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。     

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。     

肌皮神经与正中神经之间交通支的观测及意义

目的：调查肌皮神经与正中神经之间交通支的出现率并探讨其临床意义。方法：解剖观测56侧成人上肢尸体标本。结果：肌皮神经与正中神经之间交通支的出现率为21．43％，依交通支发出的数量可将其分为两种类型：I型、Ⅱ型，I型又以其发出的部位分为Ia型(高位型)、Ib型(穿喙肱肌型)和Ic型(低位型)三种。结论：肌皮神经和正中神经之间的交通支并不少见，在臂部手术时应对其加以保护。     

神经嫁接术治疗脑外伤、脊髓伤后痉挛性瘫痪的神经干内显微解剖与嫁接位点的选择

目的:通过分析常用神经嫁接术之神经根、主要神经干的干内神经显微解剖,确定神经束或束组的解剖定位及走行规律,为选择嫁接神经切口位置、切开深度、范围提供解剖学依据,探讨依据该解剖学规律标定切口的可行性。方法:选用成人尸体标本8具,16侧,分离出主要神经,进行测量对照及术中验证,按照腕表表针刻度法进行标记,确认不同平面神经束或神经纤维分布位点。结果:主要神经根、干内神经束解剖位置具有规律性,如无明显变异,可根据各神经不同平面神经束、纤维分布定位,确定切开受体神经的位点。根据神经嫁接术中电刺激及术后效果评估反证显示,按该方法选择定位可达到70%~80%的准确率。结论;通过神经干内显微解剖,确定受体神经楔形切口嫁接位置是可行的。     

肌皮神经的解剖及其临床意义

目的 对肌皮神经位置及分支进行观测,为临床肌皮神经损伤与神经移位修复提供解剖学基础.方法 对15具成人防腐尸体的双侧上肢进行解剖观察,并测量肌皮神经的起点、长度、分支及交通支等.结果 肌皮神经主干长(50.07 ± 46.08)mm,起始点左右径(3.21 ± 1.17)mm,前后径(1.97 ± 1.16)mm,起点...     

骨间后神经及其拇示指肌支的解剖学特征

目的　观察前臂骨间后神经及其拇示指肌支的解剖学特征。 方法　解剖43具尸体的86侧上肢部桡神经深支及其分支到腕背部,观测骨间后神经的行程与投影及其拇示指肌支起始部位横径、长度和骨性标志线与神经干间夹角关系等参数。 结果　骨间后神经及其各分支均呈扁薄的窄带状神经束,其主干和多数肌支都走行在前臂后面中2/4段浅、深层肌之间,终末支止于腕背侧的梭形膨大部;主干起始处横径为（3.79±0.64）mm,各分支在起始部的平均横径（除指伸肌支约2.0 mm外）均小于1.0 mm;在旋后位,它呈向桡侧开放的弓形线段投影在肱骨外上髁至尺骨茎突连线的尺侧,半旋前位时则投影于该连线上或其桡侧。 结论　前臂后面中2/4段是骨间后神经主干及其大多数拇示指肌支在临床上易被损伤、误伤发生的高风险区域。     

正中神经返支和掌皮支血供的显微解剖

目的为修复正中神经返支提供带血管蒂神经桥接的有关数据和掌皮支血供的解剖学资料。方法用体视学方法研究了40侧灌注红色乳胶液的返支和掌皮支的营养血管。观察返支营养血管的来源、长度、外径和进入神经干的方式;观察掌皮支营养血管的来源和进入神经的方式。结果返支营养动脉主要发自掌浅弓凹侧筋膜支(称之来源动脉)。来源动脉起点至“零点”距离(11.62±2.30)mm,外径(0.95±0.10)mm,长度(10.12±1.30)mm。营养动脉主干长度(2.84±0.10)mm,外径(0.42±0.15)mm。营养动脉从返支主干近侧1/3段直入式进入神经者占86.5%;从返支中、远侧段伴入式进入神经者占14.5%;掌皮支营养动脉主要发自尺动脉(占52.5%)和桡动脉(占37.5%),以直式、伴入式和肌支式进入神经。结论返支营养动脉可作为血管蒂神经移植的受体血管。     

经颈椎后路健侧颈7神经移位手术治疗中枢性上肢痉挛性瘫痪的解剖研究及临床应用

目的:探讨经颈椎后路健侧C 7神经移位手术治疗中枢性上肢痉挛性瘫痪的解剖特点,并观察其临床疗效。 方法:选取5具新鲜冰冻成人尸体头颈部标本,其中男3具、女2具,年龄56～72岁、平均66岁 。模拟经颈椎后路健侧C 7神经移位手术,显微镜下分离和显露左侧C 7神经...     

额神经末支解剖特点及其在前额除皱术中的意义

目的：为了前额除皱术切口位置和分离平面的选择提供解剖学依据。方法：对18例成人头部标本进行大体和显微解剖研究以及组织切片观察。结果：（1）眶上神经绕过眶上缘后分为溶，浅二支，浅支位额肌深面并穿过该肌分布于额部皮肤，深支行于额肌，帽状腱膜与骨膜之间直达人字缝；（2）滑车上神经在皱眉肌外侧和穿经皱眉肌后穿过额肌到达头皮，结论：（1）前额除皱术中冠状切口应尽量靠近人字缝，并在骨膜下剥离皮瓣，以避免损伤眶上神经，（2）切断皱眉肌时宜在直 下仔细操作以减少对滑车上神经的损伤。     

面神经颞支在眼轮匝肌上部的分布特点及临床意义

目的:观测面神经颞支在眼轮匝肌上部的分布特点。方法:9例福尔马林固定的成人尸头,18侧,在腮腺内解剖出面神经主干,追踪解剖颞支从腮腺至进入眼轮匝肌处。分别测量进入眼轮匝肌的颞神经最上分支和最下分支点到以外眦、睑裂中部、内眦为坐标的垂直和水平距离。结果:颞支的分支在进入眼轮匝肌外缘(以外眦为坐标点)的最上分支为( 2.58±0.32cm, 2.89±0.32cm),最下分支为(0 cm, 2.81±0.32 cm)。Y轴上颞神经最上分支和最下分支距X轴的距离分别为在以外眦、睑裂中部、内眦为坐标点的颞神经最上分支和最下分支距X轴的距离分别为(3.53±0.39)cm和(1.14±0.15)cm,(3.87±0.38)cm和(1.26±0.10)cm,(3.22±0.39)cm和(1.02±0.14)cm。面神经颞支的分支沿眼轮匝肌纤维水平向内走行并相互分支吻合。在Y LC轴、Y MP轴、Y MC轴上分别距X轴(1.14±0.15)cm、(1.26±0.10)cm、(1.02±0.14)cm三点弧形连线以下的区域,无面神经分支分布。结论:在无面神经分布的区域,切开眼轮匝肌纤维不会损伤面神经;在眼轮匝肌深面的筋膜脂肪层进行分离可以避免面神经分支的损伤。     

Heubner回返动脉的显微解剖及其临床意义

目的:研究Heubner回返动脉的显微解剖及其与A1的关系,以及与眶额动脉和额极动脉的区别。方法:成人尸体头颅标本15例(30侧),经翼点入路,在手术显微镜下对Heubner回返动脉及相关结构进行观察后,取出脑组织块,解剖观察和测量回返动脉、眶额动脉和额极动脉。结果:(1)根据回返动脉与A1的关系,将其分为:远外侧型占22.2%、周围型占69.4%、内侧型占8.3%。(2)回返动脉直径为(0.77±0.12)mm,绝大部分起源于前交通动脉周围2mm的大脑前动脉;眶额动脉的直径为(0.63±0.16)mm,均起源于A2段,距前交通动脉的距离平均(5.51±3.4)mm;额极动脉的直径为(0.66±0.18)mm,距前交通动脉的距离为(1.41±0.51)cm。结论:识别回返动脉并明确其与A1、眶额动脉和额极动脉的关系对手术中Heubner回返动脉的保护具有重要意义。     

Anatomical study of the communicating branches between the medial and lateral plantar nerves

The plantar areas of the foot have specific biomechanical characteristics and play a distinct role in balance and standing. For the forefoot surgeon, knowledge of the variations in the anatomy of communicating branches is important for plantar reconstruction, local injection therapy and an excision of interdigital neuroma. The anatomy of the communicating branches of the plantar nerves between the fourth and third common plantar digital nerves in the foot were studied in 50 adult men cadaveric feet. A communicating branch was present between the third and fourth intermetatarsal spaces nerves in all eight left feet and in six right feet (overall, 28%), and absent in 36 (72%). A communicating branch was found in 14 ft. Ten of the 14 communications were from the lateral to the medial plantar nerve. The length of the communicating branch ranged from 8 to 56 mm (average 16.4 mm) and its diameter was 0.2–0.6 times of the fourth common plantar digital nerve. The angle of the communicating branch with the common plantar digital nerve from which it originated was less than 30° in 11 ft, 30–59° in 27 ft, 60–80° in 8 ft, and more than 80° in 4 ft. Classification of the branch is based on the branching pattern of the communicating branch and explains variations in plantar sensory innervations. We think that the perpendicular coursing communicating branch is at higher risk to be severed during surgery.     

选择性腓肠肌肌支切断小腿减肥术应用解剖

目的:为临床选择性切断腓肠肌肌支进行小腿减肥术提供形态学依据。方法:常规解剖后,在23侧女性下肢标本上观察测量腓肠肌肌支等相关胫神经分支的起始、宽度、长度及相互关系等。结果:(1)腓肠肌内、外侧头肌支的起始形式与邻近神经的组合形式有7种;(2)腓肠肌内、外侧头肌支在胫神经上的起点较恒定,均落在窝中点上下不超过2.2cm的范围以内,平均值(3.8±6.9)mm,起始宽度分别为(2.1±0.5)mm和(2.3±0.4)mm,从起点到肌门的长度分别为(4.1±1.4)mm和(4.8±1.2)cm,各共干形式中的共干段长度为(1.2±0.5)cm;(3)腓肠内侧皮神经的起点几乎总是该段胫神经分支中的最高者,而腓肠肌内、外侧头肌支的相互位置关系也较恒定,前者有95%(19侧)起点高于后者,并多起自胫神经的内侧缘或后内侧。结论:腓肠肌内、外侧头肌支的起点位置恒定,但它们与邻近神经的组合形式复杂,宜在充分熟悉其各种组合形式及相互位置关系的基础上,按一定的顺序有计划地仔细寻找及分离神经及其共干段,宜在肌门处进行切断,以确保在切除腓肠肌内、外侧头肌支的同时,避免损伤比目鱼肌肌支和腓肠内侧皮神经。     

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.     

Communications between the palmar digital branches of the median and ulnar nerves: A study in human fetuses and a review of the literature

In this study, median nerves (MNs) and ulnar nerves (UNs) were dissected in 200 palmar sides of hands (left and right) of 100 (50 male, 50 female) spontaneously aborted fetuses with no detectable malformations. The fetuses, whose gestational ages ranged from 13 to 40 weeks, were dissected under an operating microscope. The MN divided first into a lateral ramus and a medial ramus and then formed a common digital nerve. The first common digital nerve trifurcated in all of the studied cases. The branching patterns were classified into two types (Type 1 and Type 2) based on the relationship with the flexor retinaculum (behind/distal of it). A communication branch between the UNs and MNs in the palmar surface of the hand was found in 59 hands (29.5%). The proper palmar digital nerves were numbered from p1 to p10, starting from the radial half of the thumb to the ulnar half of the little finger, and these nerves exhibited six types of variations. The present data obtained from human fetuses will aid in elucidating the developmental anatomy of the nervous system and provide hand surgeons with a more complete anatomical picture to help them to avoid iatrogenic injuries. Clin. Anat. 23:234–241, 2010. © 2009 Wiley‐Liss, Inc.     

经海绵窦脑神经的显微外科解剖及其临床意义

目的 :了解与海绵窦相关的脑神经走行及其周围结构的显微解剖关系 ,为经该区的直接显微手术提供依据。方法 :用 30例成人头颅标本 ,在手术显微镜下对海绵窦内脑神经 (CN)及周围结构直接进行解剖观察和测量。结果 :经海绵窦的脑神经在后面大多在外侧壁 ,较易分辨 ,Parkinson切口前限可从动眼神经入口平面延长到前床突 (ACP)尖平面。脑神经向前则行走于ACP下缘 ,经床突间隙 (CS)入路磨除ACP时极易损伤 ,其中以动眼神经和滑车神经距离最近 ,在ACP根部 ,动眼神经和滑车神经均紧贴ACP根部底层硬膜入眶 ,距离分别只有 (0 .64± 0 .2 2 )mm (0 .2 6～ 1 .0 8mm)和 (0 .55± 0 .0 6)mm (0 .1 6～ 0 .96mm)。结论 :为途经海绵窦外侧壁手术入路和经CS手术磨除ACP时避免损伤脑神经提供了显微解剖学资料。     

Microanatomical study on the functional origin and direction of the thoracodorsal nerve from the trunks of brachial plexus

Ipsilateral C7 nerve root transfer or neurotization has been used for the repair of brachial plexus avulsions. In this procedure, the ipsilateral C7 nerve root is used as a donor nerve and is implanted into the damaged nerve of the brachial plexus in order to reinnervate distal muscles. However, this procedure may result in unintended injury to the thoracodorsal nerve, which receives motor fascicles form the cervical nerves of C6, C7, and C8, but mainly from C7. Damage to the thoracodorsal nerve ultimately results in weakness or paralysis of the latissimus dorsi muscle, which it innervates. In the present study, 20 adult cadaveric brachial plexus specimens and 3 fresh specimens were dissected using microscopy. The origin and direction of motor fascicles from the three trunks of the brachial plexus to the thoracodorsal nerve were investigated. Motor fiber counts of C7 and the thoracodorsal nerve were also performed. Several observations can be made: (1) The origin of the thoracodorsal nerve can be divided into three types: Type A, the thoracodorsal nerve originated from the superior and middle trunks; Type B, the thoracodorsal nerve originated from the inferior and middle trunks; and Type C, the thoracodorsal nerve originated from all three trunks. (2) More than 52% of the motor fibers in the thoracodorsal nerve originated in the C7 nerve root. (3) Motor fascicles from C7 to the thoracodorsal nerve were mostly localized in the posterior-internal part of C7 at the trunk-division boundary. In conclusion, we suggest that: (1) Because of variation in the origin of the thoracodorsal nerve, electromyography should be routinely performed intraoperatively during C7 nerve root transfer to determine the origin type and avoid thoracodorsal fascicle injury. (2) Preservation of the posterior-internal part of C7 (selective C7 transfer) can protect thoracodorsal nerve fascicles from damage and prevent postoperative dysfunction of the latissimus dorsi muscle.     

经椎体前路健侧颈7神经移位术治疗中枢性上肢痉挛性瘫痪的解剖学研究与临床应用

目的 解剖观察经椎体前路C₇神经移位术中C₇神经的定位、走行及长度等相关解剖特征;探讨椎体前路健侧C₇神经移位术治疗中枢性上肢痉挛性瘫痪的可行性、安全性及临床疗效。方法 （1）选取4具新鲜冰冻成人尸体头颈部标本,其中男2具、女2具,年龄46~72岁（平均59岁）。模拟椎体前路C₇神经移位术,显微镜下游离C₇神经近端椎间孔处至远端神经分叉处,测量C₇神经与锁骨内侧缘垂直距离、C₇神经长度以及椎体前路C₇神经移位的最短距离。（2）回顾性分析2019年11月—2020年12月江苏省苏北人民医院2例脑出血术后中枢性上肢痉挛性瘫痪患者的临床资料。患者均为女性,年龄分别为50岁和51岁,患侧上肢瘫痪,肌力分别为0级和1级,肌张力均较高。2例患者均采用椎体前路健侧C₇神经移位手术治疗,观察患者上肢感觉与运动功能、上肢肌力和肌张力恢复情况,以及手术并发症情况。结果 （1）经椎体前路可充分显露和定位两侧C₇神经,C₇神经走行于前斜角肌与中斜角肌之间,C₇神经与锁骨内侧缘垂直距离1.7~2.5（2.1±0.3）cm,C₇神经长度5.6~6.8（6.4±0.5）cm,椎体前路C₇神经移位的最短距离4.8~5.7（5.3±0.4 cm）。（2）2例中枢性上肢瘫痪患者均顺利完成椎体前路健侧C₇神经移位手术。2例患者术后健侧上肢运动功能均正常,健侧上肢出现疼痛和麻木感,均在1个月恢复。2例患者患侧上肢痉挛症状均得到明显缓解,其中1例患者随访12个月,末次随访时患侧上肢感觉正常,近端肌力3级、远端肌力2级;另1例患者随访8个月,末次随访时患侧上肢感觉正常,近端肌力1级、远端肌力0级。2例患者均未见切口感染、健侧上肢肌力减退等并发症发生。结论 对于中枢性上肢痉挛性瘫痪,经椎体前路健侧C₇神经移位术治疗安全、可行,是一种较好的选择。