髂腹下神经、髂腹股沟神经和生殖股神经变异1例

国内外文献中关于髂腹下神经、髂腹股沟神经或生殖股神经的变异包括起源、行程、数目、分支分布等诸多情况[1～4].作者在解剖1具青年女性尸体时,发现其髂腹下神经、髂腹股沟神经和生殖股神经分支或分布都有异常.该变异尚未见文献报道.     

Anatomy of the ilioinguinal and iliohypogastric nerves with observations of their spinal nerve contributions

Proper anesthesia and knowledge of the anatomical location of the iliohypogastric and ilioinguinal nerves is important during hernia repair and other surgical procedures. Surgical complications have also implicated these nerves, emphasizing the importance of the development of a clear topographical map for use in their identification. The aim of this study was to explore anatomical variations in the iliohypogastric and ilioinguinal nerves and relate this information to clinical situations. One hundred adult formalin fixed cadavers were dissected resulting in 200 iliohypogastric and ilioinguinal nerve specimens. Each nerve was analyzed for spinal nerve contribution and classified accordingly. All nerves were documented where they entered the abdominal wall with this point being measured in relation to the anterior superior iliac spine (ASIS). The linear course of each nerve was followed, and its lateral distance from the midline at termination was measured. The ilioinguinal nerve originated from L1 in 130 specimens (65%), from T12 and L1 in 28 (14%), from L1 and L2 in 22 (11%), and from L2 and L3 in 20 (10%). The nerve entered the abdominal wall 2.8 ± 1.1 cm medial and 4 ± 1.2 cm inferior to the ASIS and terminated 3 ± 0.5 cm lateral to the midline. The iliohypogastric nerve originated from T12 on 14 sides (7%), from T12 and L1 in 28 (14%), from L1 in 20 (10%), and from T11 and T12 in 12 (6%). The nerve entered the abdominal wall 2.8 ± 1.3 cm medial and 1.4 ± 1.2 cm inferior to the ASIS and terminated 4 ± 1.3 cm lateral to the midline. For both nerves, the distance between the ASIS and the midline was 12.2 ± 1.1 cm. To reduce nerve damage and provide sufficient anesthetic for nerve block during surgical procedures, the precise anatomical location and spinal nerve contributions of the iliohypogastric and ilioinguinal nerves need to be considered.     

Retroperitoneal course of iliohypogastric,ilioinguinal, and genitofemoral nerves: A study to improve identification and excision during triple neurectomy

Triple neurectomy of the iliohypogastric (IHN), ilioinguinal (IIN), and genitofemoral (GFN) nerves is an available treatment option for chronic groin pain when conservative measures are ineffective. This research study attempted to define the variability of IHN, IIN, and GFN by categorizing variation and establishing a relationship to clinically significant landmarks. 22 cadavers (43 specimens) were dissected. Age, gender, ethnicity, BMI, and pertinent medical history were recorded for each specimen. Nerve emergence, insertion, and split points were measured in relation to clinically significant landmarks. Retroperitoneal trajectories of IHN, IIN, and GFN were analyzed and categorized based on nerve branching patterns. IIN and IHN had three branching patterns – type A (47%) in which the IIH and IIN exit as separate branches; type B (26%) in which the IIH and IIN exit as a single bundle and split; and type C (28%) in which the IIH and IIN exit and do not split. The GFN had three branching patterns—type 1 (50%) in which the GFN exited from the psoas major and then split into the genital and femoral branches; type 2 (30%) in which the GFN exited and did not split; and type 3 (20%) in which the GFN exited the psoas major already split into the genital and femoral branches. Variations in the IHN, IIN, and GFN nerves outlined in this study will provide surgeons with clinically useful information aiding in successful and efficient localization of these nerves during retroperitoneal procedures, including laparoscopic triple neurectomy. Clin. Anat. 28:903–909, 2015. © 2015 Wiley Periodicals, Inc.     

Emergence and course of the ilioinguinal nerve of the groin

The aim of our study was to find a way of preserving the ilioinguinal nerve during surgical procedures for the repair of inguinal hernias. 40 inguinal regions were dissected, 37 ilio-inguinal nerves studied. The emergence of the nerve was at 4.21 cm of the anterior superior iliac spine, at 0.78 cm of the inguinal ligament on average. Its course was parallel to the inguinal ligament, always lay under the aponevrosis of the external oblique abdominal muscle, it passed through the superficial abdominal ring in 67.56% before proceeding on anterior side of spermatic cord. This result allowed us to examine the possibility of the nerve course variation's, of anastomosis with iliohypogastric nerve and particularly the best way to identify it when surgical procedures are performed in the lower portion of the abdomen.     

Emergence and distribution of the ilioinguinal nerve in the inguinal region: applications to the ilioinguinal anaesthetic block (about 100 dissections)

The variations in the emergence and distribution of the ilioinguinal nerve are the cause of the failures of the ilioinguinal block and the difficulties at interpreting the ilioinguinal nerve syndrome. In order to identify its variations and set reliable anatomical landmarks for performing the ilioinguinal block, we dissected 100 inguinal regions of 51 adult corpses. The nerve was absent in seven cases and double in one case. The ilioinguinal nerve emerged from the internal oblique muscle, passing at 1 ± 0.8 cm of the inguinal ligament and 3.33 ± 2 cm of the ventral cranial iliac spine. It appeared behind the inguinal ligament and/or the ventral cranial iliac spine in 19 cases and presented a common trunk with the iliohypogastric nerve in 13 cases. In 47 cases, the nerve appeared in the form of a single trunk. Sixteen modes of division and eight types of predominantly anterior scrotal topographic distribution could be noted. These results show the high variability of the emergence and the sensory distribution of the ilioinguinal nerve. They enable us to propose techniques for ilioinguinal block performance using more accurate anatomical landmarks formed by the inguinal ligament and the ventral cranial iliac spine and a better diagnostic approach of ilioinguinal neuropathies.     

经改良髂腹股沟入路手术治疗髋臼骨折

目的:针对标准髂腹股沟入路的缺点进行改良。方法:1997年8月～2000年1月使用标准髂腹股沟入路治疗24例髋臼骨折,2000年2月～2003年11月使用改良髂腹股沟入路治疗35例髋臼骨折,记录每例的切口显露和关闭时间,术后常规拍X线片,对结果进行统计学检验。结果:标准和改良髂腹股沟入路组的切口显露时间(x±s)分别为(42.36±4.58)min和(29.64±3.19)min;切口关闭时间(x±s)分别为(52.42±6.64)min和(35.86±4.27)min。标准和改良髂腹股沟入路组达到解剖复位、复位欠佳和不满意复位的病例数分别为13、7、4例和29、4、2例。经统计学检验,P<0.05,差异具有显著性。结论:与标准髂腹股沟入路相比,改良髂腹股沟入路具有解剖相对简单、创伤小、手术时间短、显露充分、复位质量高、并发症少等优点。     

The adrenergic and AChE-positive nerves in pig vagina

The experiments were performed on 5 sexually immature and 6 mature pigs. The segments of vagina were collected and then cut by means of a freezing microtome. The adrenergic nerves were detected according to Torre and Surgeon's (1976) glyoxylic method, and examined under a fluorescent microscope. Presence of AChE-positive fibers was detected using Karnovsky-Roots (1964) method. Both the adrenergic and the AChE-positive fibres were found in all layers of vaginal and around the blood vessels. As results from the studies, pig vagina is much more innervated with AChE-positive nerves than with adrenergic ones. Distribution pattern of these fibers is similar in all layers of the vagina. No differences were found between innervation of vagina in sexually mature and immature pigs.     

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。     

The rat renal nerves during development

The prenatal and postnatal development of the innervation of the rat kidney has been investigated using immunocytochemical methods. The efferent innervation was studied using dopamine-beta-hydroxylase and neuropeptide Y antibodies. Calcitonin gene related peptide and substance P antibodies were used to investigate the afferent innervation. Kidneys from embryos of 14 to 20 days, from newborn rats, and from animals of 4, 10, 12, 21, 38, 60, and 90 days of age were studied. Slices of whole kidneys were analyzed, and frozen sections were used to investigate the location of the nerves in more detail. Both afferent and efferent nerves are observed inside the kidney by embryonic day 16. At birth, the afferent nerves are found (1) forming a rich plexus in the renal pelvis; (2) associated with the renal vasculature as far as the interlobular arteries (cortical radial arteries) and (3) in the corticomedullary connective tissue. The efferent innervation appears, at birth, to extend to the interlobular arteries and to the afferent arterioles of the perihilar juxtamedullary nephrons. The efferent innervation increases rapidly during the following days, and by postnatal day 21 a distribution of the innervation similar to that of the adult is observed. While the afferent innervation reaches the major target regions of the kidney by birth, the efferent does most of its expansion into the kidney postnatally. Afferent and efferent fibers are found, extrarenally and intrarenally, in the same nerve bundles. This proximity between afferent and efferent fibers may represent anatomical bases for their interaction in the adult as well as during development.Supported by U.S. Public Health Service Grant Rol 18340 from the National Institute of Health     

颈部脊柱部分结构的神经分布

对10具完整成人男尸颈部椎间盘、前纵韧带及椎前筋膜的神经支配进行了观察,颈部脊柱及其周围组织的神经支配丰富。由颈交感干和节直接发支到椎前筋膜,并由此分布至颈部软组织;至椎间盘的神经来自颈交感干及节、脊神经腹侧支和椎动脉神经丛;达前纵韧带的神经单独发自交感干和交通支。为了证实是神经组织,对3例2～5岁新鲜童尸作了组织学检查。     

The clinical anatomy of accessory mental nerves and foramina

Since three‐dimensional computed tomography was developed, many researchers have described accessory mental foramina. The anatomical and radiological findings have been discussed, but details of accessory mental nerves (AMNs) have only been researched in a small number of anatomical and clinical cases. For this article, we reviewed the literature relating to accessory mental foramina (AMFs) and nerves to clarify aspects important for clinical situations. The review showed that the distribution pattern of the AMN can differ according to the position of the accessory mental foramen, and the reported incidence of AMFs differs among observation methods. A review of clinical cases also revealed that injury to large AMF can result in paresthesia. This investigation did not reveal all aspects of AMNs and AMFs, but will be useful for diagnosis and treatment by many dentists and oral and maxillofacial surgeons. Clin. Anat. 28:848–856, 2015. © 2015 Wiley Periodicals, Inc.     

组织工程化人工神经研究进展

利用各种神经导管可成功桥接修复短段周围神经缺损已为许多学者公认 ,但是 ,这些神经导管由于缺乏许旺细胞或内部支架来支持、促进神经再生轴突长距离生长 ,因此不能有效修复长段周围神经缺损[1,2 ] 。应用组织工程技术构建神经导管 ,为修复长段周围神经缺损提供了新的方法和思路。这项研究的核心是模拟周围神经天然结构 ,将许旺细胞与生物支架材料有机结合成为类似Ｂ櫣ｎｇｎｅｒ带的结构 ,为再生神经提供良好的生长环境 ,充分发挥许旺细胞对再生神经的营养 ,诱导作用 ,从而促进神经的再生。组织工程化人工神经的主要内容是将经体外培养扩…