肩胛背神经的解剖学研究及其临床意义

目的 :研究肩胛背神经的解剖学特点及其临床意义。方法 :在 49侧成人整尸标本上观测肩胛神经的起源 ,走行 ,在中斜角肌内的长度 ,与中斜角肌的关系 ,中斜角肌的形态 ,肩胛背神经的分支等。结果 :肩胛背神经来源于C5的有 3 4侧 (占 69.4% ) ,肩胛背神经的走行分 2种类型 :第一种类型是发出后跨中斜角肌的表面向下、外、后走行 ,约40 %者中斜角肌的表面大部分为腱性者 ;第二种是穿过中斜角肌向下、外、后走行 ,在中斜角肌内走行的长度为 2 0 .9±6.1mm ,途中结构大部分为腱性者占 17.9%。结论 :肩胛背神经起始部走行方式及其与中斜角肌比邻中的致密的纤维组织 ,是该神经易造成卡压的形态学基础     

肩胛背神经卡压的应用解剖学研究

观察并分析腱性纤维束是否为造成肩胛背神经卡压的主要因素。方法：在３２侧成人尸体标本上，观测肩肿背神经的起源、走行、分支、分布及其与中斜角肌的解剖关系。结果：肩胛背神经７５％（２４／３２）从Ｃ５神经根发出；由前内侧向后外侧从中斜角肌穿过，其长度为１．２±０．３ｃｍ，在其内侧缘有大部分键性纤维组织存在。该神经除发出２～５支肌支外，另有２５％（８／３２）还发出细小分支走向肩背部。结论：中斜角肌内侧缘的限性结构特点是造成肩胛背神经卡压的形态学基础。     

Selective blockade of the dorsal scapular nerve for scapula surgery

The dorsal scapular nerve, a proximal branch of the brachial plexus, may be imaged using ultrasound. This nerve supplies the rhomboid and levator scapulae muscles while providing significant sensory innervation to the scapula. An ultrasound-guided nerve block of the dorsal scapular nerve provided analgesia after surgery of the scapula. Selective blockade of this nerve, without blocking the remainder of the brachial plexus, results in specific analgesia of the scapula, sparing sensory and motor function of the ipsilateral arm.     

超声引导肩胛背神经阻滞的可行性

目的探讨超声引导下第5颈椎横突后结节(PTFCV)处阻滞肩胛背神经(DSN)的可行性。方法对20例单侧肩胛间区疼痛患者行超声检查,观察PTFCV及DSN,测量PTFCV距皮肤的垂直距离。并于PTFCV处行超声引导下DSN阻滞。记录操作时间、术中及术后并发症,并以疼痛缓解程度评估治疗效果。结果通过超声可准确识别所有患者的PTFCV,PTFCV距皮肤表面垂直距离为(1.09±0.22)cm。20例中,仅8例(8/20,40.00%)的DSN可被超声识别。对20例(20/20,100%)患者均成功实施超声引导下DSN阻滞,操作时间(9.05±0.41)min。术后患者疼痛缓解率为(70.92±17.15)%。未出现明显的术中及术后并发症。结论超声引导下于PTFCV处阻滞DSN省时、易行,且安全、有效。     

Surgical anatomy of the axillary nerve

Any surgical approach that splits the deltoid puts the axillary nerve at risk secondary to extension from traction or sharp dissection. Standard texts an anatomy and chapters on surgical approaches frequently state the axillary nerve comes to lie approximately 2 inches from the acromion. However, a large series of cadavers of varying sex and size on which these measurements had been obtained could not be found in an extensive literature search. Fifty-one embalmed cadaveric specimens representing 102 shoulders were dissected in the static portion of this study. In nearly 20% of cadavers the nerve at some point along its course around the humerus in the deltoid muscle was less than 5 cm from the palpable edge of the acromion. This was especially true of female cadavers with short arm spans; in one cadaver the nerve was 3.1 cm from the acromial edge. Abducting the shoulder to 9cr decreases the distance from the nerve to the palpable edge of the acromion nearly 30%. Five centimeters does not describe an absolute safe zone for the axillary nerve. Furthermore, abduction of the arm brings the nerve even closer to commonly used bony landmarks.     

肩胛背神经合并胸长神经卡压的解剖学和临床研究

目的：研究肩胛背神经合并胸长神经卡压的机理及其诊断和治疗。方法：解剖20侧陈旧性成人尸体的C5神经，观察肩胛背神经和胸长神经的起点及其走行过程中与周围结构的关系。分析16例肩胛背神经合并胸长神经卡压征的诊断，治疗及效果。结果：肩胛背神经与胸长神经起始段合干者70％，两神经合干后穿入中斜角肌在C5起点处的腱性组织，6例患者痛点局封后2例效果不佳改手术治疗，12例手术治疗后随访4个月－8年，8例症状全部消失，3例疗效不佳，1例较术前加重，结论：两神经合干穿入中斜角肌在C5起点的腱性组织，是两神经同时受卡压的解剖学基础，手术治疗的疗效明显优于保守治疗。     

指固有神经背侧支的应用解剖学研究

目的 为指固有神经背侧支的临床应用提供解剖学基础。方法 观测12只新鲜成人手标本48个手指指固有神经背侧支出的出现率、直径、走向及分支。结果 示、中、环指及小指桡侧指固有神经发出的单一分支形成背侧支者占92．86％（78．84）,背侧支缺如者占7．14％（6．84侧）。各指背侧支均在近节手指近、中1／3平面发出,并从指侧面斜向指背远端走行。在近指间关节桡背（或尺背）侧向背面及中节指背发出2－5条分支。除小指外,2－4指指桡、尺侧背侧支的直径粗细均有显著性差异（P＜0．05）,桡侧＞尺侧。小指飞侧无指固有神经背侧支。结论 示、中、环及小指的桡侧指固有神经背侧支走向恒定,可包含在同指逆行岛状皮瓣内,适用于修复指腹软组织缺损。     

Surgical anatomy of the recurrent laryngeal nerve revisited.

OBJECTIVES: Previous anatomic studies of the recurrent laryngeal nerves (RLNs) have described the variability in the course of the RLN. The anatomy of the nerve appears more constant along its distal segment near the cricothyroid joint, which is our surgical approach to the initial identification of the nerve. Understanding the topographical anatomy of the nerve in this region facilitates quick and safe nerve identification. The surgical topographical anatomy of the nerve in this region has not been studied in detail, which is the focus of this study. METHODS: A total of 278 RLNs in 190 patients were dissected during thyroidectomy and/or parathyroidectomy. The course of the nerve was recorded, paying particular attention to the directional course along its distal portion. The angle in which it coursed in relationship to a line paralleling the tracheoesophageal groove was determined. RESULTS: All 278 nerves were identified. Seventy-eight percent of the right-sided nerves coursed between 15 and 45 degrees, and 77% of the left-sided nerves coursed between 0 and 30 degrees. It appears that the nerve is more likely to travel at a more obtuse angle with right-sided RLNs and in patients with a low-lying cricoid. There was no permanent postoperative RLN palsy, and the incidence of temporary palsy was 1%. CONCLUSIONS: Approaching the nerve along its distal portion is safe and effective. The surgical topographical anatomy in this region is described in detail. Some of the potential advantages of identifying the nerve more distally include less chance of disrupting the blood supply to the inferior parathyroid gland, dissection along a shorter portion of the nerve, and less variability of the nerve.     

Surgical anatomy of the dorsal face of the hand and the wrist

The anatomical knowledge of the dorsal aspect of the hand has been enriched these last years by a more surgically applied approach, especially of that of its integument and blood supply. The vascularization of the superficial nerves, the anastomoses between the dorsal and palmar arterial networks has allowed designing new flaps, ante- and retrograde, usable in the coverage of more and more distal defects. The extensor apparatus shows many anatomic variations, often asymptomatic, except the extensor digitorum brevis manus muscle, which can mimic a mass at the dorsal aspect of the hand.     

肩胛背神经卡压征32例的临床治疗

目的观察肩胛背神经的局部解剖、分析肩胛背神经被卡压的因素及其治疗方法。方法对30具60侧陈旧性成人尸体进行解剖学观察,观察肩胛背神经的起点、行径及与周边的关系。分析32例肩胛背神经卡压征的治疗方法及随访结果。结果肩胛背神经的起始段常和胸长神经合干,由前内侧向后外侧从中斜角肌中穿过,此处常有腱性组织包绕,与胸长神经分开走行后,发出分支至肩胛部和腋下。32例中均作保守治疗,23例24侧疗效较好。7例8侧保守治疗无效,改作手术治疗,术后随访3个月至2年,症状完全或基本解除。结论肩胛背神经卡压大部分包括于胸廓出口综合征中,但也可以单独出现。治疗以局部封闭为首选,症状严重者可考虑手术治疗。     

Surgical anatomy of the axillary nerve within the quadrangular space

OBJECT: There is a paucity of literature regarding the surgical anatomy of the quadrangular space (QS), which is a potential site of entrapment for the axillary nerve. Muscle hypertrophy of this geometrical area and fascial bands within it have been implicated in compression of the axillary nerve. METHODS: Fifteen human cadavers (30 sides) were dissected for this study. Measurements of the QS and its contents were made. The mean height of this space was 2.5 cm and the mean width 2.5 cm; its mean depth was 1.5 cm. The axillary nerve was always the most superior structure in the space, and in all cases the nerve and artery hugged the surgical neck of the humerus just superior to the origin of the lateral head of the triceps brachii muscle. This arrangement placed the axillary nerve in the upper lateral portion of the QS in all cadaveric specimens. The nerve branched into its muscular components within this space in 10 sides (33%) and posterior to it in 20 sides (66%). The cutaneous component of the axillary nerve branched from the main trunk of the nerve posterior to the QS in all specimens. Fascial bands were found in this space in 27 (90%) of 30 sides. CONCLUSIONS: Knowledge of the anatomy of the QS may aid the surgeon who wishes to explore and decompress the axillary nerve within this geometrical confine.     

Morphological anatomy of thoracolumbar nerve roots and dorsal root ganglia

The aim of this study is to ascertain the anatomic parameters of the spinal roots and dorsal root ganglia and to demonstrate their clinical significance. Samples from 24 adult autopsy subjects were obtained from roots and dorsal root ganglia at levels L1 through L5. The anatomic parameters of epidural nerve roots: the distance between the epidural nerve roots and the proximal edge of the dorsal root ganglia and the average diameter of the nerve root gradually, increased from L1 to L5. The midline nerve root angle gradually decreased from L1 to L5. The anatomic parameters of subarachnoid nerve roots: the length of subarachnoid nerve roots and both the ventral and dorsal roots’ diameter, increased from L1 to L5. The number of ventral and dorsal rootlets per nerve root ranged from one to three. The anatomic parameters of dorsal root ganglia: the length and width of the thoracic and lumbar dorsal root ganglia, gradually increased from L1 to L5. The locations of the dorsal root ganglia were recorded as the intraspinal, intraforaminal and extraforaminal using some bony landmarks. Most dorsal root ganglia located intraforaminally, and the extraforaminal type is more common in the L5 root than other thoracic and lumbar roots, regardless of age. This knowledge is a must not only to avoid complications but also for the success, safety and effectiveness of microsurgical operations.     

Surgical anatomy of the musculocutaneous nerve: a photographic essay

The objective in this study was a microscopic dissection and examination of the musculocutaneous nerve. The origin of the musculocutaneous nerve and its relationship with the surrounding structures, motor and sensory branches, and fascicular structures were studied. The anastomoses between this nerve and other major nerves in the arm and forearm are also described.     

Surgical anatomy of the external branch of the superior laryngeal nerve

Background: The variations in the anatomy of the external branch of the superior laryngeal nerve (EBSLN) are generally classified according to the relationship of the nerve to the superior thyroid artery, or the superior pole of the thyroid. Both artery and superior pole are themselves variable landmarks, and therefore are not consistent between subjects. We sought to examine EBSLN anatomy in relation to alternate, more consistent surgical landmarks. Methods: Fifteen hemi‐larynges from 20 embalmed human cadavers were dissected anatomically. Each nerve was categorized using established classification systems, and terminal branching patterns were also noted. Nerve location was recorded in relation to three different constant anatomical structures: the laryngeal prominence, midline junction of the cricothyroid muscles and ipsilateral cricothyroid joint. Results: All cadavers were of European descent. The EBSLN had two branches to the cricothyroid muscle in 34% of cases. The EBSLN anatomical types found were mainly Cernea type 1 (80%), with 7% type 2a and 13% type Ni. An EBSLN was more likely to lie in an ‘at risk’ location if the subject was less than 160 cm tall. The EBSLN entered the crico‐thyroid muscle at a median distance of 14 mm lateral from the laryngeal prominence and 8 mm inferiorly. The median distance from the medial‐most point of the cricothyroid muscle junction was 14 mm laterally and 14 mm superiorly, and from the cricothyroid joint the entry lay a median distance of 10 mm superiorly and 11 mm medially. Conclusions: The variability of EBSLN anatomy is again evident, as is the need for careful and knowledgeable surgical technique. New surgical landmarks for the relations of the insertion of the EBSLN reveal a deployment range for each, but one of more of these landmarks may prove useful in thyroid surgery.     

Surgical anatomy of the internal branch of the superior laryngeal nerve

The internal branch of the superior laryngeal nerve (ibSLN) may be injured during anterior approaches to the cervical spine, resulting in loss of laryngeal cough reflex, and, in turn, the risk of aspiration pneumonia. Such a risk dictates the knowledge regarding anatomical details of this nerve. In this study, 24 ibSLN of 12 formaldehyde fixed adult male cadavers were used. Linear and angular parameters were measured using a Vernier caliper, with a sensitivity of 0.1 mm, and a 1° goniometer. The diameter and the length of the ibSLN were measured as 2.1±0.2 mm and 57.2±7.7 mm, respectively. The ibSLN originates from the vagus nerve at the C1 level in 5 cases (20.83%), at the C2 level in 14 cases (58.34%), and at the C2–3 intervertebral disc level in 5 cases (20.83%) of the specimens. The distance between the origin of ibSLN and the bifurcation of carotid artery was 35.2±12.9 mm. The distance between the ibSLN and midline was 24.2±3.3 mm, 20.2±3.6 mm, and 15.9±4.3 mm at the level of C2–3, C3–4, and at the C4–5 intervertebral disc level, respectively. The angles of ibSLN were mean 19.6±2.6° medially with sagittal plane, and 23.6±2.6° anteriorly with coronal plane. At the area between the thyroid cartilage and the hyoid bone the ibSLN is the only nerve which traverses lateral to medial. It is accompanied by the superior laryngeal artery, a branch of the superior thyroid artery. The ibSLN is under the risk of injury as a result of cutting or compression of the blades of the retractor at this level. The morphometric data regarding the ibSLN, information regarding the distances between the nerve, and the other consistent structures may help us identify this nerve, and to avoid the nerve injury.