股部皮神经营养血管皮瓣的应用解剖

目的：为股部皮神经及其营养血管为蒂的岛状皮瓣提供解剖学基础。方法：８侧经动脉灌注红色乳胶成人新鲜下肢标本，解剖观测股部主要皮神经血供及其筋膜皮支的分布范围；２侧成人新鲜下肢标本经墨汁灌注，皮肤脱水透明后观测各皮神经营养血管的分支分布及吻合。结果：①股外侧皮神经有营养动脉２～６支，超始外径１．０±０．４ｍｍ，其筋膜皮支分布达神经内侧４．１ｃｍ，外侧５．９ｃｍ；②股前皮神经有营养动脉１～５支，外径１．０±０．３ｍｍ，其筋膜皮支分布达神经内侧２．４ｃｍ，外侧３．４ｃｍ；③股后皮神经有营养动脉１～３支，外径０．９±０．３ｍｍ，其筋膜皮支分布达神经内侧３．９ｃｍ，外侧３．２ｃｍ。结论：以股部各主要皮神经及其营养血管为蒂可沿其皮神经走行设计切取顺行或逆行岛状皮瓣     

臀中皮神经的形态特点及其与臀骶部痛的关系

目的：探讨臀中皮神经与臀骶部的关系。方法：对３０具成尸标本的臀中皮神经的组成、走行及毗邻关系进行了观测。结果：①该神经由骶神经后外侧支组成，由Ｓ１＋Ｓ２组成的占３２．６％，Ｓ２＋Ｓ３组成的占３０．３％；②臀中皮神经走行于骶髂关节背面；③穿经骶髂后长韧带，韧带形成长１．５±０．３ｃｍ的隧道；④多出隧道后该神经分为２～３支穿经臀大肌内侧缘至皮下。结论：臀中皮神经走行迂曲，四周均为韧带结构，损伤、退变等情况下易使之受到卡压而产生臀骶部疼痛，是臀中皮神经卡压综合征的解剖学基础。     

臀上皮神经的解剖学观察及其与腰腿痛的关系

为了进一步了解腰背区的神经供给及配合腰腿痛病因研究的目的,我们解剖了100侧中国成人尸体的臀上皮神经。据本组观察,臀上皮神经可由胸_(12)、腰_(1～5)和骶_1脊神经后外侧支的皮支成分组成。参与此神经的组成情况如下:胸_(12)40例,腰_1及腰_2各100例,腰_3 96例,腰_4 48例,腰_5 11例,骶_1 4例。我们的观察表明腰_(4,5)脊神经后支有大量的外侧皮支,这与以往文献引用的胚胎学的说法不一致——后者否认腰_(4,5)脊神经后支有外侧皮支。根据我们的资料,我们把臀上皮神经分成四型:单支型1例;二支型15例;三支型66例;四支型18例。臀上皮神经的内侧支和最内侧支之半数以上,穿过附于髂嵴的腰背筋膜后层附着部的深面,进入臀部浅筋膜中。当腰部急剧扭转时,此附着部对神经的牢固固定及紧张的牵拉可能部分地有助于这些穿支的损伤。骶棘肌外侧缘与髂嵴之交点或该点稍内侧处,为臀上皮神经穿出的体表定位点。     

桡神经浅支的应用解剖

在３０例成人上肢标本上观测了桡神经浅支浅出处、分支处的位置和距桡骨茎突的距离，结果表明：８３．３％的桡神经浅支在前臂中下１／３处浅出，临床上对桡神经浅支卡压症采取局部封闭治疗或手术松解时，应在桡骨茎突近侧８．８±１．２ｃｍ，肱骨外上髁最突出点与桡骨茎突连线内侧０．４±０．３ｃｍ处进行为宜。为临床探讨桡神经浅支卡压症的病因和治疗提供应用解剖学资料。     

肩胛上神经和腋神经联合阻滞治疗肩周炎的应用解剖

目的：为神经阻滞治疗肩周炎提供解剖学基础。方法：在３４侧经常规防腐处理的成人尸体标本上解剖出肩胛上神经和腋神经,观察其走行位置及分支分布,拟定穿刺点及体表定位。结果：①肩胛上神经主要分支有冈上肌支和冈下肌支。肩胛上神经在肩胛横韧带处距皮肤的距离和冈上肌支起始段距皮肤的距离均为４．０～４．５ｃｍ,冈下肌支起始段距皮肤的距离为４．０ｃｍ。②腋神经主要分支有前支和后支。腋神经穿四边孔处距皮肤的距离为５．     

膝关节神经支切断术的解剖学基础

目的：为膝关节神经支切断术治疗膝关节疼痛性疾患提供解剖学基础。方法：在３５侧常规防腐成人下肢标本上,对股内侧肌支和上关节支进行解剖观测。结果：股内侧肌支在股骨内上髁上１３．３±４．２ｃｍ处延续为膝关节支,在股骨内上髁后０．５±０．４ｃｍ、上２．８±１．２ｃｍ处分支,分布于膝关节内侧及前面内侧半;上关节支在股骨外上髁后１．３±０．５ｃｍ、上２．４±０．６ｃｍ处分支,分布于膝关节外侧及前面外侧半。结论：手术切断股内侧肌支膝关节支和上关节支治疗膝关节疼痛性疾患具有可行性。     

带腓浅神经及其营养血管筋膜皮瓣的应用解剖

目的：提供带腓浅神经及其营养血管筋膜皮瓣的形态学依据。方法：在３２侧成人下肢标本上,观测了腓浅神经及其营养血管、周围皮肤的血供情况。结果：腓浅神经（皮下段）近侧的血供为腓浅动脉深支的皮动脉、第１支肌间隔动脉,起始处外径分别为０．８ｍｍ、１．１ｍｍ;第１支肌间隔动脉穿出深筋膜前长为１．８ｃｍ。远侧则为腓动脉穿支之升支、降支的皮支和足背动脉皮支,起始处外径分别为０．９ｍｍ、０．７ｍｍ和０．８ｍｍ,穿出深筋膜前长分别为１．２ｃｍ、０．７ｃｍ和０．８ｃｍ。其神经支在神经干内或旁彼此吻合,构成纵向链式血管网,并借分支与皮肤、皮下及筋膜血管网沟通。结论：可设计带皮神经及其营养血管筋膜皮瓣,顺行或逆行转位修复邻近部位软组织缺损     

前臂外侧皮神经与桡神经浅支交通1例

前臂外侧皮神经与桡神经浅支交通１例王斌①刘德群①赵少平①在解剖１成年男性左上肢标本时，见其桡神经浅支与前臂外侧皮神经之间有交通支，这种变异较少见，约占５．１％，现报道如下：在距桡骨茎突１６ｃｍ处前臂外侧皮神经分为前、中、后三支。中支在距桡骨茎突７ｃｍ...     

前臂外侧皮神经替代桡神经浅支1例

前臂外侧皮神经替代桡神经浅支,根据中国人体质调查第一集统计２１６例中,此种变异有６例,占２． ８％± １． １％,较少见。笔者在制做标本时,发现右侧桡神经浅支缺如,该神经所分布的区域被肌皮神经的前臂外侧皮神经所代替,为积累临床资料,现报道如下： 男性,约７５岁,身长 １５５ ｃｍ,双上肢对称等长,左侧臂丛各分支走行正常,右侧肌皮神经的各肌支走行正常,前臂外侧皮神经由肌度神经分出后,在距肱骨外上踝平面的上方 １．５ ｃｍ处穿出深筋膜至皮下,该神经的起始部最宽径为２．９ｍｍ,经前臂的后外侧下行,在行程中先后…     

轴型血管蒂股前外侧真皮下血管网皮瓣的应用解剖

在１２侧灌注颜料的新鲜下肢上，解剖观察了以旋股外侧动脉降支为蒂的股前外侧真皮下血管网皮瓣血供、真皮下血管网的构筑及静脉回流，结果显示：①皮动脉穿出深筋膜后随即分成２～６支主要分支各自斜行浅筋膜途中发出浅筋膜分支、真皮下血管网分支和混合型三种分支；②真皮下血管网分支在真皮下层形成“血管树”或“蜘蛛痣”状吻合稠密的血管网；③在制备股前外侧真皮下血管网皮瓣时需保留血管蒂周围２．５ｃｍ不超薄，其余周边部分超薄至保留皮下脂肪２～３ｍｍ；④真皮下静脉也吻合成网，通过皮动脉伴行静脉或股外侧浅静脉回流。文中讨论了皮瓣的血供特点和优点。     

The medial branch of the lateral branch of the posterior ramus of the spinal nerve

In the needle insertion of epidural anesthesia with the paramedian approach, the needle can pass through the longissimus muscle in the dorsum of the patients. When the needle touches a nerve in the muscles, the patients may experience pain in the back. Obviously, the needle should avoid the nerve tract. To provide better anesthetic service, analysis of the structure and where the concerned nerves lie in that region is inevitable. Material and method: We studied five cadavers in this study. Two cadavers were fixed with Thiel’s method. With these cadavers, we studied the nerve running of the posterior rami of the spinal nerve from the nerve root to the distal portion. Three of them were used for the study of transparent specimen, with which we studied the course and size of the nerve inside the longissimus muscle. Results: We observed there were three branches at the stem of the posterior rami of the spinal nerves between the body segment T3 and L5, i.e. medial branch, medial branch of the lateral branch and lateral branch of the lateral branch. The medial branch of the lateral branch supplied to the longissimus muscle. With the transparent specimen, we found that there were different nerve layouts between the upper thoracic, lower thoracic, upper lumbar, and lower lumbar segments in the medial branch of the lateral branch in the longissimus muscle. In the lower thoracic and upper lumbar segments, the medial branch of the lateral branch of the upper lumbar segments produced layers nerve network in the longissimus muscle. L1 and L2 nerves were large in size in the muscle. Conclusion: In the upper lumbar segments the medial branch of the lateral branch of the posterior rami of the spinal nerve produced dense network in the longissimus muscle, where the epidural needle has high possibility to touch the nerve. Anesthetists have to consider the existence of the medial branch of the lateral branch of the posterior rami of the spinal nerve when they insert the needle in the paramedical approach to the spinal column.     

骶骨上关节突和外侧沟的形态及其临床意义

对260个骶骨的上关节突外侧沟作了观察,以它和上关节突关节面下缘的关系分成四型。其中Ⅰ型(钩绕型)占26.2％.对上关节突关节面的位置、形态和不对称性作了统计;并在15侧尸体上观察了我五腰神经后内侧支的走行特点。指出第五腰神经后内侧支在Ⅰ型外侧沟中有可能被第五腰椎下关节突压榨引起腰骶部疼痛。     

肋间臂神经的解剖及其临床意义

目的：为乳癌腋清扫术中保留肋间臂神经(ICBN)提供解剖学基础。方法：对25具成人尸体的50侧腋区进行了解剖，对肋间臂神经及上下相邻皮神经的走行、分支、支配、粗细等情况进行解剖观察。结果：ICBN可分为缺如型、单干型、单干分支型、双干型及3干型；84％的臂内侧皮神经与ICBN上支、上干相交通；34％的第3肋间神经外侧皮支可发支支配腋窝底；3侧第1肋间神经外侧皮支主干进入上臂内侧。结论：肋间臂神经为第2肋间神经外侧皮支的分支，通常为上支或上干，与臂内侧皮神经联合构成，可有第3或第1肋间神经的外侧皮支参与。其损伤可造成乳房切除术后疼痛综合征，乳癌腋清扫术中经胸小肌后方或经腋静脉下方能顺利找到该神经并加以保护。     

脊神经后支神经痛诊治及其解剖学基础

目的介绍脊神经后支神经痛诊断与治疗及其解剖学基础。方法回顾性分析我院软组织门诊诊断为脊神经颈、胸、腰段后支神经痛62例,诊断仅靠检查皮肤痛觉决定,治疗皆采用强的松龙加局部麻药依据其解剖学基础,药物注射至神经穿出斜方肌或背阔肌的肌性部或其腱膜处,注射部位在颈、胸、腰段各有不同。在注射后5~10 min内止痛,可以立即判断诊断无误。结果 62例皆在注射后5~10 min疼痛消除,治疗后痊愈49例,经第2次注射后痊愈11例,经第3次注射后痊愈2例,注射时间间隔1周。结论对于确诊为脊神经后支神经痛的病例,按颈、胸、腰段不同部位注射强的松龙加局部麻药的方法,紧密结合其解剖学基础,可以获得良好的疗效,不失为首选的治疗方法。     

Examination of the variations of lateral femoral cutaneous nerves: report of two cases

The origins, courses and relations of lateral femoral cutaneous nerves (LFCNs) were examined bilaterally in 28 cadavers, and the variations were observed in two. On the right side of one cadaver, the ventral rami of the first and second lumbar spinal nerves were united and then this nerve was divided into four branches. From medial to lateral, these branches were the obturator nerve, the femoral nerve, the medially located LFCN and the laterally located LFCN. On the left side of another cadaver, there were three LFCNs. All of these nerves pierced the psoas major muscle anterolaterally. Two of these nerves, which pierced the psoas major muscle more proximally than the third, united with each other by a communicating branch anterior to the iliacus muscle. These types of variations are very important, especially in the presence of paresthesias or pain in the anterior thigh, lateral thigh and gluteal region. In these cases, surgeons must always remember the possible variations of the LFCN during surgical procedures in order to prevent injury and the occurrence of meralgia paresthetica.     

Danger of damaging the medial branches of the posterior rami of spinal nerves during a dorsomedian approach to the spine

Postoperative atrophy of the deep back muscles may be caused by denervation during a dorsomedian approach to the thoracolumbar spine; ensuing instability of the spine with poor clinical results, perhaps due to such muscle loss, has been observed in 11.7% of cases (Sihvonen et al., 1993, Spine 18:575--581). More specifically, this complication may be caused by damaging the medial branches of the posterior rami of the spinal nerves during lateral retraction of the muscles. To investigate the anatomic topography of the medial branches of the posterior rami of the spinal nerves, 18 carbol-formol-fixed specimens were dissected using an operation microscope; also, 3 fresh cadavers were cut in horizontal and vertical planes with a rotary cryotome to confirm the anatomic topography observed in the fixed specimens. In the thoracolumbar spine the medial branch of the posterior ramus of the spinal nerve is subject to ligamentous fixation by the strong fibers of the mammillo-accessory ligament, which extends between the mammillary process and accessory process infero lateral to the superior articular process. When the dorsomedian approach to the thoracolumbar spine is enlarged laterally to the articular processes by retracting the paraspinous muscles, the medial branches of the posterior rami of the spinal nerves are endangered. This may cause postoperative pain as well as dynamic instability beyond the corresponding segments. The results of our anatomic study suggest that the posterior surgical midline approach to the thoracolumbar spine should not be enlarged laterally to the articular processes to prevent injury to the medial branches of the posterior rami of the spinal nerves.     

腰椎后外侧部血供的应用解剖学研究及临床意义

目的：探讨腰椎后外侧入路摘除极外侧椎间盘突出手术中减少血管损伤的方法。方法：对30侧经动脉灌注乳胶的成人尸体标本进行局部解剖研究，解剖观测椎间孔前缘以后的腰动脉各级分支的起源、走行、外径及与出口神经的关系。结果：腰动脉从椎间孔前缘向外后内发出分支。在椎间孔外区，后支主干及其分支与出口腰神经前支的关系密切，血管呈“树叉”状从外侧将神经包绕。结论：紧贴腰椎峡部外缘，将后支血管及其分支推向外侧，是显露腰神经前支与极外侧型突出椎间盘的最安全、快捷的方法。     

臀上皮神经痛诊治的解剖学基础(系列报道之八)

目的 介绍臀上皮神经痛的诊断与局部注射的治疗方法。方法 选择门诊确诊为臀上皮神经痛的患者20余例。有用强的松龙混悬液加局部麻药局部注射神经穿过背单身汉肌腱膜与胸腰筋膜处的治疗方法。结果 所有病例皆在注射后短时止痛，多数病例一周后痊愈，少数病例经2-3次注射后痊愈，极少数失访。结论 对诊断正确的患者，采用强的松龙局部注射法，可以获得满意的效果。