The Anatomic Study Of The Spontaneous Disruption Of The Deep Branch Of Radial Nerve

[Objective]To study the anatomic factors in the spontaneous disruption ofthe deep branch of radial nerve, and provide the theoreticalindications for clinical diagnosis, treatment and selecting theapproach of operation.[Methods]16 adult fresh and freezing cadaver upper extremity specimenswere included in this study, in which 12 specimens from male and 4from female, and right and left sides occupy even half. Therespecimens were injected by red latex before dissection.The upper extremity specimens were dissected under 5-timesoperating lope: following the course of radial nerve in the upperextremity, exposing the radial nerve from the lateral intermuscularseptum to the supinator muscle by opening the myotube of humerus,exposing the deep and superficial branch of the radial nerve throughthe spatium intermusculare of brachioradialis and brachialis,chipping the nerve and its comites with micro-operating instruments.The observation was focused on the morphologicalcharacteristics of the radial nerve and it's branches, the variationsand the features of muscular branches from the radial nerve. Thedistances of deep branch of radial nerve from its origin to theinsertion point to arched of supinator (arche frohse) were measured.observe The relationship of the deep branch of radial nerve with theextensor carpi radialis brevis (ECRB) and arche frohse was observedand the circum-tissue around the deep branch of radial nerve whenthe forearm pronating and supinating or the elbow flexing andextending was also recorded.The relation between the radial nerve and the adjoiningrecurrent branch of arteria and venae radialis was recorded, thecalibers of the blood vessels were measured. The condition ofwhether or not existing the the radial nerve compression by vasslesand the number of oppressed points were also observed, the distancebetween oppressed points to the arche frohse, the number ofmuscular branches from the recurrent radial artery was recorded andwhether or not existing the anomalous bundles in the course of thenerve was also observed.[Results](1) The morphological features of the radial nerve---thephenomenon of "turnover": in 18.88 % (3sides/16sides) exsiting thephenomenon of the "turnover". The radial nerve began to turnoverfrom lateral to medial before the radial nerve divided into superficialbranch and deep branch, the point was about 70.74mm from archefrohse, and finished at about 40.32mm proximal to the edge of thearche frohse, the angle of turnover is 180°, the length of turnoverwas about 30.28mm. The result of turnover was the exchangedposition of the superficial branch and deep branch of the radial nerve,the superficial branch turned across from the superficies to themedial.(2) The recurrent branches of arteria and venae radialis are themain comites of the deep branch of radial nerve. The branches werenumurous in number, 7~9 rami had the highest occurrence rate isabout 68.75% (11sides/16sides). The nutritional vessels to the nervehad about 3~6 rami. The relationship between the recurrent branch ofarteria radialis and the deep banch of radial nerve had 3 types:Type I: (43.75%): the blood vessels clamped on the deep branchof radial nerve at 1.80~1.95cm proximal to the edge of arcade offrohse;Type II (31.50%): the blood vessles give 4~9 branches to strideover the nerve like sector at the circumscription about 1.35-5.80cmthat proximal to the deep branch course under arcade of frohse. Theresults elementary coincide with our results come from the clinicalstatistic that the site where easy to spontaneous breakage;typeIII(18.75%): recurrent branch of arteria radialis give a main branch,vessel diameter is about 2.0mm,below the deep and superficial branchof the nerve, arch the deep branch of thenerve, the distance from archpoint to the arcade of frohse is about 1.50~2.80cm.(3) Abnormal fiber bundles: we observed an abnormal fibercrossed the deep branch of radial nerve in 37.5% specimens (6sides),the site of which was about 3.10±1.05cm proximal to edge of thearcade of frohse. Its was from the vascular adventitia of the recurrentbranch of arteria and venae to ECRB, the width of which was about0.6cm~1.8cm. it crossed and oppressed over the deep branch ofradial nerve.(4) The tendon structure of ECRB and arcade of frohse. In56.25% specimens, the muscle origin of the ECRB was tendonoustissue completely;in 75% specimens, the arcade of frohse wastendonous, the former covered partly or wholly over the latter, therewere 3 relationships we can find between the origin of the ECRB andthe arcade of frohse: (1) in 56.25% (9sides), the tendonous structure ofECRB completely covered the arcade of frohse, they became duplexstructures, Overshoot the arcade of frohse about 7.5±1.6mm;(2) in31.25% (5 sides), the arc-shaped tendonous structure of the ECRBpartly covered the arcade of frohse;(3) in 12.5% (2sides), the twoparts were wholly overlapped.[Conclusions]16 fresh-adult cadaver upper extremities were dissected under5-times operation lopes, we found that the spontaneous disruption ofthe deep branch of radial nerve had some morphological andanatomical basis:(1) The phenomenon of "turnover "from lateral to medial thattake place in the radial nerve and its branch of deep and superficial isthe basis of morphological and latent etiological factors in thespontaneous disruption of the deep branch of radial nerve(2) The relationship between the recurrent branch of arteriaradialis and the deep banch of radial nerve had 3 types: type I: theblood vessels clamped on the deep branch of radial nerve;type II:theblood vessles stride over the nerve like sector. they are the anatomicalfoundation that we can't neglect and we infer that: the nerve usuallypresent multi-section pathological changes like allanto,we consider itis maybe relate to the nerve's segmental blood supply.(3) Abnormal fiber bundles oppressed the nerve or directsevered the nerve seriously was a significant anatomical foundationand etiological factor in the spontaneous disruption of the deepbranch of radial nerve(4) there were 3 relationships we can find between the origin ofthe tendon structure of the ECRB and the arcade of frohse: the type Iand type II oppressed the nerve at different plane. Intermittentmotivate oppressed and long mechanical oppressed was anotherimportant anatomical factor.(5) Treatment: we think that the best treatment is operation andthe reserved treatment is inefficient.