交感干臂丛间灰、白交通支的解剖学特点及其临床意义

目的:探讨交感干臂丛间交通支的分布特点及其临床意义.方法:选用33具成年防腐尸体,解剖并观测交感干与臂从交通支的走行分布特点.结果:1.颈中神经节或节间支与臂丛交通支多对称分布,至第5、6颈神经的42条交通支在第5、6颈椎横突水平内行自头长肌、颈长肌间沟后行入神经.2.星状神经节(或颈下神经节及胸l神经节)发出向内上方加入第7、8颈神经的交通支除1例外均对称分布.至C8神经的交通支与C8神经结合前51侧发出分支与C7,神经相交通,其中45侧穿过第7颈椎横突孔.至C7神经的交通支与C7神经结合前41侧发出分支与C6神经相交通,分支伴椎动脉经第6颈椎横突孔上行,29侧分支沿途发出许多细小纤维支至椎动脉及周围椎间、横突间关节.结论:1、交感干与臂丛间的交通支具有典型的分布特点,可为研究交感神经对臂从神经功能支配及颈椎前路扩大减压术时减少损伤提供解剖学资料.2、至C7神经的交通支分布特点可为临床上通过椎神经阻滞治疗顽固性颈痛提供解剖学依据.     

寰枢关节错位与胸锁乳突肌和斜方肌疼痛的解剖关系的初步研究

目的　观察寰枢椎与副神经及第2颈神经的解剖关系,以及观察胸锁乳突肌和斜方肌的神经支配特点,为寰枢关节错位致胸锁乳突肌和斜方肌疼痛提供解剖学依据。 方法　对3具共6侧成年人颈部尸体标本进行解剖,观察寰椎横突与副神经、寰枢外侧关节与第2颈神经前支、寰枢椎椎间孔外韧带的解剖结构,以及观察胸锁乳突肌和斜方肌的神经支配特点,测量副神经与寰椎横突尖的最短距离。 结果 (1)胸锁乳突肌和斜方肌均受副神经和颈丛（第2~4）神经支配,并且副神经与颈丛神经存在交通支联系。(2)副神经走行在寰椎横突前方,二者关系密切,副神经与寰椎横突尖的距离为4.84~7.60 mm(左侧)和3.22~6.80 mm（右侧）。(3)寰枢椎存在椎间孔外韧带,该韧带与第2神经相连,并附着在寰椎横突。(4)第2颈神经前支贴着寰枢外侧小关节向前走行。 结论 寰枢关节错位可能会刺激副神经及第2颈神经或其前支,从而引起胸锁乳突和斜方肌紧张、疼痛。     

人与狗迷走/交感干的比较解剖及其喉上神经外支纤维成分

目的　对人与狗的颈段迷走/交感干进行比较解剖,并鉴定狗的喉上神经外支的纤维成分。方法 随机解剖经福尔马林固定的成年人尸体颈部（n=50）及狗的颈部（n=10）,暴露其颈交感干与喉上神经及其外支间的交通;并取狗的喉上神经外支,甲醛固定,明胶包埋,恒冷切片后用Karnovsky AchE组化方法染色并观察。 结果 狗的迷走神经结状神经节与颈上神经节完全或部分融合,迷走神经干与交感神经干完全或部分融合为迷走-交感干;而人的结状神经节与颈上神经节互相分离;颈上神经节与喉上神经及其分支之间存在交通,其中颈上神经节与喉上神经外支相交通者占86%。AchE染色显示：狗的喉上神经外支含AchE阳性有髓神经纤维、AchE阴性有髓神经纤维和AchE阳性无髓神经纤维。 结论 喉上神经外支呈袢状,而非干式,含躯体运动、交感神经节后及躯体感觉纤维,因此喉上神经外支为一混合神经。     

神经肽Y在兔颈部交感神经节与脊神经节间通路应用研究

目的　通过电刺激兔颈脊神经节,检测颈交感神经节内的神经肽Y （neuropeptide Y,NPY）含量,研究颈交感神经节与颈脊神经节间的通路联系,探讨颈性眩晕发病机制中的神经解剖学基础。 方法　96只新西兰兔随机分为C2、C3、C4、C5、C6、C7组及相应对照组（每组8只）,麻醉后显露相应的脊神经节,给予波宽0.5 ms、频率30 Hz、5 V电刺激,5秒/次,每1 min重复1次,共5次,30 min后,灌注固定,切取双侧颈上、下交感神经节,切片,免疫反应,染色,观察。 结果　电刺激C2、C3脊神经节后,同侧颈上交感神经节内NPY含量升高（P<0.05）;电刺激C4、C5脊神经节后,同侧颈上交感神经节和颈下交感神经节内NPY含量均有明显变化（P<0.05）;电刺激C6、C7脊神经节后,同侧颈下交感神经节内NPY含量升高（P<0.05）。 结论　颈脊神经节和颈交感神经节间存在神经电生理上的通路联系,且具有节段性、同侧性特点,为颈性眩晕的发病机制及临床分型提供了实验依据和理论基础。     

颈神经后支的解剖及其临床意义

目的为临床诊治椎孔外颈神经后支卡压提供解剖学基础。方法对20具(40侧)成人尸体的颈神经后支起源、走行、分支、分布及其与颈椎周围组织的解剖关系进行观测。结果C     

枕颈区后路柔性动态固定的生物力学研究

目的 探讨柔性和动态固定方式对枕颈区稳定性的影响。 方法 采用6具新鲜成人枕颈区Oc~C4节段进行测试,模拟以下状态：（1）完整状态;（2）损伤状态：齿状突II型骨折加寰枕关节囊损伤;（3）坚强固定：C1、C2用普通椎弓根螺钉固定,C3侧块螺钉,直径3.5 mm钛棒连接;(4)柔性固定：直径2.0 mm钛棒连接;(5)C1用2枚转动钉固定;(6)C1、C2用4枚转动钉固定;（7）C1、C2、C3用6枚转动钉固定。通过脊柱试验机对标本施加1.5 Nm的纯力偶矩,三维运动测量系统分析枕颈区Oc~C3角度运动范围和中性区。 结果 直径2.0 mm的棒固定后的运动范围,在各个方向上均大于坚强固定,有显著性差异（P<0.05）。与坚强固定比较,在 C1、C2采用2~4枚转动钉固定,在各方向上运动范围相当（P>0.05）。 C1、C2、C3使用6枚转动钉固定仅在旋转方向上明显增加了Oc~C3运动范围,差别有统计学意义（P=0.031）。不同固定方式在屈伸、侧弯和旋转方向上均显著减小了固定节段的中性区（P<0.05）。 结论 枕颈区Oc~C3节段,采用直径2.0 mm的细棒固定,各方向的稳定性均弱于坚强固定。在C1、C2采用2~4枚转动钉固定,与坚强固定的稳定性相当。在C1、C2、C3采用6枚转动钉固定,仅在旋转方向上弱于坚强固定。     

颈部脊柱部分结构的神经分布

对10具完整成人男尸颈部椎间盘、前纵韧带及椎前筋膜的神经支配进行了观察,颈部脊柱及其周围组织的神经支配丰富。由颈交感干和节直接发支到椎前筋膜,并由此分布至颈部软组织;至椎间盘的神经来自颈交感干及节、脊神经腹侧支和椎动脉神经丛;达前纵韧带的神经单独发自交感干和交通支。为了证实是神经组织,对3例2～5岁新鲜童尸作了组织学检查。     

大鼠脑底动脉环含NPY、VIP、SP、CGRP神经的来源

本文应用免疫组织化学结合颈上神经节切除术探讨了支配大鼠脑底动脉的含ＮＰＹ、ＶＩＰ、ＳＰ、ＣＧＲＰ神经的来源，并用交点计数法进行定量分析。结果表明去左侧颈上节后，含ＮＰＹ神经Ⅲ类纤维（环行纤维）在同侧筛内动脉，大脑前动脉的中段、尾侧段，颈内动脉，大脑后动脉吻侧段，后交通支上的密度降低约５０％；Ⅰ类纤维（纵行纤维）仅在同侧后交通支上的密度有降低，而Ⅱ类纤维（斜行纤维）在各段血管上的密度基本上不变，提示脑底动脉环仅部分血管上的含ＮＰＹ神经部分来自同侧颈上节。去一侧颈上节后，脑底动脉上含ＶＩＰ、ＳＰ、ＣＧＲＰ神经元无明显改变，说明支配大鼠脑底动脉的含ＶＩＰ、ＳＰ、ＣＧＲＰ神经既不在颈上节起源，它们的纤维也不经过此神经节。     

喉上神经襻的新亚型及其临床应用

目的:研究喉上神经襻的分型,为预防颈部手术中喉上神经外支的损伤提供解剖学基础.方法:随机集用成年尸体50具(计100侧),解剖出喉上神经及其分支喉外支和喉内支,显露迷走神经干和颈交感神经链,观察喉上神经襻的组合形式.结果:除2侧外,98侧颈交感神经链与喉上神经及其分支相吻合,形成襻.根据襻的不同形态,将其分为en、tn、in、tnen、inen 5种类型,其出现率分别为82％、9％、3％、2％和2％.本实验显示了18种喉上神经襻的新亚型.结论:颈交感神经链与喉上神经及其分支之间普遍存在交通,86％颈交感神经链与喉上神经外支之间存在交通者;喉上神经外支呈襻状,而非干式;甲状腺手术尽可能接近甲状腺囊单根结扎甲状腺血管,以避免喉上神经襻和/或外支的损伤.     

喉返神经及其分支的变异与临床意义

目的：为甲状腺手术中对喉返神经的定位和保护提供解剖学基础.方法：解剖50具（100侧）人颈部尸体标本.在甲状腺手术区对喉返神经及其分支进行定位观测.结果：（1）86.0%的喉返神经分支呈树枝状,称树枝型（多支型）;14.0%喉返神经分支与分支或分支与交感神经链、喉上神经间吻合成袢状,称喉返神经袢.（2）根据不同的交通形式,可分为3型：A型,喉返神经分支与分支相交通者3侧（3%）;B型,其分支与交感链之间相交通者2侧（2%）;C型,分支与喉上神经交通者2侧（2%）;D型,分支与分支、分支与交感链、喉上神经之间相交通者7%（7侧）.结论：在甲状腺及颈部手术中,应仔细分离、注意喉返神经的各种变异,以免损伤喉返神经和（或）其分支.     

Topographical anatomy on the communicating branch between the spinal accessory nerve and the anterior root of the first cervical nerve

The aim of this study was to clarify the morphological characteristics of the communicating branch between the spinal accessory nerve and the anterior root of the first cervical nerve (McKenzie branch), a structure severed during intradural selective rhizotomy for treatment of spasmodic torticollis. The right and left sides of 50 upper cervical segments of spinal cords were dissected and examined under a surgical microscope. Seven of the total 100 samples were found to have the McKenzie branch. Two types of McKenzie branch, which run close to the vertebral artery, were also identified, which might be helpful for improving the surgical results of intradural selective rhizotomy.     

The terminal insertional segments and communications of the vertebral nerve in the human cervical region

Twenty-four cadavers (48 sides) were used to clarify the terminal insertional segment and communications of the vertebral nerve in the cervical region under a surgical microscope. After displacing the prevertebral muscles (longus colli and longus capitis) laterally, the ventral parts of the transverse foramen of vertebrae (from C2 to C6) were removed, and the insertional segment and communicates of the vertebral nerve surrounding the vertebral artery were observed. The results showed: (1) the vertebral nerve ascended along the ventral or mediodorsal vertebral artery and terminated mainly at C3 (22/36 sides) but not terminated at C4 or C5 only; (2) the superficial communicates from the cervical sympathetic trunk ran in a proximal and distal direction when the fibers entered the anterior branches of the cervical nerves. The fibers running to the proximal direction communicated with the vertebral nerve in the part of transverse foramen; (3) motor and/or sensory rami supplying the prevertebral muscles, corpus vertebrae and intervertebral discs could pass through an "arched-shaped" fiber bundle on the ventral surface of the vertebral artery. In conclusion, the vertebral nerve and the fibers surrounding the vertebral artery could be considered as a stable deep pathway of cervical sympathetic nerves. The deep pathway (vertebral nerve and its branches) with the superficial pathways (cervical sympathetic trunk and its branches) formed a sympathetic nervous "plexus" in the cervical region. This sympathetic nervous "plexus" may be involved in the effects of cervical ganglionic blockade.     

Anatomical study of the communicating branches of cords of the brachial plexus and their clinical implications

The aim of this study was to investigate the occurrence and patterns of the communicating branches of cords of the brachial plexus (BPs). This study was performed with 50 fixed adult cadavers (all 100 sides). The BPs were exposed, the presence of the communicating branches of BPs were determined, measured, and photographed. The communicating branches were identified in 27 sides of the BPs. According to enthesis, the communicating branches between the medial and lateral cords (25 sides) were divided into five types. The most common branches connected the lateral cord with the medial root of the median nerve (16 sides). All the communicating branches between the lateral and medial cords obliquely crossed anterior to the axillary artery and passed below the thoracoacromial artery trunk. The distance of the communicating branch with the origin of thoracoacromial artery trunk was 1.60 ± 0.64 cm. The length, transverse diameter, and anteroposterior diameter of communicating branch were 1.67 ± 0.62 cm, 1.77 ± 0.63 mm, and 1.91 ± 0.34 mm, respectively. These anatomical data about the communicating branches will be helpful for surgeons who perform surgical procedures in the cervical and axillary regions. Clin. Anat. 27:631–636, 2014. © 2013 Wiley Periodicals, Inc.     

The communicating branch of the 4th cervical nerve to the brachial plexus: the double constitution, anterior and posterior, of its fibers

Twenty-four adult cadavers (48 sides) were used to investigate the incidence of a branch arising from the ventral ramus of the fourth cervical nerve (C4) with the phrenic nerve and subsequently joining the brachial plexus. Six brachial plexuses with spinal cords and phrenic nerves were dissected under a surgical microscope to investigate localization of fibers contained in the C4 branch to the brachial plexus. The incidence of the C4 branch was 23% (11/48 sides). Branches from C4 to the brachial plexus divided into anterior and posterior divisions on four sides (4/6 sides). On two sides, the branch did not divide but consisted entirely of an anterior division (2/6 sides). In the brachial plexus, anterior division fibers of the C4 branch were intertwined with fibers from the anterior divisions of the ventral rami of the fifth and sixth cervical nerves. They then passed to the suprascapular nerve and the anterior division of the superior trunk (6/6 sides). On the other hand, posterior division fibers of the C4 branch were intertwined with fibers from the posterior divisions of the ventral rami of the fifth and sixth cervical nerves. They then passed to the suprascapular nerve (2/6 sides) and the posterior division of the superior trunk (4/6 sides). The anterior division of the C4 branch received fibers from the ventral rootlets of the entire fourth cervical segment, whereas the posterior division received fibers from the ventral rootlets of the caudal half of the fourth cervical segment only. The fact that the suprascapular nerve received fibers from both the anterior and posterior divisions of the C4 branch was considered to support our claim that the human suprascapular nerve belongs to both the anterior and posterior divisions of the brachial plexus.     

Nerve communication between the glossopharyngeal nerve,external carotid plexus and the superficial cervical ansa: human autopsy case

The authors encountered a very rare human autopsy case in which the supernumerary branch of the glossopharyngeal nerve and a nerve branch arising from the external carotid plexus communicated with the superficial cervical ansa. This anomaly was observed on the left side of a 71-year-old male cadaver during the gross anatomical seminar at Niigata University in 2004. The nerve fascicle and fiber analyses indicated that the supernumerary branch of the glossopharyngeal nerve separated cranial to the branches to the pharyngeal constrictor muscles, carotid sinus and stylopharyngeal muscle and sent the nerve fibers to the muscular branches to the platysma and the cutaneous branches to the cervical region. Additionally, it was shown that the branch arising from the external carotid plexus sent the nerve fibers to the cutaneous branch to the cervical region. Although the external carotid plexus is primarily postganglionic sympathetic fibers originating from the superior cervical ganglion, the vagus and glossopharyngeal nerves gave off branches connecting to the plexus, and therefore it was not possible to determine the origins of this branch of the external carotid plexus. The present nerve fascicle analysis demonstrates that the supernumerary branch of the glossopharyngeal nerve, which innervated the platysma, did not share any nerve components with the branches to the pharyngeal constrictor muscles, carotid sinus and stylopharyngeal muscle, suggesting that this supernumerary branch may be categorized into the different group from these well-known branches.     

A variation of the brachial plexus characterized by the absence of the musculocutaneous nerve a case report

A variation of the brachial plexus characterized by the absence of the musculocutaneous nerve on both sides was observed during the dissection of a 72 year-old female cadaver. The long thoracic nerve included only the fibers from C5 and C6 on the left side. The musculocutaneous nerve was absent and two branches from the lateral cord innervated the coracobrachialis muscle. The median nerve innervated the biceps brachii and brachialis muscles in the arm and also gave off the lateral antebrachial cutaneous nerve. Additionally, a communicating branch was found from the median nerve to the ulnar nerve in the forearm. The knowledge of the anatomical variations of the peripheral nerve system can help give explanation when encountering an incomprehensible clinical sign.     

Patterns of reinnervation of denervated cerebral arteries by sympathetic nerve fibers after unilateral ganglionectomy in rats

Summary In order to clarify the manner in which previously denervated cerebral arteries become reinnervated after unilateral excision of the superior cervical ganglion (SCG), we observed directly the reinnervating sympathetic nerve fibers originating in the contralateral SCG by using anterograde labeling with wheat germ aggulutinin-horseradish peroxidase in rats. The nerve fibers sprouted from the nerve fibers in the contralateral anterior cerebral artery and reinnervated the arterial wall of the anterior cerebral artery of the denervated side as early as one week after ganglionectomy. In addition to this sprouting route, three other reinnervating nerve fiber routes were observed in the circle of Willis of the denervated side two weeks after ganglionectomy: the proximal portion of the internal carotid artery, the route passing between bilateral ethmodial arteries, and the posterior communicating artery. Eight weeks after ganglionectomy, these reinnervating nerve fibers formed a fairly dense plexus in a circular pattern in the circle of Willis. However, the reinnervation could not be observed in the arterial branches derived from the circle of Willis (middle cerebral artery and posterior cerebral artery) even 16 weeks after ganglionectomy. The present results clearly demonstrated the time course, distribution pattern and limitation of the reinnervation from the contralateral SCG following unilateral ganglionectomy. The fact that reinnervation could be observed only in the main cerebral arteries of the circle of Willis, in which the nerve plexus appeared to have a circular pattern, suggests a difference between the qualities of sympathetic innervation controlling the cerebral circulation in these arteries and the other arterial branches related to these differences in reinnervation capacity.     

面神经下颌缘支的应用解剖

目的了解面神经下颌缘支的正常层次解剖位置,为涉及面侧区和颌下区的美容外科手术提供临床应用解剖学资料。方法解剖33具（共66例）成人尸体标本的头颈部标本,观察了面神经下颌缘支的分支类型、走行、与面动脉的位置关系以及穿出腮腺处和与面动脉的交叉处的体表位置。结果面神经下颌缘支为1-2支,以单干型居多,约占58%,大多行于下颌骨下缘上方约占44%,行于骨下缘下方者占5%。未发现面神经下颌缘支不与面动脉交叉,位置在均下颌角下缘上、下方约0.5-1 cm范围内。面神经下颌缘支经过面动脉的浅面和深面者分别占89%和6%;面神经下颌缘支穿出腮腺处的体表位置分别在下颌角上方和下颌支后缘前方1 cm交点附近,面神经下颌缘支与面动脉交处距下颌支后缘约4 cm,距下颌骨下缘约1 cm。结论面神经下颌缘支的毗邻和行程关系较为复杂,了解其与周围结构的重要位置关系,可以减少美容外科手术因神经损伤造成下唇及口角功能障碍的发生。     

An anatomical study of the recurrent laryngeal nerve: its branching patterns and relationship to the inferior thyroid artery

Abstract: The aim of this study was to provide information about the morphology and topography of the recurrent laryngeal nerve (RLN), its external features and branches, as well as its relationship to the inferior thyroid artery, the inferior horn of the thyroid cartilage and the thyroid gland. The RLNs in 50 adult cadavers (100 sides) were dissected and analyzed. A communicating loop connecting one branch of the RLN to another or a twig originating from the cervical sympathetic trunk was present in 13 of 100 sides. A double left RLN appeared in 2 sides; a right non-recurrent inferior laryngeal nerve appeared in one side. All of the RLNs, including looped ones, bifurcated into laryngeal branches and extralaryngeal branches, with most of the former further dividing into the anterior and posterior branches entering the larynx. The relations of the RLN to the inferior thyroid artery, the inferior horn of the thyroid cartilage and the thyroid gland were inconstant. The information gained from this study will be of value in thyroid surgery.     

An anatomical study of the recurrent laryngeal nerve: its branching patterns and relationship to the inferior thyroid artery

The aim of this study was to provide information about the morphology and topography of the recurrent laryngeal nerve (RLN), its external features and branches, as well as its relationship to the inferior thyroid artery, the inferior horn of the thyroid cartilage and the thyroid gland. The RLNs in 50 adult cadavers (100 sides) were dissected and analyzed. A communicating loop connecting one branch of the RLN to another or a twig originating from the cervical sympathetic trunk was present in 13 of 100 sides. A double left RLN appeared in 2 sides; a right non-recurrent inferior laryngeal nerve appeared in one side. All of the RLNs, including looped ones, bifurcated into laryngeal branches and extralaryngeal branches, with most of the former further dividing into the anterior and posterior branches entering the larynx. The relations of the RLN to the inferior thyroid artery, the inferior horn of the thyroid cartilage and the thyroid gland were inconstant. The information gained from this study will be of value in thyroid surgery.