斜方肌神经支配的解剖学研究

目的 :通过解剖学研究 ,了解斜方肌神经支配方式对根治性颈清扫术术后肩功能可能产生的影响 ,根据神经支配的特点 ,探讨改进手术方法以改善根治性颈清扫术后肩功能的可能性 .方法 :解剖 16具成人尸体 2 2侧颈部 ,观察斜方肌的神经支配 .结果 :68.18%的副神经在胸锁乳突肌后缘前接受颈丛分支的交通 ,所有斜方肌均接受颈丛分支的支配 ,多来源于 C3、C4,其中 ,88.37%的分支在颈后三角位于椎前筋膜的浅面 ,颈丛均有肩胛提肌分支且位于椎前筋膜的深面 .结论 :斜方肌受副神经和颈丛的双重支配 ,大多数颈丛斜方肌支在根治性颈清扫术中会被切断 .通过颈清扫术中保留 C3、C4到斜方肌分支或用颈丛肩胛提肌支与副神经移位吻合来改善术后斜方肌功能具有解剖学上的依据 .     

运用术中神经电图确定斜方肌神经支配的临床研究

目的：通过术中神经电图明确颈丛斜方肌支及副神经对斜方肌的动力支配作用。方法：在术中直接刺激暴露的副神经及C2-C4神经干,在斜方肌的上中下三部分分别记录肌肉收缩时产生的复合肌肉动作电位,以确定副神经及颈丛斜方肌支对斜方肌的支配作用及其范围。结果：副神经对斜方肌的各部分都具有动力支配作用,而一部分颈丛斜方肌支对斜方肌也存在不恒定的动力支配作用,其中C2主要是通过加入副神经的方式支配斜方肌的,C3、C4则多为独立支配斜方肌。结论：斜方肌接受副神经及颈丛斜方肌支的双重动力支配作用,如根治性颈清扫术中保护颈丛斜方肌支,则可能在一定程度上改善患者术后肩功能。     

C3、C4颈丛斜方肌支对斜方肌中下部分支配作用的研究

目的:明确C3、C4颈丛斜方肌支对斜方肌中下部分的支配作用。方法:选择73例接受不同颈清术式的患者,其中18例保留副神经及颈丛斜方肌支(A组);11例仅保留副神经(B组);17例保留C3、C4斜方肌支(C组);27例切除副神经及C2-C4斜方肌支(D组),分别于术后2周、6个月、1年及2年检测各患者的肩功能和斜方肌肌电指标进行比较。结果:A组术后肩功能恢复最好;C组患者斜方肌中下部分的功能与B组无明显差异,且上部分功能优于D组。结论:C3、C4颈丛斜方肌支对斜方肌中下部分有支配作用,这种支配可使患者术后的部分肩功能得到明显改善,其改善程度不亚于仅保留副神经的患者。     

颈清扫术中改善术后肩功能方法的初步探讨

目的　观察并论证两种改进颈清扫术式的优越性及改善术后斜方肌功能的效果。方法　 2 4例需行颈清扫术的患者 ,每组 12例 ,分别在颈清扫术中保留颈丛斜方肌分支 (MRND1)或采用颈丛肩胛提肌支与副神经移位吻合 (MRND2 )。结果　手术 6月后 ,MRND1和 MRND2均可获得较大程度的斜方肌功能恢复 ,MRND1和MRND2的上肢平均最大外展角度分别为 96 .6 7°和 98.13°,5 0 %的患者可以外展上臂超过 90°。结论　 MRND1和MRND2均可较大程度地保存和恢复术后斜方肌的功能 ,改善传统颈清扫术 (RND)后的肩综合征 ,既不违反根治肿瘤的原则 ,同时具有简便、无联带运动、利于斜方肌神经再生、功能恢复等优点。临床上可以用来代替传统 RND,以提高患者的生存质量     

不同颈清术式对口腔鳞癌患者术后肩功能的影响

目的:比较4种不同颈清术式对患者术后肩功能的影响.方法:选择4|D例接受不同颈清术式的患者,其中7例保留副神经及C2-C4斜方肌支(A组);8例仅保留副神经(B组);11例保留C3-C4斜方肌支(C组);14例切除副神经及C2-C4斜方肌支(D组),分别于术前、术后2周及6个月检测各患者的肩功能和斜方肌肌电指标进行比较.结果:A、B组术后肩功能恢复最好;C组在6个月时的各项指标也明显优于D组.结论:在根治性颈清扫术中保留有功能的颈丛斜方肌支,可在一定程度上改善患者术后肩功能.     

颈神经丛深支对斜方肌运动功能的影响

目的　探讨颈神经丛深支在斜方肌运动功能中的作用。方法　采用电生理方法 ,测定切断副神经后的不同时期 ,刺激颈神经丛深支在大鼠斜方肌得到的肌电大小 ,并作统计学分析。结果　保留颈神经丛深支 ,术后不同时期 ,在大鼠斜方肌上均能测到肌电且肌电值差异有显著性。结论　颈神经丛深支是支配斜方肌的另一运动神经来源 ,根治性颈清扫术中对该神经的保护能有效地预防肩综合征的发生。     

改良根治性颈淋巴清扫术中两种副神经解剖方法比较

目的：比较改良根治性颈淋巴清扫术术中两种不同的副神经解剖方法的差异。方法：对我院81例术前判断cNo的口腔癌患者行功能性颈淋巴清扫术,副神经解剖方法分胸锁乳突肌前缘和斜方肌前缘两种,记录观察统计副神经与周围组织解剖关系,比较副神经解剖时间,术中误伤副神经几率及术后肩综合征发生情况。结果：胸锁乳突肌前缘解剖方法快速简便,受颈丛神经干扰少,不易误伤副神经,术后肩综合征发生率低,易于掌握,平均副神经解剖时间10~15 min;而斜方肌前缘解剖方法平均20~30 min,术中易受颈丛神经分支的干扰,容易误伤副神经。结论：胸锁乳突肌前缘解剖方法比斜方肌前缘解剖方法有较明显优越性。     

颈淋巴清扫术后肩综合征的防治

探讨预防颈清扫术后肩综合征的方法。方法观察１１例接受根据治性颈清扫术患者，其中８例切降副神经，保留颈神经丛深支，３例同时切降副神经及颈神经丛深支，术后６月进行肩功能的临床和斜方肌骨电检查。     

根治性颈淋巴清扫术改善术后肩功能的方法探讨

目的 探讨一种改进根治性颈清扫术式对术后肩功能的影响。方法 随机选择20例需行颈清扫术的患者分为2组，每组10例。试验组行根治性颈清扫术时保留颈丛深支，对照组行常规根治性颈清扫术。术后3周及6个月随访．对术后患侧斜方肌功能进行评价。结果 术后3周两组患者均有不同程度的肩功能受损；术后6个月试验组患者患侧肩部无明显下垂，患侧上肢外展稍超越水平线。对照组患侧肩部有不同程度下垂，肩部疼痛，麻木，上肢外展不能超过水平线。结论 保留颈丛深支的根治性颈淋巴清扫术能明显改善术后患侧的肩臂功能，减轻传统术式术后肩部的疼痛、麻木感。该术式不影响根治颈清扫术的疗效，易于临床开展。     

颈横血管为蒂的斜方肌上部肌皮瓣及肩胛冈骨肌皮瓣的应用解剖

目的：进一步探讨以颈横血管为蒡的斜方肌上部肌皮瓣及肩胛冈骨肌皮瓣的应用解剖学基础。方法：解剖观测32侧斜方肌上部、肩胛冈的形态、血供。结果：斜方肌上部近似于梯形,A、B、C和D四缘平均长度为174.63、157.18、86.98、80.95mm,面积126.78cm^2,肩胛冈全长131.21mm;颈横动脉干、颈浅动脉干及其升支、肩胛冈支平均长度分别为42.50、27.80、43.12、28.75mm,起点外径分别为2.71、2.39、1.96、0.50mm,升支发出0.5mm以上肌皮穿支3－6支,回流静脉与相应动脉伴行。结论：斜方肌上部及肩胛冈形态及血供适合形成以颈横血管为蒂的组织瓣,修复口腔颌面部组织缺损。     

Trapezius muscle innervation from the spinal accessory nerve and branches of the cervical plexus

The aim of this study was to demonstrate the extent of motor innervation of the trapezius muscle from the accessory nerve and branches of the cervical plexus using intraoperative electroneurography and histochemical staining. In 34 patients during radical neck dissection the accessory nerve and C2-C4 branches running to the trapezius were identified and stimulated. Potentials were registered under three conditions: intact accessory nerve, section of superior part of communication between the nerve and the cervical branches, and complete section of the nerve. Projections that did not elicit responses were analyzed for acetylcholinesterase activity. Before cutting the accessory nerve, its stimulation led to a recordable contraction in all parts of the trapezius muscle in all patients. C2 contributions were seen in 15, C3 in 21 and C4 in 20 patients. After sectioning of the upper half of the nerve, the results were similar. After the nerve was completely cut, C2 contributions were seen in only 2 patients, but C3 were seen in 20 patients and C4 in 19 patients. Histochemical staining revealed that the branches with no responses contained both motor and sensory axons. The accessory nerve provides the main motor input to the trapezius muscle, but preservation of the C2-C4 branches to the muscle during modified neck dissection should improve outcomes.     

Shoulder-arm-syndrome after radical neck dissection: its relation with the innervation of the trapezius muscle.

In a clinical and electromyographic follow-up of 54 patients who underwent radical neck dissection, vast differences in the individual severity of the shoulder-arm-syndrome were found: 31% experienced severe limitations of shoulder mobility combined with severe pain, whereas 41% suffered only mild discomfort and 28% were free of complaints. These clinical findings were compared to recent anatomical observations concerning individual patterns of innervation of the trapezius muscle. It could be shown that the role of the cervical plexus in the innervation of the trapezius muscle is of great importance and that its subfascial branches are able to maintain the motor supply following radical neck dissection in about 2/3 of patients.     

Stability of the sternoclavicular joint. A retrospective study

Enlargement of the sternoclavicular joint is a well-documented but little recognised complication of radical neck dissection [AJR 3 (1971) 584]. We examined the stability of the sternoclavicular joint in 61 patients who had had radical neck dissection, functional neck dissection or sternomastoid division in the treatment of torticollis. Our findings support the hypothesis that postoperative stability of the sternoclavicular joint depends on the integrity of the accessory nerve and probably the proprioceptive branches of C3 and C4 of the cervical plexus. We conclude that in patients who require surgical section of the sternomastoid muscle in the treatment of torticollis, or for venous access in microvascular reconstruction, enlargement of the sternoclavicular joint should not occur as a postoperative complication, unlike those patients who have radical neck dissection with resection of the accessory nerve.     

Bony mass associated with hypertrophy of the sternohyoid muscle after radical neck dissection

As a late complication after radical neck dissection, this paper reports a bony mass at the sternal end of the clavicle associated with hypertrophy of the sternohyoid muscle. The bony mass and hypertrophy of the muscle were considered due to continuous mechanical strain by the drooping of the shoulder caused by injury of the accessory and cervical nerves, left-handed physical labour, and the lack of the sternocleidomastoid muscle in rotating the head.