下颈椎侧方入路的应用解剖

目的 :为下颈椎侧方入路提供应用解剖学基础。方法 :在 3 0具成人尸体标本上 ,沿胸锁乳突肌后缘 ,对应C5～ 7椎体作纵切口 ,由浅入深分别经臂丛前、后方逐层解剖观测至椎骨的解剖结构。结果 :①臂丛前方有前斜角肌、膈神经和甲状颈干 ;椎体前方有颈长肌 ,颈交感干位于颈长肌的外侧缘 ,椎动脉贴颈长肌外缘上行入横突孔 ;②臂丛后方有中、后斜角肌及肩胛提肌 ,椎弓两侧有项部肌 ;颈深动、静脉走在半棘肌和多裂肌之间 ;③臂丛颈 5～ 8四个根的长度分别是 3 3± 8.6、2 7.2± 7.4、3 8.8± 8.6和 2 0 .4±6 .0mm ;根角度 (神经根于椎间孔处与椎体垂线的夹角 )分别是 43°± 9°、5 2°± 10°、6 2°± 10°和 74°± 7° ,相邻神经根间隙距离为 :C5～ 6 :5 .3± 1.7mm ;C6～ 7:5 .6± 1.6mm ;C7～ 8:6 .0± 1.6mm ;④胸膜顶在第 7颈椎末端下方平第 1肋颈高度。结论 :下颈椎侧方入路可一次切除半侧颈椎骨的病灶。在臂丛前方径路中要保护好膈神经、椎动脉、交感干 ;臂丛后方径路中保护好胸长神经和肩胛背神经 ;处理横突时要注意对臂丛根的保护。     

腋神经的显微外科解剖

本文在25具(男13,女12)专供研究用成人尸体上,应用显微外科解剖技术,对50侧腋神经的臂丛来源,分支及其分支部位,长度,宽、厚度和神经束等进行观察测量。腋神经主干的长度平均为44.56±1.20mm,是臂丛五大分支中最短的神经干之一,其起始处、中点处和分支处的宽、厚度分别为3.45±0.11、1.97±0.05mm,3.80±0.11、1.90±0.05mm,5.43±0.13、1.93±0.06mm。前述三处的神经束分别有:2.88±0.19、 3.88±0.23和5.62±0.24个。此外还观察了腋神经各分支的神经束,讨论了有关临床应用注意点。     

椎管内臂丛前后根的显微解剖及其临床意义

目的:研究臂丛椎管内前后根的显微解剖,为臂丛撕脱伤的诊治提供解剖学基础。方法:在15例防腐灌注红色乳胶的成人尸体的颈胸段标本上,对椎管内臂丛前后根的位置、形态和血供进行观察和测量。结果:臂丛前后根之间有齿状韧带相间隔;前根起始处与脊髓中线的距离从上至下由C5的2.2mm逐渐增大到T1的3.1mm,后根则从C5的4.2mm逐渐减小到T1的2.7mm;前后根与脊髓纵轴的夹角从C5的51.4°、54.8°逐渐减小到T1的21.7°、19.9°;前后根的长度从C5的14.9mm、13.9mm逐渐增大到T1的21.1mm、19.0mm;前后根的直径均以C6最为粗大,分别为2.1mm、3.3mm,后根比相应前根粗;前后根的血供来自椎动脉、颈深动脉和颈升动脉发出的节段性动脉。结论:熟悉臂丛椎管内前后根的显微解剖有助于临床臂丛根性撕脱伤的诊治。     

臀丛神经损伤的诊断

<正> 文中报告了684例臂丛神经损伤病例。结合术前、术后功能检查,并对各臂丛神经恨的机能支配及其临床意义进行了分析。提出了臂丛神经损防的诊断步骤:(1) 有无臂丛神经损伤;(2) 判断损伤部位;(3) 根、干、束、支的定位诊     

正中神经副根变异1例

<正>笔者在解剖1具男性尸体时,发现其左侧正中神经起始部位存在1副根变异。经查阅相关资料,此类变异较为少见,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。尸体来源于华北理工大学基础医学院解剖学教研室,成年男性,50岁左右,身长168cm。该例左侧臂丛各根、干、股、束形成正常。正中神经由来自臂丛内、外侧束的3根合成,其中1根来自臂丛内侧束,2根来自臂丛外侧束(包括1外侧主根和1外侧副根)。正中神经内侧根自臂丛内侧束发出,长5.     

神经电生理技术在臂丛神经损伤定位诊断中的应用价值

目的:探讨神经电生理检查在臂丛神经损伤定位诊断中的应用价值。方法:选择2013年6月至2018年2月就诊于泉州市正骨医院的臂丛神经损伤患者65例,其中男46例,女19例。病程6 d～4年,年龄2个月～85岁,右侧臂丛神经损伤34例,左侧臂丛神经损伤31例,所有患肢分别进行运动传导速度(MCV)、末端潜伏期(LAT)、复合肌肉动作电位(CMAP),感觉传导速度(SCV)、感觉神经动作电位(SNAP)及尺神经运动F波检测,对其异常结果进行分析,观察神经损伤情况。同时用同心针电极对受损神经所支配的肌肉进行肌电图检查。结果:65例患者中,其中全臂丛损伤6例,臂丛(C5+C6根性)损伤7例,臂丛(C5根性)损伤6例,臂丛神经上中干损伤8例,臂丛神经上中下干损伤7例,臂丛神经上干损伤5例,臂丛神经束支部损伤20例,臂丛锁骨上下联合损伤6例。其中合并多发周围神经损害1例,合并尺神经肘段损伤1例,合并副神经损伤3例,膈神经损伤2例。结论:神经电生理检查可以提供臂丛神经五大分支(腋神经、肌皮神经、桡神经、正中神经、尺神经)的功能状态、受损程度及损伤部位,对临床诊断、治疗和预后判断起着重要作用。     

锁骨中点内上方阻滞臂丛神经的解剖学

目的:为临床麻醉工作者提供锁骨中点上方阻滞人路方法.方法:在经10％甲醛溶液固定的60侧头颈、上肢标本及锁骨中点矢状切断面标本上测量臂丛的长度、第1肋上面臂丛神经3束汇合处的直径,确定臂丛阻滞进针点、进针方向、进针角度、进针深度、确定锁骨下动脉的保护角度.结果:臂丛神经的长度为108.09mm±12.49 mm;第1肋...     

尺神经与桡神经共干起自后束1例

在标本解剖过程中,发现1例成年男性尸体标本左侧尺神经起自臂丛后束并与桡神经共干(图1),现报道如下:左侧臂丛的各根、干、股形成正常。腋窝内臂丛的内侧束、外侧束和后束围绕在腋动脉周围。臂丛后束发     

尺神经、肘管的解剖学观察及临床意义

目的解剖学观察测量成人尺神经、肘管的形态结构,为临床手术治疗肘管综合症提供解剖学基础。方法采用解剖学方法对成人尸体26具(男16具,女10具)解剖观察测量肘管后壁长度,切开肘管后壁,将尺神经前移,测量其前移的最大距离。结果肘管后壁长度:男性为(2.38±0.43)cm,女性为(2.15±0.38)cm;切开肘管后壁将尺神经前移至肱骨内上髁前方皮下,最大前移的距离:男性为(1.53±0.31)cm,女性为(1.38±0.41)cm。结论临床手术治疗肘管综合症,切开肘管后壁进行时,可切开长度在2.15~2.38 cm,肘管内尺神经前移距离在1.38~1.53 cm之间,不会产生术后神经张力增加。     

臂丛分支多处变异

<正>笔者在解剖1具老年男性尸体时,发现臂丛的中干前股与尺神经和正中神经内侧根存在交通支,并有低位型正中神经,以及肩胛下神经与胸背神经等多处变异。经查阅国内相关文献未见报道,为积累国人解剖学数值和临床臂丛手术提供变异参考,现报道如下。1中干前股与尺神经和正中神经内侧根分别有交通支中干发出2股,1股向后并入后束,另一股向前与上干前股汇成外侧束,在距外侧束发出起始点9.92 mm处发出1支交通支(起始点外径1.16 mm,终点外径2.64 mm),该交通支走行26.24 mm后又分出2支,1支走行22.82 mm后并入正中神经     

Anatomical Study of the Brachial Plexus in the Common Marmoset (Callithrix Jacchus)

To elucidate the forelimb phylogeny of primates, anatomical analysis of the brachial plexus in platyrrhines is beneficial. In the present study, six brachial plexuses and the surrounding arteries of four common marmosets were dissected. In five specimens, the brachial plexus consisted of five ventral rami from the fifth cervical nerve (C5) to the first thoracic nerve (T1). In one specimen, the ventral ramus of the fourth cervical nerve joined with the brachial plexus. In five specimens, the upper trunk was composed of C5 and the sixth cervical nerve (C6). In one specimen, the ventral division of C6 merged with the ventral branch of the middle trunk to constitute the lateral cord. The seventh cervical nerve constituted the middle trunk, and the eighth cervical nerve and T1 formed the lower trunk in all specimens. The lateral cord gave rise to the musculocutaneous nerve, and the remaining component merged with the medial cord. The confluence of the lateral and medial cords immediately bifurcated into the median and ulnar nerves. These branching patterns of the musculocutaneous, median, and ulnar nerves were consistent and similar to the human counterparts. In the dorsal division, the single posterior cord as observed in the human brachial plexus was not observed. The axillary artery did not pass between the medial and lateral roots of the median nerve, and the axillary artery bifurcated into the brachial artery and the superficial brachial artery. Anat Rec, 300:1299–1306, 2017. © 2017 Wiley Periodicals, Inc.     

Modified grant method protocol for dissecting and identifying the brachial plexus

Dissection of the brachial plexus is an important part in the anatomical course, but it is difficult for medical students to identify individual nerves of the brachial plexus due to its complexity and numerous variations. We have recently adopted the Grant method (1991) to guide students in the successful identification of this plexus. However, according to the Grant method the part of the upper limb including the brachial plexus is dissected before the neck part, which makes it impossible to identify the roots, trunks, and cords of the brachial plexus, and to identify the nerve branches extending from the brachial plexus. Here, we propose of anatomical dissection protocol of the brachial plexus a modified Grant method for medical students and instructors. The points of the modified protocols are: (1) to dissect the brachial plexus after the dissection of the neck part, (2) to identify the nerve trunks at the scalenus gap after dissecting the lateral, medial and posterior cords. The modified Grant method can be adapted to any other dissecting protocol of the brachial plexus, and will allow students to cope with many variations of the brachial plexus when they occur.     

Musculocutaneous and median nerve branching: anatomical variations. Case Series from UR clinical anatomy and literature review

IntroductionThe brachial plexus is highly variable, which is a well-known anatomical fact. Repeated observations on anatomical variations, however, constitute current trends in anatomical research.Case seriesIn an anatomical dissection course, three uncommon variations in the brachial plexus were identified in three young adults'' cadavers. In one case, the musculocutaneous nerve gave a branch to the median nerve, while the median nerve gave or received musculocutaneous branches in the two remaining corpses.ConclusionAnatomical variations of the brachial plexus do occur in our setting. The cases we presented are about anatomical variations of branching patterns of the median and musculocutaneous nerves. Knowledge of those variations is essential for surgery and regional anesthesia of the upper limbs.     

膈神经的解剖及临床应用研究进展

目的:为膈神经移位治疗臂丛根性撕托伤,提供应用解剖学资料.方法:查阅与膈神经移位治疗臂丛根性撕托伤相关的解剖与临床文献资料,分析其应用价值和意义.结果:提供膈神经在颈部、胸腔内和膈肌内的走行、位置、毗邻及分支分布资料.结论:膈神经移位是用来治疗臂丛根性撕托伤的主要动力神经;臂丛探索仍是诊断臂丛损伤的全标准.     

Technical note: the design of a stereotactic frame for direct MRI-anatomical correlation of the brachial plexus

The purpose of this study was to identify optimal magnetic resonance imaging (MRI) conditions to visualize discrete alterations of brachial plexus components, as part of a biomechanical study of minor nerve compression syndromes. A method was developed allowing direct comparison between the MRI image and the subsequently obtained matching anatomic section of the same specimen. We designed a stereotactic frame to obtain the precise orientation of the MRI plane with reference to the specimen and adapted a vertical band saw for multiplanar sectioning of cadaveric specimens. Two cadaveric upper quadrants were examined by MRI (TR 450 ms, TE 13 ms, pixel matrix 512 × 512 and FOV 23–26 cm) and anatomical slices were produced. One specimen was sectioned axially, while the second specimen was sectioned in an oblique plane corresponding to the natural longitudinal axis of the upper part of the brachial plexus. MR images and the corresponding slices exhibited a strong correlation. This correlation was checked by using vitamin A pearls as landmarks. MR images revealed more detail after the correlating anatomical slices were analyzed. The present study shows that the method is suited for direct MRI-anatomic comparison of the brachial plexus and is also proposed for application to other topographical regions.     

臂丛根部的显微外科解剖研究及其临床意义

为进一步认识臂丛神经诸根间根部损伤后其病理特点差异的形态学基础，用显微外科解剖及ＨＥ，Ｍａｓｓｏｎ＇ｓ染色组织病理检查方法对椎管内臂丛神经诸根的显微结构进行观测。结果提示：臂丛神经诸根之间在解剖结构上存在一定的差异，由于这种差异的存在，造成颈５．６神经根在受到同等暴力作用下较７．８及胸１神经根不易形成根性撕脱。即使颈５．６神经根根性撕脱，亦往往伴有节后损伤。作者认为对于臂丛上干近椎间孔的节后损伤，     

膈神经移位至臂丛上干前股的临床应用及疗效分析

目的：报道膈神经移位至臂丛上干前股的临床应用，分析疗效欠佳的原因并探讨应对措施。方法：回顾白1999年3月-2005年2月行膈神经移位至臂丛上干前股术式的38例患者手术情况，对肌皮神经恢复情况进行随访并功能评定，并对影响疗效的各因素进行分析以探讨相应的防治措施。结果：获15个月以上随访患者共29例，优良率为62．1％，功能恢复优良组与非优良组患者的病程及牵拉伤比率存在显著性差异（P〈0.05）。再手术探查发现手术失败的原因有：神经吻接口张力大、存在臂丛的组成变异及多段损伤等。基于神经解剖特点，作者针对减低膈神经吻接口张力提出了手术改良措施并取得满意的疗效。结论：影响该术式疗效的因素有多种，严格把握手术适应症及术中仔细探查是提高治疗效果的关键；通过术式改良可有效降低神经吻接口张力，有助于神经恢复。     

Absence of musculocutaneous nerve: two case reports

Anomalies of the brachial plexus including its terminal branches as well as the course and distribution of the nerves in the upper limb have been reported in the literature. Two cases of absent musculocutaneous nerve from the lateral cord of the brachial plexus encountered during routine gross anatomical dissection are reported. The median nerve took over the area of supply of the musculocutaneous nerve by giving both the muscular and sensory branches. Out of 24 upper limbs dissected, the musculocutaneous nerve was found to be absent in 8% of the cases. The clinical implications of the absent musculocutaneous nerve and its etiology in light of its development is discussed.     

Innervation of the elbow joint: Is total denervation possible? A cadaveric anatomic study

The aim of this anatomical study was to find out if total denervation of the elbow joint is technically feasible. The endbranches of the brachial plexus of eight fresh-frozen upper arm cadavers were dissected with optical loupe magnification. All major nerves of the upper limb (except the axillary and the medial brachial cutaneous nerve) give some terminal articular endbranches to the elbow. The articular endbranches arise from muscular endbranches, cutaneous endbranches, or arise straight from the main nerves of the brachial plexus. A topographic diagram was made of the different nerves innervating the elbow joint. The ulno-posterior part of the elbow is innervated by the ulnar nerve and some branches of medial antebrachial cutaneous nerve. The radial-posterior part of the elbow is innervated exclusively by the radial nerve. The ulno-anterior part of the elbow is innervated by the median nerve and the musculocutaneous nerve. The radio-anterior part of the elbow is innervated by the radial nerve and the musculocutaneous nerve. These elbow innervation findings are relevant to both anatomical and clinical field as they provide evidence that the total denervation of the elbow joint is impossible. Nevertheless, partial denervation, like denervation of the lateral epicondyle or the ulnar part of elbow, is technically possible.     

肌间沟臂丛神经阻滞相关结构的观测

目的为肌间沟臂丛神经阻滞入路和预防并发症的发生提供解剖学基础。方法对50侧尸体颈部与肌间沟臂丛神经阻滞入路相关结构及其毗邻关系进行了解剖观测。结果肌间沟臂丛神经穿刺进针深度(即皮肤至第6颈椎横突距离。从环状软骨向后引一直线与胸锁乳突肌后缘相交点处的皮肤进针)为(18±1.4,12～22)mm。获得了与臂丛穿刺相关结构的观测结果。结论为肌间沟臂丛神经阻滞入路和预防并发症的发生提供了解剖学依据。