大鼠副神经及其分支与膈神经主干毗邻关系的显微解剖学研究

目的:了解大鼠副神经及其分支与膈神经主干相邻关系,为副神经移位膈神经重建高位颈髓损伤大鼠呼吸功能提供显微解剖学依据.方法:在16倍手术显微镜下解剖40只健康雄性SD大鼠双侧副神经及其分支.用精确度为0.001 mm游标卡尺测量副神经各段的直径、长度以及与膈神经主干起始端的距离.结果:副神经出颈静脉孔后(4.191±0.135)mm即分出胸锁乳突肌支,该支长(5.657±0.283)mm,直径(0.221±0.039)mm,与膈神经主干起始端的距离为(10.041±3.181)mm;副神经锁骨上段两斜方肌支之间主干直径为(0.274±0.032)mm,与膈神经主干起始端的距离为(5.154±0.782)mm;副神经锁骨下水平发出内、外侧支之前的直径为(0.216±0.027)mm,与膈神经主干起始端的距离为(-1.416±0.216)mm.另外测量大鼠膈神经主干起始段直径为(0.208±0.016)mm.结论:副神经锁骨下水平发出内、外侧支之前的直径与膈神经主干起始端直径较接近,且可直接缝接膈神经重建高位颈髓损伤大鼠的呼吸功能.     

副神经移位膈神经重建高位颈髓损伤后呼吸功能的相关解剖学研究

目的:为副神经移位膈神经重建高位颈髓损伤大鼠呼吸功能提供显微解剖学依据。方法:30只健康雄性SD大鼠在16倍手术显微镜下解剖双侧副神经、膈神经及其分支。用精确度为0.001m m游标卡尺测量各段的直径、长度、副神经及其分支与膈神经主干起始端的距离。结果:大鼠膈神经主干起始部直径为(0.207±0.051)m m。副神经出颈静脉孔后(4.191±0.135)m m即分出胸锁乳突肌支,该支长(5.657±0.283)m m,直径(0.221±0.039)m m,与膈神经主干起始端的距离为(10.041±3.181)m m;副神经锁骨上段两斜方肌支之间主干直径为(0.274±0.032)m m与膈神经主干起始端的距离为(5.154±0.782)m m;副神经锁骨下水平发出内、外侧支之前其直径为(0.216±0.027)m m,与膈神经主干起始端的距离为(-1.416±0.216)m m。结论:副神经锁骨下水平发出内、外侧支之前其直径与膈神经主干起始端直径较接近,且可直接与膈神经缝接。     

大鼠副神经主干及其与颈丛交通支的神经纤维性质研究

目的运用乙酰胆碱酯酶组化法鉴别大鼠副神经主干及其与颈丛交通支的神经纤维性质,通过显微镜计数得出副神经主干的神经纤维数目,为临床提供一定的解剖学依据。方法运用乙酰胆碱酯酶组化法鉴别大鼠副神经与颈丛交通支的纤维性质．并用显微镜计数副神经主干的纤维数目。结果①大鼠副神经主干经乙酰胆碱酯酶组化法染色结果为混合性反应。②大鼠副神经主干的平均神经纤维总数为（179．06±31．78）根,其中运动神经纤维（160．83±32．86）根,感觉神经纤维（18．23±7．39）根。③大鼠副神经与颈丛交通支的神经纤维经乙酰胆碱酯酶组化法染色结果为阴性反应。结论大鼠副神经主干的神经纤维性质为混合性,以运动性神经纤维为主;大鼠副神经与颈丛交通支的神经纤维性质为感觉性。     

大鼠膈神经移位迷走神经支配心脏的实验解剖学研究

目的：为大鼠膈神经移位迷走神经支配心脏提供显微解剖学依据。方法：20只健康雄性SD大鼠在10倍手术显微镜下解剖双侧膈神经、迷走神经及其分支。用游标卡尺（精确度为0．02mm）测量膈神经分支直径、长度，迷走神经各段的直径、长度及其与膈神经起始端的距离。结果：（1）大鼠膈神经分支有胸骨支、前外侧支、后支，迷走神经分支有咽支、喉前神经、返神经、心支和胸腹腔支。（2）大鼠膈神经主干起始端直径为（0．22±0．04）mm，其与迷走神经咽支、喉前神经、左侧返神经、右侧返神经、心支、锁骨上水平部的距离分别是（8．46±0．06）mm、（35．98±0．06）mm、（25．66±0．04）mm、（22．88±0．06）mm、（42．06±0．04）mm、（2．46±0．82）mm。结论：迷走神经锁骨上水平发出的主干与膈神经主干起始端较接近，可以与膈神经直接缝合。     

胸小肌移植重建拇对掌功能的神经解剖学研究

目的为临床应用胸小肌移植重建拇对掌功能手术过程中神经吻接提供解剖学依据。方法解剖观测胸内侧神经及尺神经深支分支特点,比较相关神经有髓神经纤维数目,确定手术过程中神经吻接。结果胸内侧神经为胸小肌的主要支配神经,其在第3肋间隙近锁骨中线处入胸小肌,有髓神经纤维计数为(868±130)根;尺神经深支穿出内侧肌间隔后在第3、4掌骨间隙分别发出两明显肌支,其有髓神经纤维计数分别为(394±49)根、(708±78)根;P3L4(尺神经深支在第4掌骨间隙的分支,其分布于第3骨间掌侧肌和第4蚓状肌)与胸内侧神经、正中神经返支有髓神经纤维数目都比较接近。结论胸小肌移植重建拇对掌功能手术中,在切取胸小肌时以胸内侧神经作为供体神经,以第3肋间隙与锁骨中线交点为标记寻找该神经;尺神经深支中P3L4肌支与胸内侧神经吻合最匹配。     

大鼠迷走神经和膈神经的解剖相关性实验研究

目的 为大鼠迷走神经移位膈神经重建高位颈髓损伤大鼠的膈肌功能提供显微解剖学依据。 方法　10只健康雌性SD大鼠在10倍手术显微镜下解剖双侧膈神经、迷走神经及其分支。用数显卡尺测量迷走神经与膈神经在“膈神经主干起始平面”、“锁骨上平面”、“入膈肌平面”的相对距离,用读数显微镜测量各平面迷走神经和膈神经的直径。 结果　在颈部,迷走神经直径为（0.3284±0.0247）mm,膈神经直径为（0.2267±0.0164）mm,二者的相对距离很接近,无论是在“膈神经主干起始平面”还是“锁骨上平面”,平均都不超过2.5 mm;在“入膈肌平面”平面,迷走神经直径为（0.2912±0.0326）mm,膈神经直径为（0.2794±0.0282）mm,二者的相对距离较颈部远,左侧为（8.71±0.804）mm,右侧为（6.203±0.952） mm。 结论　(1)在颈部,迷走神经与膈神经的直径相差不大,相对距离很接近,二者可直接无张力缝合。(2)在入膈肌平面,迷走神经与膈神经的直径大致相同,相对距离稍远,但将膈神经和迷走神经向上游离一段距离后仍可实现二者的直接无张力缝合。     

部分膈神经与喉返神经前支吻接治疗双侧喉麻痹的显微外科解剖

借助SXP-I型手术显微镜,观察测量了30例成人膈神经(颈段)的起源、长度、位置和血供,以及喉返神经前支在喉内的主要分支,结合组织学、AchE组织化学方法,观察了膈神经,喉返神经前支的横截面积,神经束、有髓纤维和运动纤维的数目;提出了用部分膈神经与喉返神经前支吻接结合喉返神经侧肌支切断植入环杓后肌的方法以治疗双侧喉返神经损伤引起喉麻痹的手术设想。     

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     

颈襻或胸锁乳突肌支与膈神经吻接重建呼吸功能的应用解剖

目的为颈襻或副神经胸锁乳突肌支与膈神经吻接术重建截瘫患者的自主呼吸功能提供解剖学基础.方法在15具尸体上测量了舌下神经降支、颈神经降支和副神经胸锁乳突肌支的长度、末端的宽度、厚度及神经束的数目;副神经胸锁乳突肌支的末端与膈神经汇合处之间的间距;膈神经汇合处的宽度、厚度和神经束的数目.结果舌下神经降支和颈神经降支的长度分别为(40.0±8.2)mm和(32.0±6.8)mm;平喉结处的宽、厚度分别为(1.9±0.5)mm、(0.8±0.1)mm和(1.6±0.5)mm、(0.6±0.1)mm.副神经胸锁乳突肌支的长(15.9±4.2)mm;末端宽、厚度分别为(2.3±0.7)mm和(0.9±0.2)mm.副神经胸锁乳突肌支与膈神经汇合处之间有间距者为80%,平均间距(20.2±6.3)mm.膈神经汇合处的宽、厚度分别为(2.1±0.5)mm和(1.2±0.4)mm.结论舌下神经降支、颈神经降支或副神经的部分胸锁乳突肌支的长度和末端的宽、厚度均能满足与膈神经起始处行神经端-端或端-侧吻接术,以重建膈的自主呼吸功能.     

跟外侧神经的形态特点及其临床意义

目的:为临床选择跟外侧神经作为受区皮神经重建足跟感觉提供解剖依据.方法:20个成人尸体下肢标本,解剖显露腓肠内侧皮神经与腓肠外侧皮神经的会合部位至各支跟外侧神经的终末支;观察各支跟外侧神经的来源、发出部位、形态、走行、分支与分布情况;测量各支跟外侧神经自腓肠神经主干发出平面至外踝尖水平面的垂直距离及其起始部的外径.结果:大部分腓肠内、外侧皮神经于外踝尖平面上8.9 cm会合成腓肠神经主干,于其后外侧部发出跟外侧神经1～3支;其中跟外侧神经第1支分别于外踝尖平面至其卜方7.2 cm发出,跟外侧神经发出后均垂直于足底平面向下走行,终支分布于足跟负重区外侧部皮肤;跟外侧神经及其分支多为类似圆柱形态;跟外侧神经有1～3支、直径分别为(1.62±0.45)mm、(1.11±0.37)mm和(0.85±0.39)mm.结论:跟外侧神经第1支解剖恒定,较为粗大,起始部离足跟外侧缘有一定距离,具备重建跟外侧感觉所要求的皮神经解剖学特点.     

Functional anatomy of the mandibular nerve: consequences of nerve injury and entrapment

Various anatomic structures including bone, muscle, or fibrous bands may entrap and potentially compress branches of the mandibular nerve (MN). The infratemporal fossa is a common location for MN compression and one of the most difficult regions of the skull to access surgically. Other potential sites for entrapment of the MN and its branches include, a totally or partially ossified pterygospinous or pterygoalar ligament, a large lamina of the lateral plate of the pterygoid process, the medial fibers of the lower belly of the lateral pterygoid muscle and the inner fibers of the medial pterygoid muscle. The clinical consequences of MN entrapment are dependent upon which branches are compressed. Compression of the MN motor branches can lead to paresis or weakness in the innervated muscles, whereas compression of the sensory branches can provoke neuralgia or paresthesia. Compression of one of the major branches of the MN, the lingual nerve (LN), is associated with numbness, hypoesthesia, or even anesthesia of the tongue, loss of taste in the anterior two thirds of the tongue, anesthesia of the lingual gums, pain, and speech articulation disorders. The aim of this article is to review, the anatomy of the MN and its major branches with relation to their vulnerability to entrapment. Because the LN expresses an increased vulnerability to entrapment neuropathies as a result of its anatomical location, frequent variations, as well as from irregular osseous, fibrous, or muscular irregularities in the region of the infratemporal fossa, particular emphasis is placed on the LN.     

Variation of the spinal nerve compositions of thoracodorsal nerve

Thoracodorsal nerve distributes to the latissimus dorsi muscle. The aim of this study was to investigate the anatomic variation of the spinal nerve compositions of thoracodorsal nerve and to confirm which spinal nerve is a main component in participating amount. The most frequent type was consisted of C7 and C8 in 60%. Next frequent type was C6, C7, and C8 in 25%. Third type was C6 and C7 in 10% and fourth type was C7 alone in 5%. The diameter of each spinal nerve comprising thoracodorsal nerve was 1.20 +/- 0.23 (mean +/- SD) mm at C7, 0.43 +/- 0.15 mm at C8, and 0.33 +/- 0.09 mm at C6. These results show that the C7 nerve was the main component of thoracodorsal nerve and the anatomic variation appeared at the spinal nerve that participate by small amounts, as be excepted (C6 and C8).     

Formation and distribution of the sural nerve based on nerve fascicle and nerve fiber analyses

The formation and distribution of the sural nerve are presented on the basis of an investigation of 31 legs of Japanese cadavers using nerve fascicle and fiber analyses. Nerve fibers constituting the medial sural cutaneous nerve were designated as 'T', whereas those constituting the peroneal communicating branch were designated as 'F'. In 74.2% of cases (23/31), the T and F fibers joined each other in the leg, whereas in 9.7% of cases (3/31) they descended separately. In 16.1% of cases (5/31), the sural nerve was formed of only the T fibers. The sural nerve gave off lateral calcaneal branches and medial and lateral branches at the ankle. The lateral calcaneal branches always contained T fibers. The medial branches consisted of only T fibers, whereas most of the lateral branches consisted of only F fibers (71.0%; 22/31). In addition to the T and F fibers, P fibers, which derived from the superficial and deep peroneal nerves, formed the dorsal digital nerves. The P fibers were entirely supplied to the medial four and one-half toes. However, they were gradually replaced by the T and F fibers in the lateral direction. The 10th proper dorsal digital nerve consisted of T fibers only (38.7%; 12/31), of F fibers only (19.4%; 6/31) or of both T and F fibers (38.7%; 12/31). These findings suggest that the T fibers are essential nerve components for the skin and deep structures of the ankle and heel rather than the skin of the lateral side of the fifth toe. The designation of the medial sural cutaneous nerve should be avoided and only the T fibers are appropriate components for naming as the sural nerve.     

舌咽神经及鼓室神经切除手术入路的应用解剖

在１００个成年颅骨和２４侧尸头上对舌咽神经及鼓室神经切除术的应用解剖进行了研究，提出了乳突、鼓板下缘、茎突等骨性标志可作为手术入路的导向。鼓板下缘距鼓室底的距离为９．４±１．９ｍｍ，最小值为５．３ｍｍ。舌咽神经干在颈动脉鞘的前内侧易与颈动脉鞘分离。舌咽神经在近颈静脉孔处膨大形成下神经节，鼓室神经自下神经节的外侧发起者占４２．８％，后方发起者为４２．９％，前方发起者１４．３％。本文还对手术入路和手术技术问题进行了讨论。     

Branching patterns of the facial nerve and its communication with the auriculotemporal nerve

This study examines the anatomic relationships and variability of the facial nerve trunk and its branches, with emphasis on the intraparotid connections between the divisions. Microdissections were performed on 30 Korean half-heads, and the facial nerve trunks and branches were exposed. The average depth of the stylomastoid foramen from the skin surface was 21.0±3.1 mm, and the distance between the stylomastoid foramen and the bifurcation of the temporofacial (upper) and cervicofacial (lower) divisions was 13.0±2.8 mm. In 26 of 30 dissections (86.7%), the facial nerve trunk bifurcated into two main divisions, and a trifurcation pattern was seen in the other four cases (13.3%). According to the origin of the buccal branches, we classified the branching patterns of the facial nerve into four categories. In type I (13.8% of cases), the buccal branches arose from the two main divisions of the trunk but not from other branches of the facial nerve. In type II (44.8% of cases), the buccal branches arising from the two main divisions were interconnected with the zygomatic branch. In type III (17.3% of cases), the marginal mandibular branch sent nerve twigs to the buccal branch, which originated from the upper and lower divisions. In type IV (17.3% of cases), the nerve twigs from the zygomatic and marginal mandibular branches merged to the buccal branch arising from the two main divisions. Communications between the facial and auriculotemporal nerve branches, which are known as communicating auriculotemporal nerves, were observed in 28 of the 30 cases (93.3%). Familiarity with these common variations in the facial anatomy provides useful information for the surgeon in careful dissection, preservation of the facial nerve, and complete removal of the tumors in parotidectomies.     

Ⅵ～Ⅷ对脑神经生物塑化薄片断层解剖与MRI对照研究

目的 :对展神经、面神经、前庭蜗神经进行塑化切片与MRI对照研究 ,获得正常影像和断层解剖资料。方法 :采用生物塑化技术制作脑神经横断位 8例、矢状位和冠状位各 1例薄层切片 ,同时采用FLASH -3D序列完成头颅标本及 3 0例正常人脑干MR扫描 ,以MPR技术完整显示展神经、面神经、前庭蜗神经脑池段全程。结果 :塑化薄片断层、标本和活体MR扫描 ,脑神经行程、解剖形态均有良好的对应关系 ,Dorello管和展神经海绵窦段在塑化切片上显示良好 ,MRI仅能部分显示。结论 :生物塑化薄层切片能够对脑神经及相关结构进行准确显示 ,是脑神经影像学研究的重要对比方法     

Topographic anatomy of the lingual nerve and variations in communication pattern of the mandibular nerve branches

We made a thorough observation of the morphology and course of the lingual nerve (LN) and inferior alveolar nerve (IAN) to clarify their topographical relationships in the infratemporal fossa and in the paralingual area. Thirty-two Korean hemi-sectioned heads were dissected macroscopically and microscopically from a clinical viewpoint. On the 32 tracings on the radiograph, the average distance between the retromolar portion and the LN was 7.8 mm, and no case was found where the LN ran above the alveolar crest as passing along the mandibular lingual plate. The bifurcation of the LN and IAN was located around the mandibular notch, inferior to the otic ganglion in 66% of the cases, and a plexiform branching pattern of the mandibular nerve was observed in only two cases. The bifurcation spot of the LN and IAN was located 14.3 mm inferior to the foramen ovale and 16.5 mm superior to the tip of hamulus. Collateral nerve twigs from the LN to the retromolar area were observed in 26 cases (81.2%), with an average of one nerve twig. We observed four types of variations in terms of communication pattern. In four specimens, the mylohyoid nerve passed through the mylohyoid muscle and connected with the LN. In other four specimens, the IAN communicated with the auriculotemporal nerve. We also observed another type of variational communication between the IAN and the nerve to the lateral pterygoid (LPt); this was observed in only one specimen, and it could be predicted that motor innervation from the nerve to the LPt was transmitted via the mental nerve to the depressor anguli oris. Another type was observed where the IAN divided into two branches with the posterior branch being partially entrapped by the LPt muscle fibers.     

单环刺缢及同种异体神经制成人工神经修复神经缺损

目的:研究去细胞的单环刺缢体壁和同种异体神经所构成的人工组织神经的组织相容性及其修复神经缺损的效果。方法:取大鼠40只随机分成实验组、自体神经组、硅胶管组、正常组。实验组将去细胞的单环刺缢体壁缝合成神经导管,其内充填去细胞的异体神经,修复大鼠10 mm坐骨神经缺损。术后4月,通过大体观察,组织形态学观察,了解该人工组织神经修复大鼠坐骨神经缺损的疗效。结果:该人工组织神经组织相容性良好,神经功能恢复效果正常组>自体神经组>实验组>硅胶管组,实验组疗效与自体神经组接近,明显优于硅胶管组。结论:将去细胞的单环刺缢体壁和同种异体神经制成人工组织神经修复周围神经缺损是可行的。     

额神经末支解剖特点及其在前额除皱术中的意义

目的：为了前额除皱术切口位置和分离平面的选择提供解剖学依据。方法：对18例成人头部标本进行大体和显微解剖研究以及组织切片观察。结果：（1）眶上神经绕过眶上缘后分为溶，浅二支，浅支位额肌深面并穿过该肌分布于额部皮肤，深支行于额肌，帽状腱膜与骨膜之间直达人字缝；（2）滑车上神经在皱眉肌外侧和穿经皱眉肌后穿过额肌到达头皮，结论：（1）前额除皱术中冠状切口应尽量靠近人字缝，并在骨膜下剥离皮瓣，以避免损伤眶上神经，（2）切断皱眉肌时宜在直 下仔细操作以减少对滑车上神经的损伤。     

手掌分区与正中神经和尺神经

目的：为研究手掌病变、作神经吻合及阻滞麻醉提供解剖学基础。方法：手掌借5条横平行线和掌纵纹，分为桡、尺两部及6个区。解剖并观察正中神经和尺神经在手掌各区的分支及分布。结果：正中神经掌皮支和主支位于Ⅰ、Ⅱ区，主支在Ⅲ区形成4种形态的伞形结构，在C线处发出第1～3指掌侧总神经。正中神经返支由伞形结构桡侧发出，经B1点入大鱼际。尺神经主支和掌皮支位于Ⅰ区。浅支在A1点分为指掌侧总神经和小指掌侧固有神经，深支于A1点入手掌Ⅱ区深面。指掌侧总神经在E线分为指掌侧固有神经。结论：手掌神经有按区分布的特点，有助于手掌损伤离断神经的寻找和吻合，以及手掌神经阻滞麻醉的精确定位。