臂丛颈部的解剖学研究及其临床应用

目的为臂丛麻醉提供解剖学基础,并为解剖学积累新资料。方法解剖成年国人尸体20具(男16,女4)、40侧颈部。观察第5-8颈神经前支(C5-8)和第1胸神经前支(T1)及其上、中、下干的位置。测量各根、干的长度和中干末端与锁骨相交点的距离以及中干末端与锁骨相交点距胸锁关节外侧的距离。结果C5,C6,C7(即臂丛中干),C8和T1的长度分别为(33.6±0.82)mm,(均数±标准差,下同),(28.6±0.73)mm,(53.4±1.15)mm,(28.7±1.24)mm和(24.2±1.11)mm。臂丛上、下干的长度分别为(25.9±0.78)mm和(32.7mm±1.28)mm。中干(即C7)末端与锁骨相交点的距离为(26.3±0.66)mm,中干末端与锁骨相交点距胸锁关节的距离为(59.3±1.04)mm。前斜角肌的止点均平锁骨上缘(100%),其止点外缘距离胸锁关节(46.2±0.8)mm。结论臂丛颈部阻滞的最佳穿刺点位于胸锁关节沿锁骨外侧60mm、直上26mm处。

The Anatomic Study of Brachial Plexus for the Cervical Part and its Clinical Supply

Objective To provide anatomical basis for anesthesia of the brachial plexus and new anatomical data for anatomy.MethodsThe cervical regions were dissected in 20 adults' Chinese cadaver specimen(16men,4 women),40 sides.The location and lengths of the roots of the C_5,C_6,C_7(in the middle trunk),C_8 and T_1,and the superior,middle(that is C_7),inferior trunks were observed and measured.The distances from the end of the middle trunks to the clavicle,and this point to the sternoclarvicular joints were measured.ResultsThe lengths of the roots of C_5,C_6,C_7(in the middle trunk),C_8 and T_1 were(33.6±0.82)mm(average±standard deviation),(28.6±0.73)mm,(53.4±1.15)mm,(28.7±1.24)mm and(24.2±1.11)mm,respectively.The lengths of the superior and the inferior trunks of brachial plexus were(25.9±0.78)mm and(32.7±1.28)mm,respectively.The distances from the end of the middle trunks to the clavicles were(26.3±0.66)mm,and from this points to the sternoclarvicular joints were(59.3±1.04)mm.The distances from the insertion of the anterior scalene muscles to the sternoclarvicular joints are(42.6±0.8mm).ConclusionThe best puncture point for anesthesia of the brachial plexus is located at the lateral sides of sternoclarvicular joints 60mm,from this points 26 mm superiorly.