以颈横动脉浅支为蒂肩胛冈骨瓣枕颈融合术的应用解剖

目的：为枕颈融合术提供带血管蒂骨瓣转位术的应用解剖学基础。方法：在３０侧经动脉灌注红色乳胶的成人尸体标本上，解剖观测颈横动脉浅支的走行、分支及分布；另在１侧标本上摹拟手术设计。结果：颈横动脉浅支主要分支有肩胛冈支和斜方肌支。肩胛冈支外径１．６±０．３ｍｍ，长度４．９±０．６ｃｍ；斜方肌支可分为升支和降支，其中升支水平横向正中线，在第７颈椎棘突附近与颈深动脉后支及邻近皮支相吻合，斜方肌支—升支长达６．７ｃｍ，起始外径１．５±０．３ｍｍ。结论：在颈横动脉肩胛冈支和斜方肌支分支前结扎动脉干，可以斜方肌支—肩胛冈支为蒂设计肩胛冈骨瓣转位行枕颈融合的术式。     

膝关节神经支切断术的解剖学基础

目的：为膝关节神经支切断术治疗膝关节疼痛性疾患提供解剖学基础。方法：在３５侧常规防腐成人下肢标本上,对股内侧肌支和上关节支进行解剖观测。结果：股内侧肌支在股骨内上髁上１３．３±４．２ｃｍ处延续为膝关节支,在股骨内上髁后０．５±０．４ｃｍ、上２．８±１．２ｃｍ处分支,分布于膝关节内侧及前面内侧半;上关节支在股骨外上髁后１．３±０．５ｃｍ、上２．４±０．６ｃｍ处分支,分布于膝关节外侧及前面外侧半。结论：手术切断股内侧肌支膝关节支和上关节支治疗膝关节疼痛性疾患具有可行性。     

以皮神经及营养血管为蒂臂内侧皮瓣的应用解剖

目的：为带臂内侧以神经及其营养血管筋膜皮瓣提供形态学基础。方法：在３２侧成人上肢标本上,观测臂内侧皮神经营养血管及其周围皮肤的供血情况。结果：臂内侧皮神经的血供来自尺侧上副动脉肌间隔皮支、肱动脉肌间隔皮支和尺侧下副动脉肌间隔皮支,起始处外径分别为１．０ｍｍ、０．６ｍｍ和０．７ｍｍ,穿出深筋膜前长为１．５ｃｍ、１．１ｃｍ和１．２ｃｍ。其神经支在神经束间或神经旁相互吻合构成丰富的血管网,并借分支与筋膜     

腋窝入路桡神经肱三头肌支转位移植修复腋神经的应用解剖

背景：上臂后上切口入路肱三头肌肌支转位移植修复腋神经牵拉三角肌时易损伤腋神经后支及锁骨上臂丛,探查和联合其他神经转位时需变更体位。 目的：分析腋窝入路桡神经肱三头肌支转位移植修复腋神经的可行性。 方法：取常规甲醛固定成人上肢标本10具20侧,于标本平卧,上肢外展外旋位,腋窝入路,对腋窝处神经血管进行显微解剖。测量腋神经起始处至分支处距离及其分支起始处的横径,肱三头肌各肌支起始处横径,各肌支由入肌点向近端进行无损伤分离长度。 结果与结论：腋神经肩胛下肌下缘分成前后两支,前支横径平均为2.5(1.6~3.4) mm。桡神经肱三头肌长头支,起点处横径为2.2(1.4-2.8) mm。桡神经与腋神经距离平均为18.2(10.2~30.0) mm。腋神经前支与桡神经肱三头肌支横径相似,距离短。表明腋窝入路可暴露和辨别腋神经前后分支,桡神经肱三头肌支在背阔肌腱表面水平靠近腋神经,可选择任一肌支转位移植修复腋神经。      

桡神经肱肌支的解剖学研究

目的：研究桡神经的肱肌支的形态特点。方法：对７２侧固定尸体的桡神经肱肌支进行解剖与测量，并分为三种不同的类型进行比较。结果：桡神经存在肱肌支出现率为５１．４％（３７侧）。肱肌支的出现以单侧多见，与性别、侧别无关。对肱肌支的起始点、入肌点、长度及横径测量结果，将其归分为：上升型、下降型和水平型三种类型。肌支的起始点在Ｈｕｅｔｅｒ＇ｓ线上３．０～９．６ｃｍ，入肌点在Ｈｕｅｔｅｒ＇ｓ线下０．２～线上９．５ｃｍ，肌支长度０．７～９．６ｃｍ，横径为０．４～２．０ｍｍ。结论：桡神经的肱肌支较普遍存在，行上臂、肘部手术时，应对其加以保护，尤其是在肌皮神经已有损伤者更应如此     

带腓浅神经及其营养血管筋膜皮瓣的应用解剖

目的：提供带腓浅神经及其营养血管筋膜皮瓣的形态学依据。方法：在３２侧成人下肢标本上,观测了腓浅神经及其营养血管、周围皮肤的血供情况。结果：腓浅神经（皮下段）近侧的血供为腓浅动脉深支的皮动脉、第１支肌间隔动脉,起始处外径分别为０．８ｍｍ、１．１ｍｍ;第１支肌间隔动脉穿出深筋膜前长为１．８ｃｍ。远侧则为腓动脉穿支之升支、降支的皮支和足背动脉皮支,起始处外径分别为０．９ｍｍ、０．７ｍｍ和０．８ｍｍ,穿出深筋膜前长分别为１．２ｃｍ、０．７ｃｍ和０．８ｃｍ。其神经支在神经干内或旁彼此吻合,构成纵向链式血管网,并借分支与皮肤、皮下及筋膜血管网沟通。结论：可设计带皮神经及其营养血管筋膜皮瓣,顺行或逆行转位修复邻近部位软组织缺损     

股部皮神经营养血管皮瓣的应用解剖

目的：为股部皮神经及其营养血管为蒂的岛状皮瓣提供解剖学基础。方法：８侧经动脉灌注红色乳胶成人新鲜下肢标本，解剖观测股部主要皮神经血供及其筋膜皮支的分布范围；２侧成人新鲜下肢标本经墨汁灌注，皮肤脱水透明后观测各皮神经营养血管的分支分布及吻合。结果：①股外侧皮神经有营养动脉２～６支，超始外径１．０±０．４ｍｍ，其筋膜皮支分布达神经内侧４．１ｃｍ，外侧５．９ｃｍ；②股前皮神经有营养动脉１～５支，外径１．０±０．３ｍｍ，其筋膜皮支分布达神经内侧２．４ｃｍ，外侧３．４ｃｍ；③股后皮神经有营养动脉１～３支，外径０．９±０．３ｍｍ，其筋膜皮支分布达神经内侧３．９ｃｍ，外侧３．２ｃｍ。结论：以股部各主要皮神经及其营养血管为蒂可沿其皮神经走行设计切取顺行或逆行岛状皮瓣     

多血管神经蒂腹内斜肌瓣修复面瘫的解剖学基础

目的：为多血管神经蒂腹内斜肌瓣修复晚期面瘫提供解剖学基础。方法：在３６侧成尸标本上,对腹内斜肌的形态、血供及神经支配进行解剖观测。结果：腹内斜肌中部上１／２肌腹主要由第１１肋间神经支配,下１／２肌腹主要由肋下神经支配。上１／２肌腹的血供６６．７％来自第１１肋间后动脉,３３．３％来自旋髂深动脉的髂嵴支;下１／２肌腹的血供主要来自旋髂深动脉的腹壁肌支。第１１肋间神经、肋下神经在腋后线横径分别为２．２ｍｍ和２．４ｍｍ,入肌点距腋后线长分别为１３．３ｃｍ和１３．８ｃｍ。第１１肋间后动脉在腋后线外径为１．７ｍｍ,入肌点距腋后线长为１３．１ｃｍ;旋髂深动脉腹壁肌支和髂嵴支的起始外径分别为１．３ｍｍ和１．８ｍｍ,入肌点至起点长分别为５．１ｃｍ和８．６ｃｍ。结论：吻合多血管神经腹内斜肌瓣移植可全面修复晚期面瘫     

股方肌神经髋关节支切断术的应用解剖

目的：为股方肌神经髋关节支切断术提供解剖学依据。方法：对５０侧成人股方肌神经的起始、走行、分支和分布进行了解剖观测。结果：９８％的股方肌神经发自梨状肌下缘以上，发出点到股方肌上缘的长度为６．１±０．７ｃｍ，在梨状肌下缘下方０．９ｃｍ至股方肌上缘间发出２～５支髋关节支，分布于髋关节的坐股囊韧带和关节囊的后下部。结论：在梨状肌下缘至股方肌上缘间切断股方肌神经发出的髋关节支，可解除髋关节后部及下部的疼痛     

下颌神经颅外段的应用解剖

目的：为下颌神经手术提供形态学基础。方法：解剖观测２１例（男１３，女８）４２侧成人标本。结果：下颌神经（颅外段）主干长（出卵圆孔至分支处的距离）为１．３±０．４ｃｍ；宽度４．９±１．３ｍｍ，厚度１．９±０．６ｍｍ。还测量了下颌神经各分支起始处的长、宽和厚度。结论：本文结果为切断下颌神经后股和颊神经下（长）支的手术提供了形态学资料。     

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。     

Variation of the spinal nerve compositions of thoracodorsal nerve

Thoracodorsal nerve distributes to the latissimus dorsi muscle. The aim of this study was to investigate the anatomic variation of the spinal nerve compositions of thoracodorsal nerve and to confirm which spinal nerve is a main component in participating amount. The most frequent type was consisted of C7 and C8 in 60%. Next frequent type was C6, C7, and C8 in 25%. Third type was C6 and C7 in 10% and fourth type was C7 alone in 5%. The diameter of each spinal nerve comprising thoracodorsal nerve was 1.20 +/- 0.23 (mean +/- SD) mm at C7, 0.43 +/- 0.15 mm at C8, and 0.33 +/- 0.09 mm at C6. These results show that the C7 nerve was the main component of thoracodorsal nerve and the anatomic variation appeared at the spinal nerve that participate by small amounts, as be excepted (C6 and C8).     

单环刺缢及同种异体神经制成人工神经修复神经缺损

目的:研究去细胞的单环刺缢体壁和同种异体神经所构成的人工组织神经的组织相容性及其修复神经缺损的效果。方法:取大鼠40只随机分成实验组、自体神经组、硅胶管组、正常组。实验组将去细胞的单环刺缢体壁缝合成神经导管,其内充填去细胞的异体神经,修复大鼠10 mm坐骨神经缺损。术后4月,通过大体观察,组织形态学观察,了解该人工组织神经修复大鼠坐骨神经缺损的疗效。结果:该人工组织神经组织相容性良好,神经功能恢复效果正常组>自体神经组>实验组>硅胶管组,实验组疗效与自体神经组接近,明显优于硅胶管组。结论:将去细胞的单环刺缢体壁和同种异体神经制成人工组织神经修复周围神经缺损是可行的。     

臀下神经转位阴部神经的应用解剖

目的：为重建单纯脊髓圆锥或阴部神经损伤后的会阴部功能提供解剖学基础。方法：对成人尸体的臀下神经和阴部神经进行了观测。结果：臀下神经以1支(45．00％)或2支(46．67％)从盆腔穿出为多，其中85．00％穿梨状肌下孔；其穿出点的位置主要在髂后上棘与坐骨结节连线的中1／3(50．00％)或上、中1／3交界处(48．33％)。神经干的长大于3cm，与阴部神经穿出处相距仅约2cm。阴部神经出盆处主要在髂后上棘与坐骨结节连线中1／3(46．67％)或中、下1／3交界(50．00％)。结论：两神经出盆处位置接近，臀下神经的长度足以直接与阴部神经缝接，用脊髓起源节段高的臀下神经转位脊髓起源节段低的阴部神经，切实易行。     

组织工程化神经导管修复外周神经损伤

背景：神经导管技术理论上采用生物或非生物材料预制成合适的管状支架,桥接神经断端两侧,在提供神经再生微环境的同时通过神经诱导、营养作用促进神经再生。 目的：观察组织工程化神经导管修复外周神经损伤的临床效果。 方法：选择24例陈旧性上肢神经损伤患者,以患者自愿原则分2组治疗：试验组采用组织工程化神经导管修复,对照组采用自体周围体表感觉神经移植修复。治疗后随访6个月观察患者肢体神经损伤功能修复效果。 结果与结论：随访6个月后,两组肢体远端感觉运动功能与目测类比疼痛评分均较治疗前改善(P < 0.05),且试验组效果更好(P < 0.05);两组损伤侧感觉与运动神经传导速度均较治疗前改善(P < 0.05),且两组间差异无显著性意义。说明组织工程化神经导管材料符合神经修复导管支架的要求,临床应用疗效肯定。     

手掌分区与正中神经和尺神经

目的：为研究手掌病变、作神经吻合及阻滞麻醉提供解剖学基础。方法：手掌借5条横平行线和掌纵纹，分为桡、尺两部及6个区。解剖并观察正中神经和尺神经在手掌各区的分支及分布。结果：正中神经掌皮支和主支位于Ⅰ、Ⅱ区，主支在Ⅲ区形成4种形态的伞形结构，在C线处发出第1～3指掌侧总神经。正中神经返支由伞形结构桡侧发出，经B1点入大鱼际。尺神经主支和掌皮支位于Ⅰ区。浅支在A1点分为指掌侧总神经和小指掌侧固有神经，深支于A1点入手掌Ⅱ区深面。指掌侧总神经在E线分为指掌侧固有神经。结论：手掌神经有按区分布的特点，有助于手掌损伤离断神经的寻找和吻合，以及手掌神经阻滞麻醉的精确定位。     

Functional anatomy of the mandibular nerve: consequences of nerve injury and entrapment

Various anatomic structures including bone, muscle, or fibrous bands may entrap and potentially compress branches of the mandibular nerve (MN). The infratemporal fossa is a common location for MN compression and one of the most difficult regions of the skull to access surgically. Other potential sites for entrapment of the MN and its branches include, a totally or partially ossified pterygospinous or pterygoalar ligament, a large lamina of the lateral plate of the pterygoid process, the medial fibers of the lower belly of the lateral pterygoid muscle and the inner fibers of the medial pterygoid muscle. The clinical consequences of MN entrapment are dependent upon which branches are compressed. Compression of the MN motor branches can lead to paresis or weakness in the innervated muscles, whereas compression of the sensory branches can provoke neuralgia or paresthesia. Compression of one of the major branches of the MN, the lingual nerve (LN), is associated with numbness, hypoesthesia, or even anesthesia of the tongue, loss of taste in the anterior two thirds of the tongue, anesthesia of the lingual gums, pain, and speech articulation disorders. The aim of this article is to review, the anatomy of the MN and its major branches with relation to their vulnerability to entrapment. Because the LN expresses an increased vulnerability to entrapment neuropathies as a result of its anatomical location, frequent variations, as well as from irregular osseous, fibrous, or muscular irregularities in the region of the infratemporal fossa, particular emphasis is placed on the LN.     

Sural-tibial nerve communications in humans

We investigated the occurrence of a communication between the sural and tibial nerves in 49 legs of 28 Japanese cadavers. In front of the calcanean tendon, we found the communication in 7 legs (14.3%) or in 5 cadavers (18.9%). The sural nerve gave rise to a number of medial and lateral branches, including the lateral calcanean branch at the lateral side of the ankle. The communicating branch with the tibial nerve arose from the first medial branch and pierced the deep fascia of the leg. In 4 cases, the U-shaped communication was formed between the sural and tibial nerves, and in 3 cases, the Y-shaped communication. Electrophysiologi-cal evidence of an anomalous motor function of the sural nerve has been reported recently. We consider that the U-shaped communication between the sural and tibial nerves gives a morphological basis to the motor function of the sural nerve.     

Comparison of greater occipital nerve and greater occipital nerve + supraorbital nerve block effect in chronic medication overuse headache

Background /aimIn this study, we aimed to compare the efficacy of greater occipital nerve (GON) block alone and GON combined with supraorbital nerve (SON) block in the treatment of medication overuse headache (MOH).Material and methods82 patients were divided into two groups: 41 patients were administered bilateral GON block while the other 41 patients GON + SON block. Nerve blocks were administered every 10 days for a total of 5 sessions. After each administration and 20 days after the last injection, information on pre and post treatment numerical rating scale (NRS) score, number of painful days, analgesic intake, duration of pain were collected.ResultsThe decrease in headache evaluation parameters was similar in both groups after the block. The NRS scores in the GON and GON + SON groups before the treatment was (8.2 ±  0.7, 8.5  ± 0.7), the number of painful days in a month was (21.4 ±  6.9, 21.2 ± 4.6 days), the number of analgesics taken monthly was (45 ±  25.6, 47.5 ±  29.9), the duration of pain was (44.9 ±  24.6, 41.7 ±  22.8 h), respectively. On the 60th day of treatment, the NRS scores in the GON and GON + SON groups were found to be (6.8 ±  2.5, 4.8 ± 2.3), the number of painful days in a month was (4.2 ±  3.3, 2.2 ±  1.5), respectively. The number of monthly nalgesic consumption was (4.4 ±  3.8, 0.9 ±  1.2), and the duration of pain was (28.4 ±  19.3, 19.4  ± 16.1 h).ConclusionThis study showed significant reductions in headache parameters in both groups. However, NRS score, analgesic intake, number of painful days, and pain duration significantly better improved in the GON block added SON block group.     

腋神经和桡神经与肱骨的关系及其临床意义

目的　观测腋神经、桡神经与肱骨骨性标志的关系 ,为肱骨手术或外固定提供帮助。方法　在 30例 6 0侧成人上肢标本上观、测了腋神经、桡神经与肱骨有关骨性标志的距离。结果　肱骨最大长 (30 6 6 5± 17 4 8)mm ;肱骨最近端到腋神经(5 8 10± 5 6 1)mm ;肱骨最近端到桡神经穿外侧肌间隔处 (177 75± 11 86 )mm ;解剖颈最低点到腋神经 (16 2 4± 2 78)mm ;肱骨最近端到肱骨肌管入口处 (118 4 9± 6 6 1)mm ;并测量计算了各段占肱骨最大长的比例。结论　腋神经在肱骨近端 1/ 5处容易受损 ,而桡神经在肱骨下 3/ 5段为易损伤部。从术前和术中的影像 ,能测量和计算出神经的基本位置 ,可减少或避免神经损伤