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 等 |
| 标识字符 | |
| 拉丁文 | nervus ulnaris |
| 《神经解剖学术语》 [在维基数据上编辑] | |
在人体解剖学中，尺神经行走于尺骨旁的一根神经，肘关节的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
[编辑]手臂
[编辑]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
[编辑]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（尺侧腕屈肌和趾深屈肌的内侧半）[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]
手
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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]
- Superficial branch of ulnar nerve - supplies the palmaris brevis and gives digital branches to the medial one and a half fingers.[5]
- Deep branch of ulnar nerve - It accompanies the deep branch of the ulnar artery. It passes backwards between the abductor digiti minimi, flexor digiti minimi, and opponens digiti minimi, supplying all the three muscles, and lying on the hook of hamate bone. It then turns laterally, supplying the 3rd and 4th lumbricals and all the palmar interossei muscles and dorsal interossei of the hand. It terminates by supplying the adductor pollicis.[5]
- Articular branches to the wrist.[5]
功能
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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
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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
[编辑]尺神经及其分支支配前臂和手部的以下肌肉：
- 当尺神经经过鹰嘴和肱骨内上髁之间时，发出一条通向肘关节的关节支。
- 在前臂，尺神经的肌支通过：
- 在手部，尺神经深支通过：[3]
- 小鱼际肌群
- The third and fourth lumbrical muscles
- Dorsal interossei
- Palmar interossei
- Adductor Pollicis
- Flexor pollicis brevis (deep head)
- In the hand, via the superficial branch of ulnar nerve:
临床意义
[编辑]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
[编辑]- 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
[编辑]- 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。
- 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
[编辑]-
示脊神经臂丛 -
上臂中部横截面 -
前臂中部横截面 -
桡骨和尺骨远端横截面 -
手腕、手指横截面 -
尺动脉和桡动脉 -
右臂丛神经（锁骨下部分）位于腋窝；下面和前面观 -
右上肢正面观，示骨骼、动脉和神经的表面投影 -
右上肢后面观，示骨骼、神经的体表投影 -
尺神经 -
尺神经标记于图中 -
尺神经 -
尺神经 -
尺神经 -
臂丛深层解剖前外侧观
另见
[编辑]本条目使用了部分解剖术语。
参考文献
[编辑]- ^ 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）.
- ^ Why Does Hitting Your Funny Bone Hurt So Much?. www.houstonmethodist.org. [2024-04-02] （英语）.
- ^ 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）
- ^ 4.0 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）
- ^ 5.00 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.
- ^ 6.0 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.
- ^ 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）.
- ^ 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）
- ^ 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）
- ^ 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）
外部链接
[编辑]
- Cubital Tunnel Support Forums 互联网档案馆的存档，存档日期2022-10-04.
- Anatomy figure: 05:03-15 at Human Anatomy Online, SUNY Downstate Medical Center - "The major subdivisions and terminal nerves of the brachial plexus."
- Anatomy figure: 07:04-04 at Human Anatomy Online, SUNY Downstate Medical Center - "Anterior view of the nerves, vessels, and superficial tendons that cross the left wrist."
- Anatomy figure: 08:03-07 at Human Anatomy Online, SUNY Downstate Medical Center - "Transverse section through the carpal tunnel and distal row of the carpal bones."
- 杜克大学医学中心整形外科计划中的Ulnar nerve
- 堪萨斯大学医学中心的手部人体工学
- 图谱：hand_plexus at the University of Michigan Health System - "Axilla, dissection, anterior view"
- Overview at neuro.wustl.edu
- Shoulder Ulnar Nerve Entrapment
- 互联网档案馆的存档，存档日期2006-09-06.