| Objective:To provide morphological basis for the clinical application of the dorsal interosseous nerve by anatomising the dorsal interosseous nerve and its muscular branches and measuring revelant data and observing its anatomical characteristics.Methods:The dorsal interosseous nerve and its muscular branches were exposed by dissecting thirty adult embalmed cadaver arms.The following measurements were performed at the pronation position of the forearm with a vernier caliper(accurate to 0.01mm):distances from the origin point of the trunk to muscle entry point of each muscular branch,diameters of each muscular branch at the origin point of the trunk,distances from the origin point of each muscular branch to the latera humeral epicondyle(LHE),distances from the origin point of each muscular branch to the Lister’s tubercle of the radius(LTR),distances from the origin point of each muscular branch to the styloid process of ulna(SPU),horizontal distances from the terminal branch to the Lister’s tubercle in Lister’s tubercle plane,diameters of terminal branch in Lister’s tubercle plane,diameters of terminal branch in the proximal 10 mm to Lister’s tubercle plane,distances between the entry point of deep branch of radial nerve from the supinator tunnel and the LHE,distances between the exit point of deep branch of radial nerve from the supinator tunnel and the LHE,lengthes of deep branch of radial nerve in the supinator tunnel,included angles between line XY(line of the entry point and the exit point of deep branch of radial nerve from the supinator tunnel)and line AC(line of LHE and SPU).Respectively to LHE LTR SPT three points as the center of a circle,the distance from the origin point of each muscular branch to three points as the radius,draw three circles,the three circles’ intersection area as a symbol of body surface location.The following measurements were performed separately at the extreme pronation position and the extreme supination position of the forearm:vertical distances between the exit point of deep branch of radial nerve from the supinator tunnel and radialis border of radius,vertical distances between the exit point of deep branch of radial nerve from the supinator tunnel and ulnar border of ulna,distance difference values at different rotation position of the forearm.And then all the data were analyzed statistically.Results:1.The distances from the origin point of the trunk to muscle entry point of each muscular branch were short and less than(12.85±1.79)mm.The diameters of each muscular branch at the origin point of the trunk were small and less than(1.38±0.46)mm.2.The average distances from the origin point of each muscular branch to LHE LTR SPT three points were:extensor digitorum branch(78.80±13.84)mm,(176.46±11.86)mm,(169.17±11.62)mm;extensor digiti minimi branch(79.48±6.69)mm,(167.98±5.19)mm,(161.89±4.16)mm;extensor carpi ulnaris branch(83.03±7.55)mm,(165.43±5.20)mm,(158.45±6.74)mm;abductor pollicis longus branch(102.67±10.33)mm,(152.70±9.80)mm,(144.21±10.71)mm;extensor pollicis brevis branch(102.67±10.33)mm,(152.70±9.80)mm,(144.21±10.71)mm;extensor pollicis longus branch(109.49±13.61)mm,(139.39±15.66)mm,(130.02±18.29)mm;extensor indicis branch(155.16±28.25)mm,(90.44±30.79)mm,(85.20±29.00)mm.There were two results after the intersection of three circles:a point or an aera.3.The average horizontal distances from the terminal branch to the Lister’s tubercle in Lister’s tubercle plane were(8.66±2.22)mm.The average diameters of terminal branch in Lister’s tubercle plane were(1.78±0.66)mm.The average diameters of terminal branch in the proximal 10 mm to Lister’s tubercle plane were(0.90±0.45)mm.4.The average distances between the entry point of deep branch of radial nerve from the supinator tunnel and the LHE were(41.53±8.26)mm.The average distances between the exit point of deep branch of radial nerve from the supinator tunnel and the LHE were(75.71±12.20)mm.The average lengthes of deep branch of radial nerve in the supinator tunnel were(39.98±8.62)mm.The average included angles between line XY(line of the entry point and the exit point of deep branch of radial nerve from the supinator tunnel)and line AC(line of LHE and SPU)were(17.1±7.4)°.Line XY is located on the radial side of line AC.5.The average vertical distances between the exit point of deep branch of radial nerve from the supinator tunnel and radialis border of radius at the extreme pronation position and the extreme supination position of the forearm were(9.51±2.72)mm and(14.72±2.37)mm,and the average distance difference values were(5.10±1.64)mm.The average vertical distances between the exit point of deep branch of radial nerve from the supinator tunnel and ulnar border of ulna were(33.73±3.47)mm and(23.41±2.97)mm,and the average distance difference values were(10.32±2.30)mm.Conclusion:1.The diameter of each muscular branch of DIN was small,and the distance from the origin point of the trunk to muscle entry point of each muscular branch was short.It showed that the ability of muscular branch tolerance was poor,and it is the main cause of iatrogenic injury.2.Through the “three circle intersection localization method”,we can perform accurate localization of each muscular branch at the origin point of the trunk at body surface relatively.We also can determine the risk areas of muscular branches and guide localization and diagnosis of the dorsal interosseous nerve injury.It provided anatomical basis for avoiding the danger zone of the dorsal forearm when performing an operation on the dorsal forearm.3.The anatomical characteristics of the terminal branch were closely related to the pain of dorsal wrist.4.The anatomical characteristics of the deep branch of radial nerve in the supinator tunnel provided anatomical basis for the surgical treatment of the supinator syndrome.5.The dorsal interosseous nerve was translocated when the forearm was kept in the extreme pronation position and the extreme supination position.The translacation phenomenon provided a guide for surgical approach to the proximal end of the radius. |
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