正中神经返支卡压及易损伤部位的解剖学基础

目的：探讨腕管综合征术后大鱼际功能恢复不良的原因与返支易损伤部位。方法：对20侧成人新鲜上肢标本进行显微解剖，观测正中神经返支走行中存在的卡压因素以及易损伤部位。结果：(1)拇短屈肌浅头尺侧存在腱弓及腱纤维束结构，对正中神经返支形成卡压；(2)住屈肌支持带远侧返支与掌腱膜关系密切，在此部位掌腱膜可对返支形成卡压或术中易误伤返支；(3)走行中返支与拇长屈肌腱和示指屈肌腱存在交叉走行关系。结论：(1)返支走行中存在易卡压因素，治疗腕管综合征时应常规探查松解返支；(2)涉及拇长屈肌腱，示指屈肌腱和掌腱膜手术时，应注意防止损伤返支。     

拇长屈肌的尺侧头

作者观测了45具(男29,女16)年成尸体90侧上肢的拇长屈肌,见65.56±5.01%有尺侧头。尺侧头多双侧性地出现或否,无性差及侧差。尺侧头上端附于指浅屈肌腱或肱骨内上髁者居多,肌腹斜向外下方,汇入拇长屈肌腱的上端。支配尺侧头的神经均发自骨间前神经,起始平面大多较支配拇长屈肌挠侧头的肌支稍高,行程短。供应动脉可以是尺侧下付动脉或骨间返动脉的细小分支。尺侧头与正中神经和尺动脉关系密切。本文就,拇长屈肌尺侧头的来源、功能以及命名等作了初步讨论。     

正中神经返支"握拳三点法"体表定位

目的:研究正中神经返支简单实用的体表定位方法。方法:对20侧成人新鲜上肢标本的正中神经返支进行解剖,观测返支的走行,测量起点,最高点,入肌点,根据解剖学观测制定体表定位。结果:⑴返支起点变化较大,多起源于腕管外,正中神经返支最高点,距远侧腕横纹距离为(36.80±2.82)mm(33.98～39.62mm),距屈肌支持带远侧缘(5.35±2.25)mm(3.1～7.6mm),返支入肌点在拇短屈肌与拇短展肌肌间隙上距拇指基底桡侧缘(35.5±1.86)mm(33.64～37.36mm);⑵握拳三点定位法:①返支起点A点定位:握拳时中环指间线与拇指近节指骨基底尺侧,豌豆骨连线交点。②返支最高点B点定位法:握拳时中指指尖与拇指近节指骨基底尺侧,钩骨钩连线交点。③返支入肌点C点定位法:握拳时示中指间线与拇指近节基底桡侧,豌豆骨连线(此线为拇短屈肌与拇短展肌肌间隙的体表线)交点。结论:握拳定位法既可以给返支定位,又可以体现返支走行及常见变异。     

人鱼际肌的肌内神经分支分布和肌梭密度研究

目的探索鱼际肌肌肌内神经分支和肌梭密度的分布。方法采用改良Sihler’s肌内神经染色法和HE染色法进行解剖学研究。结果鱼际肌的神经常从肌起端深面入肌,神经入肌后在拇短展肌、拇对掌肌、拇收肌横头内与肌长轴垂直走向,拇收肌斜头和拇短屈肌内沿肌长轴平行走形。80%～82.5%的拇短屈肌和拇指对掌肌接受正中神经和尺神经的双重支配。拇短屈肌浅头和深头、拇收肌横头和斜头有独立的神经支配,可分出神经肌肉亚部。4块肌内神经分支分布密集区多在肌的中部与近端,可见"Y"、"O"、"H"或"U"型等不同的神经吻合形式。鱼际肌肌梭密度高达16.19～27.14个/g,高低顺序为拇指对掌肌拇短屈肌拇短展肌拇收肌。结论鱼际肌肌内神经吻合丰富,肌梭密度高,除拇对掌肌外,其余肌块可作整肌或半肌移植的供体。     

正中神经返支的观测及表面解剖定位

对100侧正中神经返支的形态进行观察、计测,82±3.84%源于正中神经主干分叉处。依其形态分为多支形(85±3.57%),双支型(10±3.60%),单支型(1±0.99%)、重复型(4±1.96%)。鱼际肌群(拇收肌除外)各肌神经分布呈多源性,拇对掌肌98%由正中神经返支支配。设计自舟骨结节中点与手掌第2指胰中点连线为纵轴线,通过第1掌骨小头顶端作纵轴线垂线为横轴线,以此座标测计正中神经返支的表面Ⅰ解剖定位。采用距纵轴线尺侧10～15mm设计适于临床应用的纵行切口,可避免损伤正中神经返支。     

尺神经深支的形态特点及其临床意义

目的：为临床尺管综合征和尺神经深支损伤的诊治提供解剖学基础。方法：在３０只成人手标本上解剖观测了尺神经深支的走行、毗邻关系、终末分支和分布。结果：依据尺神经深支的走行可分为：豆钩管段、小鱼际肌段、掌中段和终末段。小鱼际肌段行于小指对掌肌与第５掌骨之间的占５６．７％；在小指对掌肌间隙的走行占３０％；在小指短屈肌与小指对掌肌之间占１３．３％。终末段分支为４支型的占８６．７％，３支型占１３．３％。结论：尺神经深支的豆钩管段与豌豆骨、钩状骨钩关系密切；小鱼际肌段与第５掌骨基底紧邻。豌豆骨、钩骨钩和第５掌骨基底部骨折，极易损伤此神经。     

尺动脉腕背支背尺侧皮瓣的应用解剖

在３０侧成人上肢标本上解剖观察了尺动脉腕背支。该支于豌豆骨上方３．７±１．１ｃｍ处起自尺动脉，起始处处径为１．１±０．２ｍｍ，经尺侧腕屈肌穿过深筋膜，然后浅出至腕背部尺侧的伸肌支持带，其终末支分布于手背尺侧及小鱼际区的皮肤。该动脉与尺神经经手背支伴行，可以尺动脉腕背皮支设计手背尺侧神经血管蒂皮瓣。     

正中神经在肘部及前臂上段卡压综合征的解剖基础

目的：探讨正中神经在肘部及前臂上段卡压综合征的解剖学基础。方法；在50例上肢标本上解剖观察正中神经受压的解剖因素。结果：肱二头肌腱膜与正中神经的关系；非覆盖型80％（40侧），部分覆盖型12％（6侧）和全覆盖型4侧（8％）。64％（32侧）反转筋膜斜过正中神经前方。18．6％（8侧）旋前圆肌肱骨头肌内有明显腱束，94％（47侧）尺骨头浅面有增厚腱膜。指浅屈肌起始两头间的形态结构：88％（44侧）联合腱弓型，4％（2侧）纤维弓，8％（4侧）指浅屈肌腱束。结论：正中神经通过前臂上段及肘部时，肱二头肌腱膜，旋前圆肌肱骨头的反转筋膜和肌内腱束，尺骨头浅面的腱膜，指浅屈肌起始部的联合腱弓和纤维弓等可能是导致其受压的解剖学因素。     

关于尺神经在臂及前臂的分支及其与正中神经的吻合

共统计50个(男性、女性各25个)1—9岁儿量尸体共计100例上肢。观察尺神经在臂及前臂发出肌肢及肘关节支的情况以及尺神经与正中神经在前臂吻合的情况。 1.尺神经发出关节支至肘关节,关节支的数量是1—3支,其发出的部位有三:在肱骨内上髁以上发出的37例,占37％;在平肱骨内上髁处发出的36例,占36％;在肱骨内上髁以下发出的27例,占27％;由第一支起始点至肘关节囊的距离为0.2—1.8厘米。 2.尺神经发出肌支,以总干分支支配尺侧屈腕肌及屈指深肌的8例,占8％;支配屈指浅肌的9例,占9％;以总干分支支配尺侧屈腕肌及肘关节的14例,占14％;分别分支支配尺侧屈腕肌及屈指深肌的69例,占69％。其第一肌支发出的部位有三:在肱骨内上髁以上发出的七例,占7％;在平肱骨内上髁处发出的4例,占4％;在肱骨内上髁以下发出的89例,占89％。其最后肌支都在肱骨内上髁以下发出。第一肌支支配尺侧屈腕肌的80例,占80％;支配屈指浅肌的4例,占4％;以总干分细支支配尺侧屈腕肌及屈指深肌的1例,占1％;以总干分细支支配尺侧屈腕肌及屈指浅肌的1例,占1％;以总干分细支支配尺侧屈腕肌与肘关节的14例,占14％。最后肌支支配尺侧屈腕肌的18例,占18％;支配屈指深肌的77例,占77％,支配屈指浅肌的2例,占2％;以总干分两支分别支配屈指浅肌及尺侧屈腕肌的1例,占1％;以总干分两支分别支配屈指深肌及尺侧屈腕肌的1例,占1％;以总干分为两支分别支配屈指浅肌及屈指深肌的1例,占1％。至各肌的肌支数量是1—4支。 3.100例上肢中发现尺神经与正中神经之间在前臂前面有吻合的30例,占30％,较高于国外作者统计的百分率。其中对称的9例,不对称的21例。吻合的部位都是在屈指浅肌尺侧头与屈指深肌近侧端之间,或在屈指深肌之内;根据吻合支结合的形态特征可将吻合区分为襻型(17例)、“V”字型(4例)、“Y”字型(3例)及直綫型(6例)四种。     

正中神经前臂段浅层肌支的应用解剖

目的测量正中神经前臂段浅层肌支的解剖学数据,为正中神经的创伤修复提供形态学依据。方法采用解剖剥离测量方法,对30侧10%甲醛固定的成人上肢标本正中神经发出的前臂段浅层肌支进行解剖学观察。结果正中神经前臂段浅层肌支的分支类型有1支型、2支型、3支型和4支型。其中,旋前圆肌支以3支型(87%),指浅屈肌支(90%)以4支型,桡侧腕屈肌支(96.7%)和掌长肌支(96.7%)以1支型出现率最多。正中神经前臂段浅层肌支主要集中于前臂的4%～65%。结论确定了正中神经前臂段浅层肌支在前臂的危险区间;讨论了有利于开展带神经血管蒂肌瓣移植的肌支类型。     

The normal and variant clinical anatomy of the sensory supply of the orbit

Orbital and retro‐orbital pain are relatively common clinical conditions that are associated with such disorders as trigeminal, lacrimal, and ciliary neuralgia, cluster headaches, paroxysmal hemicrania, inflammatory orbital pseudotumor, trochleitis, and herpetic neuralgia ophthalmicus, thus making the nerves supplying the orbit of great clinical importance. Surprisingly, how pain from this region reaches conscious levels is enigmatic. Classically, it has been assumed that pain reaches the ophthalmic division of the trigeminal nerve (V₁) and travels to the descending spinal trigeminal nucleus. However, exactly where the receptors for orbital pain are located and how impulses reach V₁ is speculative. In this project, we reviewed all of the reported connections between the orbital nerves and V₁ in order to understand how pain from this region is transmitted to the brain. We found reported neural connections to exist between cranial nerve (CN) V₁ and CNs III, IV, and VI within the orbit, as well as direct neural branches to extra‐ocular muscles from the nasociliary, frontal, and supraorbital nerves. We also found reported neural connections to exist between the presumed carotid plexus and CN VI and CN V₁, CN VI and CN V₁ and V₂, and between CN V₁ and CN III, all within the cavernous sinus. Whether or not these connections are sympathetic or sensory or some combination of both connections remains unclear. An understanding of the variability and frequency of these neural connections could lead to safer surgical procedures of the orbit and effective treatments for patients with orbital pain. Clin. Anat. 27:169–175, 2014. © 2014 Wiley Periodicals, Inc.     

bFGF对同种异体神经移植后周围神经再生的影响

目的 :探讨bFGF对同种异体神经移植后周围神经再生的影响。方法 :将反复冻融的大鼠神经移植于另一大鼠的坐骨神经 ,实验组注射bFGF 1 0 0u/d共 1 0d ,对照组注射生理盐水 1 0d。术后大鼠存活 1 2周 ,光镜下用体视学方法测试再生神经纤维的面数密度 (NA)、面积密度 (AA)、横切面面积 (AE)、脊髓前角运动细胞和脊神经节细胞的体密度 (VV)、数密度 (NV)。结果 :两组均可见再生神经纤维长入异体移植神经并向远段延伸。实验组再生神经纤维的NA、AA、脊髓前角运动细胞和脊神经节细胞的VV、NV 与对照组的比较 ,有显著性差异。结论 :bFGF能促进周围神经再生 ,对脊髓前角运动细胞和脊神经节细胞的存活有保护作用。     

骨间前神经转位重建鱼际肌功能

前臂或腕部正中神经断裂,直接吻合后鱼际肌功能的恢复常常令人失望,为了解决这一难题,本文在120侧成人上肢解剖学研究的基础上,采用骨间前神经转位术修复鱼际肌支9侧,获得成功.     

红白肌纤维为肌桥缝接狗神经缺损的实验形态学研究

目的 :试图从作肌桥的肌肉条件 (红、白肌、长、短肌纤维和肌纤维排列等 )方面 ,能探讨出最适宜神经再生长条件的肌肉 ,作为临床应用的肌桥。方法 :根据文献肌纤维分型记载和本实验用SDH染色 ,确定的的红白肌纤维肌桥 ,再分别给狗股神经和正中神经缺损 3cm外缝接上 ,待术后 3 0 0d ,切取桥接神经部位 ,并将它分成神经近段、肌桥段、神经远段和远、近端缝合段五个部分。常规制成光电镜标本最后镜下观察和Luzex -F图像分析仪测定。结果 :红肌纤维为主的肌桥明显较白肌纤维为肌桥的再生效果好 (P <0 .0 5 )特别是缝匠肌尾侧部 (红肌纤维为主 )为肌桥更明显较其颅侧部 (白肌纤维为主 )的神经纤维再生数量多 (P <0 .0 5 )。结论 :并非机体肌肉为肌桥都有同样神经再生效果 ,缝匠肌尾侧部可能是一个适宜神经再生条件的肌肉。     

臂丛神经损伤患者膈神经移植肌皮神经的电生理观察

目的：评估膈神经功能测定在臂丛神经损伤神经移植前的应用价值,术后电生理观察神经移植恢复状况。方法：对50例臂丛神经损伤患者术前进行了膈神经功能测定,对其中10例膈神经功能正常者,行同侧膈神经移植肌皮神经手术,术后神经电生理随访观察肱二头肌肌电图及肌皮神经运动传导功能状况。结果：臂丛神经损伤患者约28％伴膈神经损伤,损伤的膈神经不能选择为移植动力神经。隔神经移植肌皮神经后,最早3个月出现再生电位,6个月后出现运动单位电位,12个月后运动单位电位明显增多。术后肱二头肌肌力18个月后恢复优良占80％。7例术后12个月肌皮神经引出运动神经传导电位。结论：膈神经功能测定在臂丛神经损伤患者术前可评估选择移植神经,术后电生理可随访观察神经功能恢复状况,对臂丛神经损伤患者的手术治疗有一定指导作用。     

Influence of a fabella in the gastrocnemius muscle on the common fibular nerve in Japanese subjects

The fabella is a sesamoid bone located in the proximal tendon of the gastrocnemius muscle. In rare cases, its presence may lead to a variety of clinical problems, including fabella syndrome and common fibular (CF) nerve palsy. The purpose of this study was to analyze the morphology of the fabella and CF nerve and discuss the influence of any existing fabellae on the size of the CF nerve. The morphology of the fabella and CF nerve in the popliteal region of the lateral head of the gastrocnemius muscle was investigated in 102 knees of 51 Japanese cadavers. The maximum circumference of the thigh, knee, and calf and the frequency, position, and size of the fabella were measured. In addition, the CF nerve width and thickness were measured proximal to the fabellar region and again as the CF nerve passed posterior, lateral, or medial to the region. A fabella was observed in 70 knees (68.6%). The CF nerve adjacent to the fabella was significantly wider and thinner than in the region proximal to the fabella (P < 0.001). In cases in which a bony fabella was present, there was a significant relationship between the thickness of the CF nerve and the circumference of the thigh and knee. The following factors were observed to contribute to the presence of a fabella causing alterations in the size of the CF nerve: a bony fabella, a CF nerve path posterior or lateral to the fabella, and subjects with a thin physique and bony fabella. Clin. Anat. 26:893–902, 2013. © 2012 Wiley Periodicals, Inc.     

Role of input from saphenous afferents in altered spinal processing of noxious signal that follows sciatic nerve constriction in rats

An investigation was made into a possible contribution of saphenous nerve to altered central processing of noxious information following sciatic nerve chronic constriction (CCI) in rats. Spinal sciatic neuron spontaneous and noxious evoked activities were recorded in CCI rats, CCI rats with saphenous nerve sectioned just before the sciatic nerve constriction and sham operated rats. The results show (1) high values of spontaneous and noxious evoked activities with prolonged afterdischarges in CCI rats with intact saphenous, (2) comparable high values of spontaneous activity, but significantly reduced noxious evoked activity and afterdischarges in CCI rats with sectioned saphenous, (3) values in the normal range in the sham rats. Potential mechanisms underlying these results are discussed.     

Destination of the C4 component of the prefixed brachial plexus

This study was carried out to elucidate the destination of the C4 ventral ramus that forms the prefixed brachial plexus. A total of 43 sides of Korean adults (male, 22; female, 18; unknown: 3 and right, 23; left, 20) were investigated. The various C4 destinations and their frequencies were as follows: suprascapular nerve, 97.7% (42/43); musculocutaneous nerve, 79.1% (34/43); the axillary nerve, 48.8% (21/43); and the nerve to subclavius, 16.2% (7/43). The mean quantity of nerve fibers destined to the suprascapular, musculocutaneous, and axillary nerves and the nerve to subclavius was 441.8 ± 316.5 (Mean ± S.D.), 298.2 ± 209.8, 245.8 ± 239.0, and 66.4 ± 17.2, respectively. The mean nerve fibers number of C4 contributing to the brachial plexus was 983.6 ± 618.0 (range: 100-1729). The main component that contributes to the terminal nerves (suprascapular, musculocutaneous, axillary nerves, and nerve to subclavius) is C5. These results may be useful to surgeons and clinicians dealing with terminal nerves of the brachial plexus, especially the suprascapular, musculocutaneous, and axillary nerves.     

大鼠异体神经移植后再生神经生物力学性质研究

用Ｗｉｓｔａｒ鼠作为实验模型,切下１ｃｍ坐骨神经,再用同系Ｗｉｓｔａｒ鼠坐骨神经异体桥接,修复坐骨神经的缺损,术后２４周对Ｗｉｓｔａｒ鼠的手术侧与正常侧用指标抗张强度与弹性模量（ε＝１０％）进行测试,辅以电镜,光镜观察。     

脱细胞同种异体神经移植物的制备及成分分析

目的　探讨脱细胞同种异体神经移植的制备方法及其含有的成分。方法　采用组织工程化低渗脱细胞方法制备神经异体移植物 ,光电镜观察其结构特征 ;用免疫组织化学法和聚丙烯酰胺凝胶电泳法分析神经异体移植物的成分。结果　正常的 (天然的 )周围神经经脱细胞处理后 ,清除了雪旺细胞、神经外膜和束膜的细胞 ,以及神经纤维的髓鞘和轴突 ,保存了由雪旺细胞基底膜管以及神经外膜和束膜的细胞外基质构成的三维支架结构。成分分析结果显示 ,含有LN、FN以及生长相关蛋白GAP 4 3和 6 5kDa蛋白等促进和诱导受体损伤神经再生的重要成分。结论　脱细胞异体神经移植物含有诱导和促进神经再生的相关蛋白 ,有利于受损神经的再生。