臂后侧手术入路的应用解剖

目的 :为臂后侧手术入路提供解剖学基础。方法 :在 2 0具尸体标本上对臂后侧手术入路有关的血管、神经进行解剖观察。结果 :桡神经在肱骨内上髁上方 (18.2± 0 .4)cm ,臂后中线鹰嘴上方 (13 .9± 1.3)cm ,肱骨外上髁上方 (8.4± 1.4)cm跨过肱骨后面。桡神经在桡神经沟以上发出肱三头肌长头支、肱三头肌内侧头—肘肌支、内侧头支和前臂后皮神经 ,在桡神经沟内发出肱三头肌外侧头支。肱三头肌内侧头—肘肌支走行于臂后中线的稍外侧 ,于臂后中线的稍内侧切开肱三头肌内侧头可避免损伤该神经。结论 :①肱骨后面中下部骨面宽阔而平坦 ,可放置各种类型的钢板 ;②肱骨下段后面无重要的血管、神经 ,手术较安全 ;③臂后侧手术入路适合于肱骨中下段骨折等手术处理。     

肱三头肌额外头多肌腹异常1例

在教学中发现,肱三头肌额外头多肌腹异常1例。该成年男尸左臂肱三头肌长头上方出现额外头,额外头起于肩胛冈外侧端,止于肱骨外科颈稍下方。肱三头肌长头异常发达,起于盂下结节,其肌纤维由内上向外下走行,呈螺旋状,内外侧头均有异常双肌腹出现,外侧头双肌腹均起于肱骨桡神经沟上外,内侧头两条肌腹并列起于桡神经沟下内,独立走行,在尺骨鹰嘴上方汇合成一条肌腱与长头和外侧头的肌腱共同止于尺骨鹰嘴(图1)。肌腹间均可见桡神经的分支,其中支配内侧头的分支为桡神经穿桡神经管后发出,当肱骨中部骨折,损伤桡神经时,除出现垂腕,同时会伴有屈肘力减弱的症状。     

肱三头肌额外头异常一例

解剖发现肱三头肌起始处异常1例。该尸为中年女性,其左侧肱三头肌起始处共有4个头,长头起自肩胛骨的盂下结节,外侧头和内侧头分别起自肱骨桡神经沟的外上方和下方,在长头和外侧头之间的额外头起于肩胛冈中部,四头汇合形成肌腹,以肌腱止于尺骨鹰嘴,桡神经的一分支在额外头与外侧     

胸大肌异常肌腱止于肱骨内上髁一例

在解剖一具成年男性尸体标本时,在其左侧臂前部深筋膜与肱二头肌内侧头肌腹之间观察到一条变异肌腱,起于左侧胸大肌肌腱终止于肱骨大结节嵴处,止于肱骨内上髁,腱宽0．15cm,腱长23cm。该腱自胸大肌肌腱内侧缘下行,有来自胸大肌下部的肌腱纤维汇人,斜向内下,走行于臂部深筋膜的深面和肱二头肌内侧头肌腹的浅面,而后跨过肌皮神经的前臂外侧皮神经、肱动脉、肱静脉、正中神经,在肱三头肌内侧头前面与臂内侧肌间隔相连,最后止于肱骨内上髁。     

桡神经肱三头肌支转位修复腋神经的应用解剖

目的:为桡神经肱三头肌支转位修复腋神经提供解剖学基础.方法:观测50侧上肢标本桡神经肱三头肌支的起点、横径、无损伤分离长度,测量腋神经前、后支起点、横径;在2侧新鲜上肢标本上切取上述肌支,乙酰胆碱酯酶(AchE)染色组织学观察神经束性质,体视显微镜下神经纤维计数.结果:肱三头肌每个头均有桡神经发出的的2～4支肌支,桡神经肱三头肌各肌支与腋神经前支在横径、纤维数上相近,长头及内、外侧头肌支可分离长度大于其起点与腋神经起点间的距离.结论:腋神经损伤后,桡神经肱三头肌支可转位修复腋神经重建肩外展功能.     

头静脉变异1例

头静脉起自手背静脉网的桡侧,在臂前区,行于肱二头肌外侧沟内,经三角肌胸大肌间沟内穿锁胸筋膜注入腋静脉或锁骨下静脉[1].贵要静脉起自手背静脉网的尺侧,行于肱二头肌内侧沟的下半,穿臂筋膜注入肱静脉或胶静脉.     

桡神经浅支缺如兼有副拇长屈肌和巨乙状结肠一例

在对一具老年女尸行层次解剖时，发现其左侧上肢桡神经浅支缺如，被前臂外侧皮神经替代，兼有副拇长屈肌；且有先天性巨乙状结肠。集诸多变异畸形于一身，实属罕见。1．桡神经浅支缺如左侧上肢桡神经于肱骨外上髁后上方穿臂外侧肌间隔进入肘窝，走行于肱肌与肱桡肌之间的沟中，     

右侧头静脉走行及注入点变异1例

在解剖l例成年男尸时,见其右侧头静脉走行及注入点变异(图1),此变异罕见[1,2],为积累国人解剖学资料及为临床诊疗提供形态学依据,现报道如下: 该男尸右侧的头静脉自手背静脉网的桡侧发出,逐渐转至前臂前面的桡侧上行,其在前臂的走行正常.头静脉在肱骨外上髁所在冠状面以下2.55 cm处与肘正中静脉呈18.5°角相交通(此处头静脉压扁外径为4.64 mm),之后头静脉沿肱肌外侧沟行向外上方,其走行11.49 cm后在肱三头肌外侧头与肱肌之间注入肱深静脉,注入点压扁外径为3.72 mm.     

桡神经浅支缺如一例

作者在进行连续层次解剖过程中,于28例尸体中发现一例尸体的左上肢桡神经浅支缺如。为积累国人资料和提供临床参考,报告如下。男性老年尸体,身长150.8cm,坐高82cm。左上肢桡神经在肱骨外上髁后上方,穿臂外侧肌间隔,进入肘窝,位于肱二头肌腱外侧,走行在肱肌与肱桡肌之间的沟中。桡神经在 Frohse 氏腱弓上缘未     

桡神经深支的体表定位及其临床意义

目的:建立桡神经深支的体表定位方法。方法:取成人尸体标本48具(96侧上肢标本),显露桡神经深支,在前臂中立位,分别测量桡神经深支发出点与肱桡关节线的距离、桡神经深支穿出旋后肌的部位与肱桡关节线的距离及其与肱骨外上髁和Lister结节连线的水平距离、桡骨茎突与肱桡关节线的距离,并作统计学分析。结果:桡神经深支自桡神经主干发出的位置在肱桡关节上方平均为(15.4±2.5)mm。桡神经深支穿出旋后肌的部位均位于肱骨外上髁与桡骨Lister结节连线的尺侧,与连线的水平距离平均为(6.1±2.1)mm,与肱桡关节线的平均距离为(61.3±17.6)mm。结论:桡骨小头正前方或略偏外侧可作为桡神经深支近端的定位标志,肱桡关节线下方约6cm,肱骨外上髁与桡骨Lister结节连线尺侧约0.6cm可作为桡神经深支远端的定位标志。     

Surgical anatomy of the radial nerve at the elbow

An anatomical study of the brachial portion of the radial nerve with surgical implications is proposed. Thirty specimens of arm from 20 fresh cadavers (11 male, 9 female) were used to examine the topographical relations of the radial nerve with reference to the following anatomical landmarks: acromion angle, medial and lateral epicondyles, point of division between the lateral and long heads of the triceps brachii, lateral intermuscular septum, site of division of the radial nerve into its superficial and posterior interosseous branches and entry and exit point of the posterior interosseous branch into the supinator muscle. The mean distances between the acromion angle and the medial and lateral levels of crossing the posterior aspect of the humerus were 109 (±11) and 157 (±11) mm, respectively. The mean length and calibre of the nerve in the groove were 59 (±4) and 6 (±1) mm, respectively. The division of the lateral and long heads of the triceps was found at a mean distance of 126 (±13) mm from the acromion angle. The mean distances between the lateral point of crossing the posterior aspect of the humerus and the medial and lateral epicondyles were 125 (±13) and 121 (±13) mm, respectively. The mean distance between the lateral point of crossing the posterior aspect of the humerus and the entry point in the lateral intermuscular septum (LIS) was 29 (±6) mm. The mean distances between the entry point of the nerve in the LIS and the medial and lateral epicondyles were 133 (±14) and 110 (±23) mm, respectively. Our study provides reliable and objective data of surgical anatomy of the radial nerve which should be always kept in mind by surgeons approaching to the surgery of the arm, in order to avoid iatrogenic injuries.     

Topographical anatomy of the radial nerve and its muscular branches related to surface landmarks

Understanding of the anatomy of the radial nerve and its branches is vital to the treatment of humeral fracture or the restoration of upper extremity function. In this study, we dissected 40 upper extremities from adult cadavers to locate the course of the radial nerve and the origins and insertions of the branches of the radial nerve using surface landmarks. The radial nerve reached and left the radial groove and pierced the lateral intermuscular septum, at the levels of 46.7, 60.5, and 66.8% from the acromion to the transepicondylar line, respectively. Branches to the long head of the triceps brachii originated in the axilla, and branches to the medial and lateral heads originated in the axilla or in the arm. The muscular attachments to the long, medial, and lateral heads were on average 34.0 mm proximal, 16.4 mm distal, and 19.3 mm proximal to the level of inferior end of the deltoid muscle, respectively. The radial nerve innervated 65.0% of the brachialis muscles. Branches to the brachioradialis and those to the extensor carpi radialis longus arose from the radial nerve above the transepicondylar line. Branches to the extensor carpi radialis brevis usually arose from the deep branch of radial nerve (67.5%); however, in some cases, branches to the extensor carpi radialis brevis arose from either the radial nerve (20.0%) or the superficial branch of the radial nerve (12.5%). Using these data, the course of the radial nerve can be estimated by observing the surface of the arm. Clin. Anat. 26:862–869, 2013. © 2012 Wiley Periodicals, Inc.     

Unusual insertion of the coracobrachialis muscle to the brachial fascia associated with high division of brachial artery

Anatomical variations of the coracobrachialis muscle (CBM) are common. We detected an abnormal form of the CBM of the left arm during human cadaver dissection. The CBM originated from the tip of the coracoid process of the scapula and divided into muscular and musculo-aponeurotic bellies. The muscular belly inserted into the middle of the anteromedial surface of the humerus, which is the normal anatomic insertion point of the CBM. The musculo-aponeurotic belly inserted into the medial intermuscular septum as well as the brachial fascia, creating a tunnel for the passage of the brachial artery. Inside the tunnel, the brachial artery bifurcated into the radial and ulnar arteries. No abnormality of the CBM, the brachial artery, or the median nerve was detected in the contralateral arm. The phylogenic, ontogenic, functional, and clinical importance of this variant muscle is described. Knowledge of such variations is of considerable importance during invasive and non-invasive investigative procedures or orthopedic, reconstructive, or surgical procedures.     

带血管蒂肱骨中段骨膜瓣移位术的应用解剖

目的 :为带血管蒂肱骨中段骨膜瓣移位术提供解剖学依据。方法 :在 3 8侧经动脉灌注红色乳胶的成人尸体上肢标本上对肱骨中段前内侧面和部分前外侧面骨膜血管的来源、走行、分支、分布及吻合进行观测 ,并在 4侧标本上摹拟手术实验。结果 :旋肱前动脉主干行经喙肱肌和肱二头肌短头深面 ,绕肱骨外科颈外进至结节间沟外侧缘处分出升支和降支 ,升支上行分布于肱骨头及小结节部 ,降支有 2条分别沿胸大肌止腱内、外侧紧贴骨膜下行 ,为内侧降支和外侧降支。肱动脉肌间隙支自肱动脉发出后向外上走行至三角肌止端内侧发一升支即直接骨膜支上行连接旋肱前动脉的内侧降支。结论 :以旋肱前动脉内侧降支和肱动脉肌间隙支为蒂的肱骨中段骨膜瓣移位可用于修复肱骨头缺血性坏死和肱骨上、中段骨不连、骨缺损。     

Two bellies of the coracobrachialis muscle associated with a third head of the biceps brachii muscle.

Reports that describe the abnormalities and complexities of the anatomy of the arm are important with regard to surgical approaches. This case study reports a combined abnormal form of the coracobrachialis and biceps brachii muscles of the left arm of an adult male cadaver that was detected during the educational gross anatomy dissections of embalmed cadavers. The coracobrachialis muscle demonstrated two bellies which formed shortly inferior to its origin from the coracoid process of the scapula. One belly inserted into the middle of the antero-medial surface of the humerus, whereas the other belly inserted into the medial head of the triceps brachii muscle. The musculocutaneous nerve passed between the two bellies, giving a separate branch to each. We suggest that the two bellies of the coracobrachialis muscle may represent the incompletely fused short heads of the ancestral muscle. The biceps brachii muscle showed a third head, which originated mainly from the antero-medial surface of the humerus and partially from an aponeurosis belonging to the medial head of the triceps brachii muscle. These observations were confined to the left upper limb and were not accompanied by any other abnormality.     

One-third, two-thirds: relationship of the radial nerve to the lateral intermuscular septum in the arm

The radial nerve penetrates the lateral intermuscular septum of the arm before dividing into deep and superficial branches. It may be encountered in both anterior and posterior approaches to the humerus. An ability to accurately predict the point at which the nerve pierces the septum would be valuable during surgery in the arm, and would facilitate planning an approach to exploring the radial nerve after fractures of the distal humeral shaft. It would, in particular, make minimally invasive surgical techniques less dangerous. We dissected 20 cadaver upper limbs to establish whether the radial nerve enters the anterior compartment of the arm at a predictable level. We found that in almost every case the radial nerve entered the anterior compartment at a point within 5 mm of the junction of the distal and middle thirds of a line joining the lateral epicondyle of the humerus to the most lateral point of the acromion process of the scapula. This has not previously been described, and we believe is a useful aide-de-memoir to predicting the level at which the radial nerve penetrates the lateral intermuscular septum.     

Anomalous head of the brachial muscle penetrates the deltoid muscle

We report here, for the first time a specimen in which the insertion of the deltoid muscle is divided into two parts, composing a canal. The brachial muscle was composed of medial, lateral, and anomalous heads. The anomalous head arose as a thin tendon from the surgical neck of humerus, passed through the canal, and then became confluent with the lateral head. The musculocutaneous nerve innervated the brachial muscle. The lateral head, but not the anomalous head, received a thin branch from the radial nerve.     

桡神经在臂部的应用解剖

目的　研究桡神经在臂部的走行关系 ,为X线下肱骨骨折手术入路提供解剖学基础。方法　解剖 30具 6 0侧成年人上肢防腐标本 ,观察、测量桡神经与肱骨的有关距离。结果　各主要结构的平均距离及其所占肱骨最大长的百分比分别为 :肱骨最近端到肱骨肌管入口处 (118 4 9± 6 6 1)mm和 38 6 4 % ;肱骨最近端到外侧肌间隔 (177 75± 11 86 )mm和 5 7 5 9% ;肱骨最大长 (30 6 6 5± 17 4 8)mm。结论　桡神经在肱骨中 1/ 5段为危险区域 ,从术前和术中的影像 ,能测量和计算出神经的大概位置 ,从而决定进针位置和固定方法的较好方案     

A case of an accessory brachialis muscle

Functionally, the brachialis muscle serves a critical role as the primary flexor of the arm at the elbow. However, few reports exist in the literature, which describe variations of this muscle. We present a case of an accessory brachialis muscle (AcBr), found during routine dissection at Harvard Medical School during 2003. The AcBr originated medially from the mid-shaft of the humerus and the medial intermuscular septum. During its course medially, toward the elbow, the AcBr crossed both the brachial artery and the median nerve. The distal tendon split to surround the median nerve before inserting into the common tendon of the antebrachial flexor compartment muscles. Embryological origins and clinical considerations including median nerve entrapment are considered.