腋窝入路桡神经肱三头肌支转位移植修复腋神经的应用解剖

背景：上臂后上切口入路肱三头肌肌支转位移植修复腋神经牵拉三角肌时易损伤腋神经后支及锁骨上臂丛,探查和联合其他神经转位时需变更体位。 目的：分析腋窝入路桡神经肱三头肌支转位移植修复腋神经的可行性。 方法：取常规甲醛固定成人上肢标本10具20侧,于标本平卧,上肢外展外旋位,腋窝入路,对腋窝处神经血管进行显微解剖。测量腋神经起始处至分支处距离及其分支起始处的横径,肱三头肌各肌支起始处横径,各肌支由入肌点向近端进行无损伤分离长度。 结果与结论：腋神经肩胛下肌下缘分成前后两支,前支横径平均为2.5(1.6~3.4) mm。桡神经肱三头肌长头支,起点处横径为2.2(1.4-2.8) mm。桡神经与腋神经距离平均为18.2(10.2~30.0) mm。腋神经前支与桡神经肱三头肌支横径相似,距离短。表明腋窝入路可暴露和辨别腋神经前后分支,桡神经肱三头肌支在背阔肌腱表面水平靠近腋神经,可选择任一肌支转位移植修复腋神经。      

肱三头肌外侧头神经肌支和血供的应用解剖

目的 :为肱三头肌外侧头的神经肌支移位和游离肌皮瓣移植提供解剖学基础。方法 :在 3 0侧成人上肢标本上对肱三头肌外侧头的神经肌支和血管进行详细解剖观测。结果 :外侧头肌支数 2～ 4支 ,一般为 3支。入肌部位位于大圆肌腱下缘 ( 5 .3 1± 2 .0 1)、( 6.0 6± 1.2 1)、( 5 .96± 1.0 )cm ,横径分别为( 1.4± 0 .5 )、( 1.2± 0 .2 )、( 1.9± 0 .9)mm。肌皮神经肱二头肌平均 2个肌支 ,入肌部位分别在大圆肌下缘以下 ( 4 .2 1± 1.66)和 ( 4 .5 8± 1.3 2 )cm ,横径为 ( 1.4± 0 .6)和 ( 1.2± 0 .8)mm。腋神经入肌部位在大圆肌下缘以上发出。肱三头肌外侧头血供来源于肱深、旋肱后及部分近侧肌支 ,且均与肱深血管有关。结论 :肱三头肌外侧头肌支有足够长度和横径 ,在肌门处可无张力移位至肌皮神经肱二头肌支及部分腋神经肌支。以肱深血管为蒂的肱三头肌外侧头游离肌皮瓣是修复前臂肌肉皮肤缺损的良好供体     

桡神经肱三头肌支移位修复肌皮神经损伤的解剖学研究

<正>肌皮神经损伤后,引起屈肘功能丧失.我们研究以桡神经肱三头肌支与肌皮神经支吻接,以恢复之.材料和方法为刀镊解剖,规尺测量,观测了30例成人上肢标本,记录了桡神经肱三头肌支的支数、发出部位、入肌部位、可自然分离长度及横径.观测结果为桡神经肱三头肌支各分支数为8～10支,大多分支入肌部位在大圆肌下缘以下33.3±17.1mm～110.3±26.3mm之间,可分离长度为48.2～121.1mm.横径为0.5～0.9mm肌     

桡侧腕短伸肌神经血管肌蒂移位修复前臂屈肌瘫的应用解剖

在３５侧成人上肢标本上，解剖观测了桡侧腕短伸肌神经及其伴行血管的关系，该肌神经来自桡神经的深支或浅支，可分离长度平无１２．３ｃｍ以上，横径１．１ｍｍ，伴行动脉外径１．３ｍｍ，设计以神经肌支和伴行血管为蒂的桡侧腕短伸肌神经血管肌蒂，可转位修复正中神经损伤所致的前臂屈肌群的瘫痪。     

肱三头肌的解剖特点及其在臂后中部桡神经显露中的意义

目的观察肱三头肌与桡神经的位置关系,改进臂中后部桡神经的显露方法。方法尸体标本31具(62侧),在臂中部将肱三头肌外侧头自臂外侧肌间隔上钝性剥离达肱骨,继续向内侧钝性分离肱三头肌外侧头,显露桡神经,观察肱三头肌外侧头和内侧头融合的位置、融合前二者分界是否清晰,观察肱三头肌内侧头起点和外侧头起点与桡神经的位置关系。结果肱三头肌内、外侧头融合近端与桡神经穿过臂外侧肌间隔处距离(6.7±2.6)cm,约在鹰嘴窝上缘水平,融合前肱三头肌内、外侧头分界清晰。肱三头肌外侧头全部起自桡神经沟近端肱骨骨面的为79%(49侧),部分起自桡神经沟以远肱骨骨面的为21%(13侧),其中腱性的9例,肌性的4例。结论利用臂中部肱三头肌内、外侧头的解剖特点,可使臂后中部桡神经的显露更安全、合理。     

上肢神经肌支的显微解剖及其在痉挛性瘫痪治疗中的意义

目的：为寻求解除上肢痉挛性瘫痪的新途径提供理论依据。方法：在手术显微镜下,对43例成人上肢标本解剖观测,了解痉挛性脑瘫所致上肢痉挛性屈肘,旋前和屈腕畸形的主动肌神经肌支的来源,直径,可分离长度及发出部位。结果：肱二头肌肌支平均2．72支,来源于肌皮神经（97．5％）和正中神经（2．5％）,肱肌肌支平均2．74支,来源肌皮神经（80．5％）,其余分别来源于桡神经（15．3％）,正中神经（4．2％）,肱桡肌肌支平均1．77支,来源于桡神经,旋前圆肌肌支平均2．33支,来源于正中神经;尺侧腕屈肌肌支平均1．72支,来源于尺神经,它们的可分离长度分别为：肱二头肌肌支23．94mm,肱肌肌支21．63mm,肱桡肌肌支21．38mm,旋前圆肌肌支27．27mm,尺侧腕屈肌肌支21．70mm,神经肌支的横径分别为：0．99,1．00,0．86,0．84,0．83mm,在起始与进入肌门处的横径比较（t)检验无显著性差异（P＞0．05）。结论：神经肌支的横径考虑与神经所含数量有关,术中可在志始处选择性切断,切除的长度以术后不再出现神经再连续为度。     

桡神经、肌皮神经分布变异2例

根据张克劬 2 16例观察桡神经浅支缺如 ,其支配范围由前臂外侧皮神经代偿的占 2 .8± 1.1% ( 6侧 ) ;前臂外侧皮神经与桡神经浅支在桡骨茎突上方 1.0～ 7.8cm间有交通支的占 5 .1± 1.5 % ( 11侧 )。作者在解剖两例成年男性新鲜上肢标本过程中 ,发现其桡神经及肌皮神经走行变异 ,现报道如下 :例 1,左上肢桡神经浅支缺如 ,其支配区域由前臂外侧皮神经所代替。桡神经出肱肌和肱桡肌间隙后 ,在肘窝仅发出一细小分支到肱桡肌后即穿旋后肌到前臂背侧 ;而前臂外侧皮神经出肱二头肌和肱肌之间后下行于肱桡肌深面 ,在前臂中部从肱桡肌深面浅出、居皮…     

带蒂肱桡肌转位重建屈肘功能的应用解剖

在３４侧成人上肢标本上，解剖观测了肱桡肌的形态、血供及其神经，肱桡肌为长扁梭形肌，肌长３２ｃｍ，肌的血供主要来源于桡侧副动脉和桡侧返动脉，其中桡侧返血管蒂可游度的长度３．９ｃｍ，肌的神经来自桡神经，神经蒂可游离长度达６ｃｍ以上，本文对肱桡肌转位术的设计、应用要点和术式的优缺点进行了讨论。     

正中神经与肌皮神经2支交通支1例

笔者在解剖 1具老年男性尸体时发现其右侧正中神经和肌皮神经之间有 2个交通支相连 ,现报道如下 :组成右侧臂丛的 5个神经根先形成上、中、下干 ,每干都分前、后股 ,其上、中干的后股在腋动脉的后方合并下行 2 .7ｃｍ后再与下干后股合并形成后束 ,其合并处横径 2 .1ｍｍ ,后束下行 1.8ｃｍ分出桡神经和腋神经。上、中干的前股合成外侧束 ,外侧束在胸小肌上缘后方胸肩峰动脉起始处的外侧发出正中神经外侧根 (横径0 .8ｍｍ)和肌皮神经 (横径 2 .3ｍｍ)。肌皮神经在腋动脉的外侧向外下行至 2 .5ｃｍ处胸小肌下缘后方发出 :①喙肱肌支 ,支配喙肱…     

胸背神经移位与肱二头肌肌支吻接重建屈肘功能的应用解剖

目的 :为胸背神经移位与肱二头肌肌支吻接重建屈肘功能提供应用解剖学基础。方法 :取 15具 ( 3 0侧 )成人尸体 ,对肌皮神经肱二头肌肌支和胸背神经及其伴行动脉进行解剖 ,观测其走行、可应用长度、横径及分支情况 ,并取神经标本经石蜡切片、HE染色 ,对有髓神经纤维进行计数。在 2具 ( 4侧 )新鲜尸体上模拟设计手术入路。结果 :( 1)定上肢外展 60°时胸锁关节与喙突间连线中外 1/3交界处锁骨下缘为测量点。肌皮神经肱二头肌肌支发出点距测量点距离平均为 13 .1cm ,强行分离长度平均为 5 .0cm。胸背神经 1～ 3肌支距测量点平均距离分别为 :9.2、11.1、12 .3cm。 ( 2 )肱二头肌肌支发出点与胸背神经各肌支发出点的横径、束数和有髓纤维数等数值相仿。 ( 3 )在新鲜尸体上设计上肢外展 60°锁骨中点下缘至上臂上段内侧正中切口与背阔肌前缘斜行切口 ,操作简易 ,创伤较小。结论 :应用带血供的胸背神经移位与肱二头肌肌支吻接重建屈肘功能具有可行性     

骨间前神经转位重建鱼际肌功能

前臂或腕部正中神经断裂,直接吻合后鱼际肌功能的恢复常常令人失望,为了解决这一难题,本文在120侧成人上肢解剖学研究的基础上,采用骨间前神经转位术修复鱼际肌支9侧,获得成功.     

bFGF对同种异体神经移植后周围神经再生的影响

目的 :探讨bFGF对同种异体神经移植后周围神经再生的影响。方法 :将反复冻融的大鼠神经移植于另一大鼠的坐骨神经 ,实验组注射bFGF 1 0 0u/d共 1 0d ,对照组注射生理盐水 1 0d。术后大鼠存活 1 2周 ,光镜下用体视学方法测试再生神经纤维的面数密度 (NA)、面积密度 (AA)、横切面面积 (AE)、脊髓前角运动细胞和脊神经节细胞的体密度 (VV)、数密度 (NV)。结果 :两组均可见再生神经纤维长入异体移植神经并向远段延伸。实验组再生神经纤维的NA、AA、脊髓前角运动细胞和脊神经节细胞的VV、NV 与对照组的比较 ,有显著性差异。结论 :bFGF能促进周围神经再生 ,对脊髓前角运动细胞和脊神经节细胞的存活有保护作用。     

The normal and variant clinical anatomy of the sensory supply of the orbit

Orbital and retro‐orbital pain are relatively common clinical conditions that are associated with such disorders as trigeminal, lacrimal, and ciliary neuralgia, cluster headaches, paroxysmal hemicrania, inflammatory orbital pseudotumor, trochleitis, and herpetic neuralgia ophthalmicus, thus making the nerves supplying the orbit of great clinical importance. Surprisingly, how pain from this region reaches conscious levels is enigmatic. Classically, it has been assumed that pain reaches the ophthalmic division of the trigeminal nerve (V₁) and travels to the descending spinal trigeminal nucleus. However, exactly where the receptors for orbital pain are located and how impulses reach V₁ is speculative. In this project, we reviewed all of the reported connections between the orbital nerves and V₁ in order to understand how pain from this region is transmitted to the brain. We found reported neural connections to exist between cranial nerve (CN) V₁ and CNs III, IV, and VI within the orbit, as well as direct neural branches to extra‐ocular muscles from the nasociliary, frontal, and supraorbital nerves. We also found reported neural connections to exist between the presumed carotid plexus and CN VI and CN V₁, CN VI and CN V₁ and V₂, and between CN V₁ and CN III, all within the cavernous sinus. Whether or not these connections are sympathetic or sensory or some combination of both connections remains unclear. An understanding of the variability and frequency of these neural connections could lead to safer surgical procedures of the orbit and effective treatments for patients with orbital pain. Clin. Anat. 27:169–175, 2014. © 2014 Wiley Periodicals, Inc.     

红白肌纤维为肌桥缝接狗神经缺损的实验形态学研究

目的 :试图从作肌桥的肌肉条件 (红、白肌、长、短肌纤维和肌纤维排列等 )方面 ,能探讨出最适宜神经再生长条件的肌肉 ,作为临床应用的肌桥。方法 :根据文献肌纤维分型记载和本实验用SDH染色 ,确定的的红白肌纤维肌桥 ,再分别给狗股神经和正中神经缺损 3cm外缝接上 ,待术后 3 0 0d ,切取桥接神经部位 ,并将它分成神经近段、肌桥段、神经远段和远、近端缝合段五个部分。常规制成光电镜标本最后镜下观察和Luzex -F图像分析仪测定。结果 :红肌纤维为主的肌桥明显较白肌纤维为肌桥的再生效果好 (P <0 .0 5 )特别是缝匠肌尾侧部 (红肌纤维为主 )为肌桥更明显较其颅侧部 (白肌纤维为主 )的神经纤维再生数量多 (P <0 .0 5 )。结论 :并非机体肌肉为肌桥都有同样神经再生效果 ,缝匠肌尾侧部可能是一个适宜神经再生条件的肌肉。     

臂丛神经损伤患者膈神经移植肌皮神经的电生理观察

目的：评估膈神经功能测定在臂丛神经损伤神经移植前的应用价值,术后电生理观察神经移植恢复状况。方法：对50例臂丛神经损伤患者术前进行了膈神经功能测定,对其中10例膈神经功能正常者,行同侧膈神经移植肌皮神经手术,术后神经电生理随访观察肱二头肌肌电图及肌皮神经运动传导功能状况。结果：臂丛神经损伤患者约28％伴膈神经损伤,损伤的膈神经不能选择为移植动力神经。隔神经移植肌皮神经后,最早3个月出现再生电位,6个月后出现运动单位电位,12个月后运动单位电位明显增多。术后肱二头肌肌力18个月后恢复优良占80％。7例术后12个月肌皮神经引出运动神经传导电位。结论：膈神经功能测定在臂丛神经损伤患者术前可评估选择移植神经,术后电生理可随访观察神经功能恢复状况,对臂丛神经损伤患者的手术治疗有一定指导作用。     

Influence of a fabella in the gastrocnemius muscle on the common fibular nerve in Japanese subjects

The fabella is a sesamoid bone located in the proximal tendon of the gastrocnemius muscle. In rare cases, its presence may lead to a variety of clinical problems, including fabella syndrome and common fibular (CF) nerve palsy. The purpose of this study was to analyze the morphology of the fabella and CF nerve and discuss the influence of any existing fabellae on the size of the CF nerve. The morphology of the fabella and CF nerve in the popliteal region of the lateral head of the gastrocnemius muscle was investigated in 102 knees of 51 Japanese cadavers. The maximum circumference of the thigh, knee, and calf and the frequency, position, and size of the fabella were measured. In addition, the CF nerve width and thickness were measured proximal to the fabellar region and again as the CF nerve passed posterior, lateral, or medial to the region. A fabella was observed in 70 knees (68.6%). The CF nerve adjacent to the fabella was significantly wider and thinner than in the region proximal to the fabella (P < 0.001). In cases in which a bony fabella was present, there was a significant relationship between the thickness of the CF nerve and the circumference of the thigh and knee. The following factors were observed to contribute to the presence of a fabella causing alterations in the size of the CF nerve: a bony fabella, a CF nerve path posterior or lateral to the fabella, and subjects with a thin physique and bony fabella. Clin. Anat. 26:893–902, 2013. © 2012 Wiley Periodicals, Inc.     

Role of input from saphenous afferents in altered spinal processing of noxious signal that follows sciatic nerve constriction in rats

An investigation was made into a possible contribution of saphenous nerve to altered central processing of noxious information following sciatic nerve chronic constriction (CCI) in rats. Spinal sciatic neuron spontaneous and noxious evoked activities were recorded in CCI rats, CCI rats with saphenous nerve sectioned just before the sciatic nerve constriction and sham operated rats. The results show (1) high values of spontaneous and noxious evoked activities with prolonged afterdischarges in CCI rats with intact saphenous, (2) comparable high values of spontaneous activity, but significantly reduced noxious evoked activity and afterdischarges in CCI rats with sectioned saphenous, (3) values in the normal range in the sham rats. Potential mechanisms underlying these results are discussed.     

Destination of the C4 component of the prefixed brachial plexus

This study was carried out to elucidate the destination of the C4 ventral ramus that forms the prefixed brachial plexus. A total of 43 sides of Korean adults (male, 22; female, 18; unknown: 3 and right, 23; left, 20) were investigated. The various C4 destinations and their frequencies were as follows: suprascapular nerve, 97.7% (42/43); musculocutaneous nerve, 79.1% (34/43); the axillary nerve, 48.8% (21/43); and the nerve to subclavius, 16.2% (7/43). The mean quantity of nerve fibers destined to the suprascapular, musculocutaneous, and axillary nerves and the nerve to subclavius was 441.8 ± 316.5 (Mean ± S.D.), 298.2 ± 209.8, 245.8 ± 239.0, and 66.4 ± 17.2, respectively. The mean nerve fibers number of C4 contributing to the brachial plexus was 983.6 ± 618.0 (range: 100-1729). The main component that contributes to the terminal nerves (suprascapular, musculocutaneous, axillary nerves, and nerve to subclavius) is C5. These results may be useful to surgeons and clinicians dealing with terminal nerves of the brachial plexus, especially the suprascapular, musculocutaneous, and axillary nerves.     

大鼠异体神经移植后再生神经生物力学性质研究

用Ｗｉｓｔａｒ鼠作为实验模型,切下１ｃｍ坐骨神经,再用同系Ｗｉｓｔａｒ鼠坐骨神经异体桥接,修复坐骨神经的缺损,术后２４周对Ｗｉｓｔａｒ鼠的手术侧与正常侧用指标抗张强度与弹性模量（ε＝１０％）进行测试,辅以电镜,光镜观察。     

脱细胞同种异体神经移植物的制备及成分分析

目的　探讨脱细胞同种异体神经移植的制备方法及其含有的成分。方法　采用组织工程化低渗脱细胞方法制备神经异体移植物 ,光电镜观察其结构特征 ;用免疫组织化学法和聚丙烯酰胺凝胶电泳法分析神经异体移植物的成分。结果　正常的 (天然的 )周围神经经脱细胞处理后 ,清除了雪旺细胞、神经外膜和束膜的细胞 ,以及神经纤维的髓鞘和轴突 ,保存了由雪旺细胞基底膜管以及神经外膜和束膜的细胞外基质构成的三维支架结构。成分分析结果显示 ,含有LN、FN以及生长相关蛋白GAP 4 3和 6 5kDa蛋白等促进和诱导受体损伤神经再生的重要成分。结论　脱细胞异体神经移植物含有诱导和促进神经再生的相关蛋白 ,有利于受损神经的再生。