肌皮神经与正中神经之间交通支的观测及意义

目的：调查肌皮神经与正中神经之间交通支的出现率并探讨其临床意义。方法：解剖观测56侧成人上肢尸体标本。结果：肌皮神经与正中神经之间交通支的出现率为21．43％，依交通支发出的数量可将其分为两种类型：I型、Ⅱ型，I型又以其发出的部位分为Ia型(高位型)、Ib型(穿喙肱肌型)和Ic型(低位型)三种。结论：肌皮神经和正中神经之间的交通支并不少见，在臂部手术时应对其加以保护。     

肌皮神经与正中神经交通1例

据中国人体质调查一书统计 ,肌皮神经与正中神经有交通的占 1 0 .2 %。作者在解剖一具成年女标本时 ,见其右侧肌皮神经发一支与正中神经交通 ,现报道如下。肌皮神经自外侧束发出 ,偏外下行进入喙肱肌 ,入肌处发出 3支支配该肌 ,主干穿过喙肱肌在肱二头肌内侧下行 ,分出 2支支配肱二头肌和肱肌。随后在距肱骨内侧髁上方 1 5ｃｍ处又向内下分出一支连于正中神经 ,本干继续前行穿过肱二头肌腱外侧移行为前臂外侧皮神经。交通支长 2 .4ｃｍ、直径 1 .5ｍｍ ,肌皮神经分支前直径为 2 .1ｍｍ ,分支后直径为 1 .0ｍｍ。正中神经接受分支前直径为 1 …     

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…     

肌皮神经及正中神经变异

正笔者在解剖一具成年男性上肢时,发现其双侧肌皮神经及正中神经在臂部存在多处变异。经查阅有关文献,双侧变异同时存在未见报道,为积累解剖学资料并为临床工作提供形态学依据,现报道如下:左侧臂丛三干合成正常,但臂丛的内侧束既夹持腋动脉也夹持腋静脉,由内侧向外侧依次为内侧束,腋静脉,腋动脉,外侧束;内侧束发出的各神经正     

右侧肌皮神经变异1例

在西北民族学院医学院2000级本科班的局部解剖学实验过程中，发现右侧肌皮神经变异1例，报道如下：男尸，身高1.41cm，年龄约60岁。右侧肌皮神经起点异常，分3支由正中神经发出。第1支在正中神经起点处从其右侧发出，长3．6cm，外径0．05cm。其末端分3支于喙肱肌上1／3处(距喙突3．9cm)进入该肌，可称作喙肱肌支。     

胸内、外侧神经与肌皮神经吻接的应用解剖

在专供研究用的18具(男9,女9)成人尸体上解剖,观察了36侧胸内、外侧神经和肌皮神经。胸内、外侧神经主干长度分别为42.81±4.18mm和40、55±3.12mm,主干入肌处的宽度分别为1.29±0.09mm和1.57±0.09mm,厚度分别为0.63±0.04mm和0.68±0.05mm。胸内侧神经中有28侧(77.8%)发出1-3支分支入肌,其上支长度为30.69±2.61mm;胸外侧神经中有26侧(72.2%)发出1-3支分支入肌,其上支长度为35.97±3.22mm。肌皮神经的自然长度为43.87±3.41mm,无损伤分离出的长度为22.94±2.17mm,起始处的宽、厚度分别为2.90±0.11mm和1.76±0.07mm。肌皮神经起点与胸内、外侧神经起点之间的距离分别为43.14±3.81mm和50.57±3.71mm。     

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     

肌皮神经并正中神经及尺神经变异1例

在解剖一具老年男性标本时，见左侧肌皮神经并正中神经及尺神经形态变异(附图)。经查有关文献，此类变异较为少见，现报道如下：     

肌皮神经的血供

在25具(男14,女11)专供研究用中国成人尸体上,应用显微外科解剖技术,解剖和测量了50侧肌皮神经的营养动脉及其来源动脉。结果:营养动脉平均为2.8支,其外径和长度分别为0.29和7.91mm。营养动脉的来源动脉主要来自腋动脉喙肱肌支、肱动脉肱二头肌支和肱动脉肱肌支。     

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.     

骨间背侧神经的解剖学特征及其临床意义

目的　研究前臂骨间背侧神经及其肌支的解剖学特征,为体表定位提供形态学基础。 方法　解剖 30具成人防腐尸体的60侧上肢骨间背侧神经及其肌支,观察骨间背侧神经的行程与神经分叉点,测量分叉点分别至肱骨外上髁（LHE）、桡骨Lister结节（LTR）、尺骨茎突（SPU）的距离等参数,通过三圆交汇法及神经分段法来确定神经的体表位置。 结果　骨间背侧神经在发出指伸肌支、小指伸肌支及尺侧腕伸肌支后,主干有4个主要分叉点（O、O1、 O2、 O3）;以分叉点分别至LHE 、LTR 、SPU 的平均距离为半径,LHE 、LTR 、SPU为圆心,绘制3个圆,三圆交汇的点或区域可作为神经的体表定位;4个分叉点又可将骨间背侧神经分为7段（O点上段、OO1段、O1点下段、OO2段、O2点下段、O2O3段、O3点下段）。 结论　骨间背侧神经分叉点结合三圆交汇定位及神经分段法,根据神经损伤的临床表现,可明确神经损伤的位置。     

桡神经浅支皮下段的解剖学特点及临床意义

目的报道桡神经浅支皮下段的解剖学特点及临床意义。方法选用福尔马林固定的成人上肢标本42例,解剖观察桡神经浅支的走行及分支分布特点。结果桡神经浅支距桡骨茎突(8.33±1.16)cm处自肱桡肌深层浅出,沿肱桡肌和桡侧腕屈肌之间于皮下前行,在桡骨茎突近端(4.58±1.06)cm处分为内、外侧支。外侧支在桡骨茎突掌侧面前行至拇指桡背侧成为拇指的感觉神经,内侧支则在桡骨茎突的近侧段绕向背侧,于桡骨茎突远侧(1.32±0.26)cm处在1、2掌骨中段水平分为第1、2掌背皮神经,进而成为手背桡侧半的感觉神经。桡神经浅支浅出处和肱桡肌的夹角为(20.7±3.16)°,桡神经浅支分为内、外两侧支间的夹角为(18.0±4.4)°,桡骨茎突水平内、外侧支的间距为(1.4±0.23)cm。结论(1)根据桡神经浅支的解剖学特点,在不同的损伤平面进行修复,以最大限度的恢复手部的感觉;(2)在应用含有桡神经浅支的皮瓣修复创面时,尽可能以神经为轴线,将神经置于皮瓣中央位置,以提高皮瓣的成活率和手术的质量。     

Classifying musculocutaneous nerve variations

A total of 56 upper limbs from fetuses and adult cadavers were dissected to record anatomical variations in the musculocutaneous nerve (MC). A systematic literature review was performed to identify current classifications of MC variations. Communications were seen between the MC and median nerves in 53.6% of the dissections from which 84.6% were proximal, 7.7% distal, and 7.7% had one proximal and one distal communication to the point of entry of the MC into coracobrachialis muscle. In six out of 54 dissections where the MC was present, the nerve did not pierce the coracobrachialis muscle. In two cases, the MC was absent and in one case the MC and the median nerve had a distal origin. This article describes current classifications of MC variations and their problems. A new classification is proposed combining preexisting ones into an integrated and more detailed overview. Clinical manifestations of isolated MC injury with and without the presence of anatomical variations are thoroughly discussed. The knowledge of these variations will allow physicians to correctly interpret anomalous innervation patters of the upper limb. Clin. Anat. 22:671–683, 2009. © 2009 Wiley‐Liss, Inc.     

掌短肌皮瓣的应用解剖学

目的：为吻合血管的掌短肌皮瓣移植提供解剖学基础。方法：３０侧灌注红色乳胶成人上肢标本,观测掌短肌的形态,肌皮瓣的血供、神经分布。结果：掌短肌呈斜方形,其桡侧长２．２±０．８ｃｍ,尺侧长２．８±０．９ｃｍ,中部宽２．８±０．６ｃｍ,中部厚２．８±０．９ｍｍ。掌短肌为尺神经浅支支配,其浅面的皮肤为尺神经浅支和尺神经的尺动脉支支配。掌短肌皮瓣的动脉血供来源有４：即尺动脉本干、掌浅支的肌皮支和皮支、掌深支和小指尺侧固有动脉的肌皮支。其静脉回流为上述动脉的伴行静脉,汇入到尺静脉,以及与手掌尺侧皮肤相连的前臂尺侧静脉。结论：以尺动、静脉为血管蒂的掌短肌皮瓣的血供来源较多,可以利用尺神经浅支和尺神经的尺动脉支形成带感觉神经的皮瓣。是修复拇指指腹大面积缺损较好的供区之一。     

Bilateral variant contributions in the formation of median nerve

Bilateral variations in the formation of median nerve (Mn) and the recurrent course of its communications with musculocutaneous nerve (MCn) are very rare. These bilateral anomalies were observed during a routine dissection of the upper limbs of an adult male cadaver in the Department of Anatomy, PGIMER, Chandigarh. On both the sides, Mn was formed by the union of three roots. There was an additional lateral root on both sides. On the right side it was a contribution from the lateral cord and on the left it arose from the anterior division of the middle trunk. On the left side the lateral cord was formed distal than usual in relation to the second part of the axillary artery. On the right side a communicating branch arising from the additional lateral root followed a recurrent course and divided into two to unite separately with medial root of median, while on the left side a single communicating branch from an additional lateral root united with the medial root of median. Recurrent course of the communicating branch between lateral root of median and medial root of median has not been reported earlier. On the right side the MCn after piercing the coracobrachialis gave another communicating branch, which joined the Mn at the level of insertion of deltoid.     

Patterns of motor branching of the musculocutaneous nerve in human fetuses and clinical significance

The purpose of this morphologic study is to investigate the course and the branching pattern of motor branches of musculocutaneous nerve (MCN) in human fetuses. Twenty upper limbs (10 right, 10 left) of spontaneously aborted formalin-fixed fetuses were dissected under a stereomicroscope to determine motor branches for the biceps brachii and brachialis and the communicating branches between the MCN and median nerve (MN). The MCN entered the proximal and middle part of coracobrachialis in 13/20 and 5/20 of arms, respectively, and the remaining 2/20 did not pierce coracobrachialis. The communication between MCN and MN was observed in 5/20 of the arms and detected only in the distal part of the coracobrachialis. The most frequently observed innervation is the type wherein a single branch to biceps brachii, which bifurcated for supplying the short and long heads (12/20). For the innervation of brachialis, the most frequent type was a single branch from the main trunk of the MCN (15/20). During the dissections, the distance between the acromion and the emerging point of the motor branches was measured. The mean distance between the acromion and the emerging point of the all motor branches for biceps brachii in all types of specimens was 33.8 ± 6.1% of acromion-lateral epicondyle length and for brachialis was 50.6 ± 11.5% of acromion-lateral epicondyle length. The data of the MCN variations in the human fetus may be useful for the clinicians and pediatric surgery.     

副神经的定位及其临床意义

目的:为有关的手术准确定位副神经提供解剖学基础。方法:12具(24侧)成人尸体标本。解剖观测副神经的行程、毗邻、体表标志、分支分布、与其与周围神经的关系。结果:副神经进入胸锁乳突肌后,75%肌支为两支,25%为1支。副神经在胸锁乳突肌后缘穿出点距耳大神经在胸锁乳突肌后缘穿出点上方(1.24±0.51)cm,距锁骨中点(10.72±1.67)cm,距胸锁关节(12.46±1.19)cm。副神经在颈后三角内位置表浅,副神经进入斜方肌点距锁骨中点(4.95±1.62)cm,沿途发出支配斜方肌的分支。结论:副神经有较为恒定的标志,上述测量的副神经体表定位有助于在有关手术中可以有效地保护或快速寻找副神经。     

阴部神经的解剖学观测及其临床意义

目的　从神经胚胎发育的角度对阴部神经的来源、组成、走行、分支进行解剖学观测,为临床会阴部手术提供依据。 方法　16具（32侧）成人尸体标本解剖观察阴部神经的组成、形态、走行、分支及其毗邻关系,测量阴部神经与毗邻结构距离等的数据。 结果　阴部神经主要由S2、S3和S4前支混合后组成,但仍有部分由S2和S3前支混合后组成。阴部神经在下行过程中有坐骨神经及股后皮神经的分支加入,三者之间相互交通的关系较为复杂;在阴部管及坐骨直肠窝,阴部神经的毗邻不同;阴部神经分为盆内和盆外分支。阴部神经在阴部管内距坐骨结节前缘下方的距离为（男25.47±3.18 mm, 女26.38±2.56 mm）;阴部神经在坐骨棘处距皮肤的距离为（男75.67±8.37 mm, 女76.89±9.48 mm）。 结论　阴部神经与毗邻神经交通复杂,细致的解剖对临床相关手术及治疗具有指导意义。     

Relationships of the musculocutaneous nerve and the coracobrachialis during coracoid abutment procedure (Latarjet procedure)

Purpose  The aim of this study was first to define first the anatomical relationships between the musculocutaneous nerve and the coracobrachialis, and then the induced modifications of these relationships by a preglenoid transposition of the vertical part of the coracoid process. Materials and methods  Twenty-one embalmed adult trunks and upper limb were dissected. First the coracobrachialis and the musculocutaneous nerve were identified through a deltopectoral approach. We measured the distances between the lateral cord of the brachial plexus and the entry point of the nerve, between the inferior tip of the tip of the coracoid process and the penetration of the nerve or its twigs, and finally the angle between the general axis of the coracobrachialis and the axis of the musculocutaneous nerve. The same measures were performed after the coracoid bone block abutment. Results  Proximal motor branches destined to the coracobrachialis varied from 0 to 3. Mean distance between the lateral cord of the brachial plexus and entry point of the nerve into the muscle was 47.2 mm before and 48.43 mm after the coracoid transfer. Mean angulations between the nerve and the muscle was 121° before and 136° after the transfer of the coracoid process. Mean distance between the inferior tip of the coracoid process and entry point of the nerve into the muscle was 55.7 mm, reduced to 48.6 mm after the coracoid transposition. Finally, the distance between the tip of the coracoid and the first motor twig entering the coracobrachialis was less than 50 mm in 75% of the cases with a mean value of 40.6 mm. Conclusions  Lesion of the musculocutaneous nerve is a known complication of the coracoid bone block abutment procedure (Latarjet–Bristow). From this study we know that they are due to lengthening of the nerve and modification of the penetration angle of the nerve into the coracobrachialis. We also infer that some motor nerve destined to the coracobrachialis might be damaged during the proximal medial release of the muscle after the detachment of the pectoralis minor muscle.