经及其分支支配前臂和手部的以下肌肉:

临床意义

尺神经可能在从臂丛的近端起点到手部的远端分支之间的任何位置受到损伤。它是肘部周围最常受损的神经。[7][8] 尺神经通常因局部创伤或物理压迫(“神经受压”)而受损。尺神经在不同水平的损伤会导致特定的运动和感觉功能缺失。

在肘部

  • Common mechanisms of injury: Cubital tunnel syndrome, fracture of the medial epicondyle of the humerus (causing direct ulnar nerve injury), fracture of the lateral epicondyle of the humerus (causing cubitus valgus with tardy ulnar nerve palsy), Driver's Elbow[9]
  • 运动功能损伤
    • Weakness in flexion of the hand at the wrist, loss of flexion of ulnar half of digits, or the 4th and 5th digits, loss of ability to cross the digits of the hand. (Note: Motor deficit is absent or very minor in cubital tunnel syndrome as the ulnar nerve is compressed in the cubital tunnel, rather than transected.)
    • Presence of a claw hand deformity when the hand is at rest, due to hyperextension of the 4th and 5th digits at the metacarpophalangeal joints, and flexion at the interphalangeal joints.
    • Weakness of adduction of the thumb, which may be assessed by the presence of Froment's sign.
  • Sensory deficit: Loss of sensation or paresthesiae in ulnar half of the palm and dorsum of hand, and the medial 1½ digits on both palmar and dorsal aspects of the hand

在腕部

  • 常见机制:穿透性伤口、Guyon管囊肿(及其他病变)[10]
  • 运动功能损伤
    • 尺侧半部分手指(第4和第5指)屈曲能力丧失,手指交叉功能丧失。
    • 在手处于静止状态时,由于第4和第5指的掌指关节过伸和指间关节屈曲,会出现爪形手畸形。
    • 与手臂上部(如肘部)的病变相比,因为屈指肌的尺侧部分不会受到影响,尺神经在腕部的损伤更容易导致爪形手英语claw hand畸形。这会将第4和第5指的远端指间关节拉到更加弯曲的位置,从而产生更加变形的 “爪子”。这就是所谓的“尺神经爪形悖论英语Ulnar claw#ulnar paradox”。
    • 拇指内收无力,可以通过检测是否存在Froment征来评估。
  • 感觉功能缺失:手掌尺侧半部分以及掌面内侧1½个手指的感觉丧失或感觉异常,背侧无影响。手背未受影响是因为尺神经的后皮支在前臂较高处分支,并未到达手腕。

在严重情况下,可能需要通过手术重新定位或“释放”神经,以防止进一步损伤。

其它图像

另见

本条目使用了部分解剖术语英语anatomical terminology

参考文献

  1. ^ N, Catena; Mg, Calevo; D, Fracassetti; D, Moharamzadeh; C, Origo; M, De Pellegrin. Risk of Ulnar Nerve Injury During Cross-Pinning in Supine and Prone Position for Supracondylar Humeral Fractures in Children: A Recent Literature Review. European Journal of Orthopaedic Surgery & Traumatology: Orthopedie Traumatologie. 2019, 29 (6): 1169–1175 [2020-05-22]. PMID 31037406. S2CID 139108013. doi:10.1007/s00590-019-02444-0 (英语). 
  2. ^ Why Does Hitting Your Funny Bone Hurt So Much?. www.houstonmethodist.org. [2024-04-02] (英语). 
  3. ^ 3.0 3.1 3.2 3.3 Bonfiglioli, Roberta; Mattioli, Stefano; Violante, Francesco S., Lotti, Marcello; Bleecker, Margit L. , 编, Chapter 22 - Occupational mononeuropathies in industry, Handbook of Clinical Neurology, Occupational Neurology (Elsevier), 2015-01-01, 131: 411–426 [2020-10-25], ISBN 9780444626271, PMID 26563800, doi:10.1016/b978-0-444-62627-1.00021-4 (英语) 
  4. ^ 4.0 4.1 4.2 4.3 Rea, Paul, Rea, Paul , 编, Chapter 3 - Neck, Essential Clinically Applied Anatomy of the Peripheral Nervous System in the Head and Neck (Academic Press), 2016-01-01: 131–183 [2020-10-25], ISBN 978-0-12-803633-4, doi:10.1016/b978-0-12-803633-4.00003-x (英语) 
  5. ^ 5.00 5.01 5.02 5.03 5.04 5.05 5.06 5.07 5.08 5.09 5.10 Krishna, Garg. 8 - Arm. BD Chaurasia's Human Anatomy (Regional and Applied Dissection and Clinical) Volume 1 - Upper limb and thorax Fifth. India: CBS Publishers and Distributors Pvt Ltd. 2010: 91,110,111. ISBN 978-81-239-1863-1. 
  6. ^ 6.0 6.1 Ellis, Harold; Susan Standring; Gray, Henry David. Gray's anatomy: the anatomical basis of clinical practice. St. Louis, Mo: Elsevier Churchill Livingstone. 2005: 726. ISBN 0-443-07168-3. 
  7. ^ Selby, Ronald; Safran, Marc; O'brien, Stephen. Practical Orthopaedic Sports Medicine & Arthroscopy, 1st edition: Elbow Injuries. msdlatinamerica.com. Lippincott Williams & Wilkins. 2007 [2014-09-30]. (原始内容存档于2014-10-06). 
  8. ^ Minieka, Michael; Nishida, Takashi, Benzon, Honorio T.; Raja, Srinivasa N.; Molloy, Robert E.; Liu, Spencer S. , 编, Chapter 54 - Entrapment Neuropathies, Essentials of Pain Medicine and Regional Anesthesia (Second Edition) (Philadelphia: Churchill Livingstone), 2005-01-01: 426–432 [2020-10-25], ISBN 978-0-443-06651-1, doi:10.1016/b978-0-443-06651-1.50058-7 (英语) 
  9. ^ Waldman, Steven D., Waldman, Steven D. , 编, Chapter 44 - Driver's Elbow, Atlas of Uncommon Pain Syndromes (Third Edition) (Philadelphia: W.B. Saunders), 2014-01-01: 126–129 [2020-10-25], ISBN 978-1-4557-0999-1, doi:10.1016/b978-1-4557-0999-1.00044-7 (英语) 
  10. ^ Fuller, Geraint; Manford, Mark, Fuller, Geraint; Manford, Mark , 编, Common peripheral nerve lesions, Neurology (Third Edition) (Churchill Livingstone), 2010-01-01: 106–107 [2020-10-25], ISBN 978-0-7020-3224-0, S2CID 88836902, doi:10.1016/b978-0-7020-3224-0.00054-9 (英语) 

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