胫神经束组及其血供的解剖学研究

目的　观察小腿段胫神经束组及其血供,为小腿段胫神经损伤修复或游离移植提供解剖学依据。 方法　①成人小腿标本26侧,分离胫神经主干及主要肌支,观察和测定各支横径、长度、起始位置、神经束无损伤分离长度。② 4侧新鲜成人小腿标本分别行动脉乳胶及墨汁灌注并制作透明标本,观察胫神经营养动脉。③ 4侧新鲜成人小腿标本上,死亡4 h内取下胫神经及分支并行胆碱酯酶染色,观察胫神经感觉束、运动束分布。 结果　胫神经主要肌支均在小腿8/8~6/8段分出,5/8~1/8段无重要肌支发出;胫神经干中内侧束组、外侧束组自然分束的距离长,平均为(361.4±7.1) mm;胫神经营养动脉丰富,胫后动脉与胫神经全程伴行,为其主要营养动脉;7/8~5/8段主要来自腓动脉,5/8~1/8段主要来自胫后动脉;胫神经内、外侧束组有相对独立的、完善的血供系统。 结论　胫神经上述解剖学特点为小腿部胫神经损伤的修复提供一定解剖学依据。小腿5/8~1/8段胫神经束组具有独立和完善血供系统,内外侧束组无损伤分离长度长,具备了带血供游离移植的供体神经解剖学特点。     

选择周围神经缝合方式的解剖学依据

神经外膜缝合法与神经束膜缝合法孰优尚有争论。本文认为缝合方式的选择应以神经干形态学结构为依据:外膜缝合法适用于混合束聚居处,结缔组织含量少的部位;束膜缝合法适用于功能束已经分开,结缔组织含量多的部位。根据解剖学研究,作者对四肢神经干的不同部位,有针对性地分析了应采用的缝合方式。     

骨骼肌桥接神经缺损研究的进展

战伤或创伤引起的周围神经断裂性损伤,当缺损的长度过大时,一般不宜采用直接拉拢缝合的方法进行修复。因为过份勉强的拉拢缝合,对神经牵拉的张力增大,容易出现神经干内的血循环障碍,再生神经在血供不良的环境中通过不顺利。超长段的神经缺损,两个断端无法接触,如果不用移植体进行桥接,近端神经发出的再生神经纤维到达缺损部位时,受阻于疤痕结缔组织,形成断端神经瘤,不能到达神经的远端,不能恢复神经通路的连续性,神     

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…     

带血供正中神经腕部感觉束转位桥接尺神经的解剖学基础

目的：探讨带血供正中神经腕部感觉束转位桥接尺神经缺损的解剖学基础。方法：14例成人上肢标本，观测腕部正中神经和尺神经的长度、神经束、血供等。摹拟带血供腕部正中神经感觉束转位桥接尺神经缺损术。结果：①正中神经腕部长度为7．8cm(7．5～8．1cm)。神经束数为19～27束，以感觉束为主，感觉束位于尺侧，运动束和混合束位于桡侧。感觉束无损伤分离长度为10．0～14．0cm。正中神经营养动脉距桡骨茎突上方6.2cm(6．1～6．6cm)处发自桡动脉，长度为5．7cm(5．1～6．1cm)，起始外径为1．2mm(1．1～1．4mm)。②尺神经腕部长度为9．4cm(8．9—9．7cm)，神经束数为14～19束，感觉束和运动束大致相等。感觉束位于掌挠侧，运动束位于背尺侧。结论：带血供正中神经腕部感觉束转位桥接尺神经缺损具有可行性。     

吻合血管移植周围神经的解剖学基础 Ⅱ、应用多种方法对周围神经内微血管的研究

用多种方法研究了神经干内的血管。神经内部血管以神经束膜为界被进一步分为神经外膜及束间血管网和神经束内微血管网。两个血管网的构型基本相似,是两个矩型网眼而大小级别不同的血管网。神经束微血管网的总面积与相应神经束的面积呈直线相关(γ=0.89)。不同神经,不同平面神经束的血管密度无显著性差异。因此,神经束的血管供给在形态学上基本相等。讨论分析了神经内血管系统在移植神经中用的重要作用。     

肘部尺神经及其血供的应用解剖学研究

目的 观察肘部尺神经及其血供,为临床带血供尺神经前移术治疗肘管综合征提供解剖学依据。 方法　①动脉灌注红色乳胶并防腐固定的30侧成人上肢标本,观测肘管段尺神经及其血供情况;游离1侧肘部尺神经及其供血动脉,观察神经与供血动脉的位置关系。②动脉灌注明胶-氧化铅悬液的成人新鲜标本6侧,游离尺神经及其营养血管,行X线摄片,观察尺神经营养血管的吻合情况。③动脉灌注红色乳胶并防腐固定的30侧成人上肢标本上模拟临床尺神经前移术,测量带血供尺神经无张力前移距离。 结果　肘部尺神经血供来自尺侧上副动脉（SUCA）、尺侧下副动脉（IUCA）和尺侧返动脉背侧支（PURA）,3条营养血管与尺神经平均伴行长度分别是15.7、5.0和5.9 cm;至肱骨内上髁距离分别是15.0、4.5和5.0 cm;带血供尺神经无张力性平均前移距离为1.8 cm。尺神经在肘部发出1~2支关节支,2~3支肌支。 结论　带血供尺神经前移术治疗肘管综合征切实可行,能很好的保护尺神经及其血供。     

正中神经鱼际肌支功能束定位显微外科解剖

目的 :为臂丛损伤后正中神经及其手内在肌支的定位提供显微外科解剖学基础。方法 :在较新鲜的上肢标本上 ,按照自然分束、醋酸浸滴法逆行显微解剖分离各功能束组 ,分段观察手内肌束组在神经干中的走行分布方位和与其他功能束的交错混合情况。结果 :(1)正中神经鱼际肌支 83 %自神经干掌桡侧汇入 ,至 5 /16平面 86%的鱼际肌支已分散到神经干截面积的 1/2以上。 (2 )正中神经鱼际肌支汇入神经干平面距尺桡骨茎突连线之间距离为 5 .3± 0 .7cm。结论 :.臂丛损伤修复正中神经手内在肌支时 ,以选择在前臂远端 (或以远 )直接修复为宜。     

SD大鼠腰骶部脊神经前根显微外科解剖学观察

目的:为实验性高选择性腰骶神经前根小束切断术治疗圆锥上损伤的痉挛性膀胱提供可靠的神经根分束的形态学依据.方法:对6只雄性SD大鼠L1-S4节段的脊神经前根自然分束进行形态学观察和显微测量.结果:粗细不一的神经小束从脊髓发出,几个神经小束形成一个神经亚束.2～6个神经亚束构成一个神经束,或由神经小束直接形成神经束.腰骶部脊神经前根一般含有1股神经束,3～13支神经小束.L5-S2节段前根的小束数目在5支以上.每一前根内有一支神经小束较粗大,直径0.1～0.2 mm左右,其余较细小,最小可至0.01 mm左右,粗细程度存在较大差异.结论:实验性高选择性腰骶部前根神经小束切断术的分束可达到神经小束水平,以7～8支为宜.     

正中神经掌皮支血供的显微解剖

在50例上肢标本,观察了正中神经掌皮支的血供,结果是正中神经掌皮支的营养动脉是来自民动脉干、桡动脉干,掌浅弓及桡动脉掌浅支的分皮,共135支,平均每条掌皮支为2.70支营养动脉,其营养动脉进入神经方式有伴入型、直入型及肌支型三种,营养动脉进入神经的方位有4种方向,即由外侧、内侧、前方和后方进入神经。     

Microsurgical anatomy of the facial nerve trunk

Dissection and manipulation of the facial nerve (FN) trunk between its exit from the cranial base through the stylomastoid foramen (SMF) and its bifurcation is a critical step in various otologic, plastic and neurosurgical procedures. This study demonstrates the anatomical relationships and variability of the FN trunk with emphasis on some important morphometric data, particularly with relevance to hypoglossal-facial nerve anastomosis (HFA). Bilateral microsurgical dissection was performed on twenty-three human cadavers fixed with formalin. The whole trunk of the FN was exposed, its diameter at the SMF and its length were measured, its branches were observed and the site of its bifurcation was determined. Anastomotic connections with other nerves and blood supply of the trunk were studied. The FN invariably emerged from the cranial base through the SMF. Its diameter upon its emergence from the foramen was 2.66 +/- 0.55 mm. Two branches consistently originated from the trunk: the posterior auricular nerve and the nerve to the digastric muscle. Less consistent were the communicating branch with the glossopharyngeal nerve and the nerve to the stylohyoid muscle. The bifurcation of the FN occurred before its penetration into the parotid gland in 15% of cases and within the gland in 85%. The length of the FN trunk was 16.44 +/- 3.2 mm. Anastomoses between the FN and other nerves were observed in one-third of the dissections. The blood supply to the FN trunk was provided by the stylomastoid artery that was identified in 91% of cases. Understanding the microsurgical anatomy of the FN trunk is essential for performing any surgical procedure in the relevant region. Surgical implications of this study are presented with emphasis on HFA surgery.     

1例永久性三叉动脉显微解剖与文献复习

目的：报道1例偶然发现的右侧永久性三叉动脉形态、特点，并进行文献复习。方法：利用显微解剖对此例永久性三叉动脉的起源、走行、分支、分布、与后循环连接关系、以及相关动脉解剖特点等进行了研究。结果：此例永久性三叉动脉与脑膜垂体干共干起源于颈内动脉海绵窦段，于展神经外侧进入后颅窝，分支与基底动脉和小脑上动脉吻合，其终末支之一延续为同侧的小脑下后动脉，此动脉与三叉神经关系密切，分支分布于脑干和小脑。结论：永久性三叉动脉与后循环关系复杂，广泛参与正常脑组织供血。     

尺神经中第七颈神经成份的行径及临床意义

用神经束追踪分离法解剖观察100侧成人第七颈神经分布至尺神经内的纤维行径。结合临床观察认为,尺神经内部有来自颈七的纤维,主要经4个交通部位加入到尺神经分布区内。证明脊神经相应节段与骨骼肌或肌群的支配关系是恒定的,只是由于在胚胎发生上臂丛组合的不同,使脊神经的分支到所支配的骨骼肌间的行径出现差异。上述研究结果,对臂丛中、下干损伤准确定位诊断有重要意义。     

Histomorphometry of the ulnar nerve and of its branches

A morphometric study has shown that 10% of the fibers of the ulnar nerve should suffice to reinnervate the biceps muscle in brachial plexus palsies. The aim of this study was to evaluate, by a morphometric study using computerized microanalysis, the cross-sectional surface areas of the different collateral and terminal branches of the ulnar nerve. This was expressed in terms of percentage of the cross-sectional surface area of the main trunk of the ulnar nerve. The study revealed that the branch to the flexor digitorum profundus bellies to the ring and little fingers formed 9.5% of the cross-sectional area of the ulnar nerve. Thus use of these fascicles destined for the flexor digitorum profundus, identified by intra-operative nerve stimulation, at the level of the arm would be sufficient for neurotisation of the nerve to the biceps. This has been confirmed by the initial clinical results in patients operated upon using this technique.     

人肌皮神经和臂丛功能束定位的组织化学法研究

采用乙酰胆碱酯酶组织化学法，研究了１０例成人肌皮神经的断面结构，并采用图像分析仪，对肌皮神经和臂丛各段断面的面积以及神经束的数目、面积和结缔组织面积进行了测量。结果表明：在肌皮神经远侧端断面，肌支束与皮支束截然分开，肌支束位于前外象限；臂丛束、股、干断面，３种纤维混合，在部分外侧束切片内可见感觉、运动纤维分区的现象。臂丛根部穿椎间孔处断面，运动、感觉与交感神经纤维各居一方。臂丛各段神经束的数目同近     

婴幼儿腮腺血管瘤摘除术相关应用解剖及临床应用

目的：为婴幼儿腮腺血管瘤摘除术提供解剖学基础。方法：采用血管乳胶灌注、显微解剖的方法对婴幼儿腮腺血供来源及其与面神经的关系进行解剖学观察。结果：颈外动脉直接分支及耳后动脉、颞浅动脉、面横动脉等的分支旧腮腺主要的供血动脉;婴幼儿面神经分支类型与成人无明显差异,主干位置恒定,易寻找,各分支纤细。结论：婴幼儿腮腺血管瘤手术时,应先行颈外动脉中段结扎,然后寻找面神经主干,沿主干分离各分支,这样可降低手术难     

尺神经及其血供在肘管综合征手术中应用解剖研穷

目的观察肘部尺神经及其血供,为尺神经前移术治疗肘管综合征提供解剖学基础。方法50侧成人上肢标本观察测量肘部尺神经及其血供情况。结果肘部尺神经血供有3个来源:尺侧上副动脉(IUCA)、尺侧下副动脉(IUCA)和尺侧返动脉后支(PURA),分别与尺神经伴行长度为(15.1±2.0)cm、(5.0±1.1)cm和(6.4±1.2)cm;尺神经在肘部发出1～2支关节支,2～3支肌支。结论行尺神经前移术治疗肘管综合征时保护尺神经及其血供是完全可能的。     

Semiquantifying of fascicles of the C7 spinal nerve in the upper and lower subscapular nerves innervating the subscapularis and its clinical inference in Erb's palsy

To elucidate anatomic basis of susceptibility for contracture of the subscapularis muscle in Erb's palsy of the brachial plexus, we semiquantitatively studied the spinal nerve origins of the subscapular nerves innervating the subscapularis, with special reference to the contribution of C7 innervation to the subscapularis. Thirty‐three sides of formalin‐fixed upper extremities were dissected to obtain the intact brachial plexus. After immersed in 10% acetic acid for 2 weeks, the upper and lower subscapular nerves innervating the whole subscapularis, were dissected retrogradely to verify their spinal nerve origins. The cross‐sectional area by C7 innervation and that by the upper trunk innervation was calculated respectively to obtain the constituent percentage of different components in the upper and lower subscapular nerves. In the upper subscapular nerve, fascicles of C7 accounted for 0% (interquartile range, 0–1.1%) of cross‐sectional area and those of the upper trunk, 100% (98.9–100%). In the lower subscapular nerve, fascicles of C7 accounted for 40.5% (23.5–47.5%) and those of the upper trunk, 59.5% (52.5–76.5%). In total, 18.6% (13.3–27.3%) of fascicles in the subscapular nerves innervating the subscapularis originated from C7, while 81.4% (72.7–86.7%) of those came from the upper trunk. It is confirmed that innervation of the subscapularis originates from more spinal cord segments than that of infraspinatus and teres minor, and this may be the main reason for which in Erb's palsy, functional recovery of the subscapularis is often faster than that of lateral rotators of the shoulder, resulting in medial rotation contracture of the shoulder. Clin. Anat., 2013. © 2012 Wiley Periodicals, Inc.     

Median nerve penetration by a muscular branch of the brachial artery

Arterial variations in the distal half of the arm are common (Anagnostopoulou and Venieratos 1999, J. Anat. 195:471-476). We observed a rare variant of a muscular branch of the brachial artery that penetrated the median nerve in the lower part of the arm. After its origin from the posteromedial surface of the brachial artery, the muscular branch passed through a nervous loop in the median nerve to enter and supply the brachialis muscle. At the site of arterial penetration, the nerve displayed perineurial thickening and increased fasciculation and interfascicular connective tissue. Three small branches of the artery supplied the nerve fascicles. We did not observe nerve compression or muscular changes, but the possibility of altered clinical symptoms produced by irritation from arterial pulsation cannot be ruled out. This variation may be clinically important because symptoms of median nerve compression arising from similar variations are often confused with more common causes, such as radiculopathy and carpal tunnel syndrome.