Buradasınız

NERVUS RADIALIS'İN VE MUSKULER DALLARININ İNSAN FETUS KOL VE ÖNKOLLARINDAKİ SEYRİ VE VARYASYONLARI

THE COURSE AND THE VARIATIONS OF RADIAL NERVE AND ITS MUSCULAR BRANCHES IN HUMAN FETUSES’ ARMS AND FOREARMS

Journal Name:

Publication Year:

Keywords (Original Language):

Abstract (2. Language): 
Aim: To determine the course and the variations of radial nerve and its muscular branches in human fetuses. Material and Method: Radial nerve dissections were made on the 200 arms and forearms of 100 fetuses (50 males and 50 females). Length, thickness and distance measurements were taken by the same person using a 0.01 mm sensitive digital compass. Results: In all arms, primarily, the medial branch of muscular branch was separating from radial nerve. This branch was originating from posterior superior part of radial nerve in 153 arms (76.5%) and anterior superior part of radial nerve in 47 arms (23.5%). On forearms it was observed that the first branches of radial nerve reached to the brachioradialis muscle and extensor carpi radialis longus muscle. It was found that the motor branch which innervates extensor carpi radialis brevis muscle exit from deep branch in 48% of the arms, from radial nerve (separating location of the deep and superficial branches) in 42% of the arms, and from superficial branch in 10% of the arms. Also it was observed, in 26% of the cases, that a muscular branch originated from radial nerve and reached to the inferolateral segment of brachial muscle. It was found that there was no relationship between radial nerve and humerus body’s upper (superiorly 0.18) and lover (inferiorly 0.17) parts. Conclusion: The course, muscular branches, innervation patterns and variations of radial nerve should be well known by the specialists especially dealing with the local surgery of this region. In the fetuses, the knowledge of the spiral course of the radial nerve on the posterior face of humerus is crucial to determine the operation approach point, and this area is less safer than adults in the fetuses, according to our results.
Abstract (Original Language): 
Amaç: İnsan fetuslarında, n. radialis'in ve musküler dallarının seyri ve varyasyonlarını tespit etmek. Gereç ve yöntem; Nevrus radialis diseksiyonları 100 fetusun (50 dişi ve 50 erkek) 200 kol ve önkol-unda yapıldı. Uzunluk, kalınlık ve uzaklık ölçümleri 0.01 mm hassas dijital kumpas kullanılarak aynı kişi tarafından alındı. Bulgular: Tüm kollarda n. radialis'ten ilk olarak ramus musculares'in medial dalı ayrılıyordu. Bu dal 153 kolda (%76.5) n. radialis'in arka üst bölümünden, 47 kolda (%23.5) ise n. radialis'in ön üst bölümünden çıkıyordu. Önkollarda n. radialis'ten çıkan ilk dalların m. brachioradi-alis ve m. extensor carpi radialis longus'a gittiği gözlendi. M. extensor carpi radialis brevis'i innerve eden musküler dalın %48 r. profundus'tan, %42 n. radialis'ten (r. superficialis ve r. profundus'un ayrım yeri), %10 r. superficialis'ten çıktığı tespit edildi. Ayrıca, n. radialis'ten m. brachialis'in inferolate-ral segmentine giden musküler bir dal (%26) gözlendi. Fetuslarda n. radialis seyri ve humerus gövde¬si ile ilişkisi incelendiğinde proksimal (üst 0.18'i) ve distal (alt 0.17'si) kısımlarda ilişki tespit edilmedi. Sonuç: Nervus radialis'in seyri, musküler dalları, innervasyon paternleri ve varyasyonlarının bu böl¬genin cerrahisiyle uğraşan uzmanlar tarafından iyi bilinmesi gerekmektedir. Özellikle, bu çalışmada tespit edilen, fetuslarda n. radialis'in humerus arka yüzündeki spiral geçişi için güvenli alanın erişkine göre daha az olduğunun bilinmesi önemlidir.
65-73

REFERENCES

References: 

1. Anna K, Elhan A. Anatomi. Cilt 2. Ankara; Günes kitabevi; 1997. 210-21.
2. Rogers AW. Textbook of Anatomy. Newyork; Churchill Livingstone; 1992. 251.
3. Williams PL, Bannister LH, Berry m. Gray's Anatomy. In: Berry M, Bannister LH, Standring SM. editors. Nervous system. 38th ed. Newyork; Churchill Livinstone; 1995. 1266-74.
4. Mazurek MT, Shin AY. Upper extremitiy peripheral nevre anatomy. Clin Orthop Relat Res. 2001 Feb;(383):7-20.
5. Gerwin M, Hotchkiss RN, Weiland AJ. Alternative operative exposures of the posterior aspect of the humeral diaphysis with reference to the radial nerve. J Bone Joint Surg Am. 1996;78(11):1690-5

6. Mekhail AO, Checroun AJ, Ebraheim NA, Jackson WT, Yeasting RA. Extensile approach to the antero¬lateral surface of the humerus and the radial nevre. J Shoulder Elbow Surg. 1999 Mar-Apr;8(2);112-8.
7. Uhl RL, Larosa JM, Sibeni T, Martino LJ. Posterior approaches to the humerus: when should you worry about the radial nerve? J Orthop Trauma. 1996;10(5):338-40.
8. Low CK, Chew JTH, Mitra AK. A surgical approach to the posterior interosseous branch of the radial nerve through the brachioradialis. A cadaveric study. Singapore Med J. 1994 Aug;35(4):394-6.

9. Polin Ra, Fox WW. Fetal and Neonatal Physiology. In: Hensınger RN. Editor. Standarts and Measurements: Fetus and Neonate. Philadelphia: W. B. Saunders company; 1992: 1688-96.
10. Bell MJ, Beauchamp CG, Kellam JK, McMurtry RY. The results of plating humeral shaft fractures in patients with multiple injuries. J Bone Joint Surg.
1985;67B:293-6.
11. Dabezies EJ, Banta IICJ, Murphy CP, Ambrosia RD. Plate fixation of the humeral shaft for acute frac¬tures, with and without radail nerve injuries. J Orthop Trauma. 1992;6:10-3.
12. Lowe JB, Sen SK; Mackinnon SE. Current approach to radial nerve paralysis. Plast Reconstr
Surg. 2002;110:1099-113.
13. Guse TR, Ostrum RF. The surgical anatomy of the radial nerve around the humerus. Clin Orthop
Relat Res. 1995;320:149-53.
14. Fleming P, Lenehan B, Sankar R, Folan-Curran J, Curtin W. One-third, Two-thirds: Relationship of the radial nerve to the lateral intermuscular sep¬tum in the arm. Clin Anat. 2004;17:26-9.
15. Özer H, Açar i, Cömert A, Tekdemir i, Elhan A, Turanlı S. Course of the innervation supply of medial head of triceps muscle and anconeus mus¬cle at the posterior aspect of humerus. Anatomical study. Arch Orthop Trauma Surg. 2006;126:549-53.
16. Zlotolow DA, Catalano LW, Barron OA; Glickel SZ. Surgical exposures of the humerus. J Am Acad
Orthop Surg. 2006;14:754-65.
17. Gerwin M, Hotchkiss R, Weiland A. Alternative operative exposures of the posterior aspect of the humeral diaphysis. With reference to the radial
nerve. J Bone Joint Surg. 1996;78A:1690-5.
18. Bacakoglu AK, Kiray A, Muratli K, Ekin A, Ergur I. Medial transposition of the radial nerve for antero-lateral plate fixation of the humerus. Cadaveric
study. Anat Sci Int. 2007;82(2):116-20.
19. Seze MP, Rezzouk J, Uzel M, Lavingnolle B, Midy D, Durandeau A. Does the motor branch of the long head of the triceps brachii arise from radial nerve? Surg Radiol Anat. 2004;26:459-61.
20. Lim AYT, Pereira B, Eng B, Eng M, Kumar VP. The long head of the triceps brachii as a free function¬ing muscle transfer. Plast Reconstr Surg.
2001;107:1746-52.
21. Haninec P, Szeder V. Reconstruction of elbow flex¬ion by transposition of pedicled long head of tri¬ceps brachii muscle. Acta Chir Plast. 1999;41:82-6.
22. Mahakkanukrauh P, Vichit S. Dual innervation of the brachialis muscle. Clin Anat. 2002;15:206-9.
23. Abrams RA, Zeits RJ, Lieber RL. Anatomy of radial nerve motor branches in the forearm. J Hand
Surg. 1997:22A;232-7.
24. Spinner RJ, Pichelmann, Birch R. Radial nerve innervation to the inferolateral segment of the brachialis muscle: From the anatomy to clinical
realitiy. Clin Anat. 2003;16:368-9.
25. Branovacki G, Hanson M, Cash R, Gonzalez M. The innervastion pattern of the radial nerve at the elbow and in the forearm. J Hand Surg.
1998;23B(2):167-9.
26. Konjengbam M, Elangbam J. Radial nerve in the radial tunnel: Anatomic sites of entrapment neu¬ropathy. Clin Anat. 2004;17:21-5.
27. Prasartritha T, Liupolvanish P, Rojanakit A. A study of the posterior interosseous nerve and the radial tunel in 30 thai cadavers. J Hand Surg.
1993;18A:107-12.
28. Cricenti SV, De angelis MS, Didio LJA, Ebraheim NA, Rupp RE, Didio AS. Innervation of the exten¬sor carpi radialis brevis and supinator muscles: Levels of origin and penetration of these muscular branches from the posterior interosseous nerve. J
Shoulder Elbow Surg. 1994;3:390-4.
29. Kirici Y, Irmak MK. Investigation of two posible compression sites of the deep branch of the radi¬al nerve and nerve supply of the extensor carpi radialis brevis muscle. Neurol Med Chir.
2004;44:14-9.
30. Riffaud L, Morandi X, Godey B, Brassier G, Guegan Y, Darnault P, Scarabin JM. Anatomic bases for the compression and neurolysis of the deep branch of the radial nerve in the radial tun¬nel. Surg Radiol Anat. 1999;21:229-33.
31. Elgafy H, Ebraheim NA, Yeasting RA. The anatomy of the posterior interosseous nerve as agraft. J
Hand Surg. 2000;25A:930-5.
32. Ay S, Apaydın N, Acar H, Akıncı M, Pişkin A, Tekdemir I, Elhan A. Anatomic pattern of the ter¬minal branches of posterior interosseous nerve.
Clin Anat. 2005;18:290-5.

Thank you for copying data from http://www.arastirmax.com