内窥镜诊治臂丛神经血管受压征手术器械入路的解剖学研究

目的探讨应用内窥镜诊治臂丛神经血管受压征的可行性,在锁骨下内窥镜入路的基础上,在腋部寻找到达第一肋表面前中斜角肌止点的手术器械安全入路,为临床应用奠定基础。方法取陈旧尸体标本2具4侧,新鲜尸体标本9具18侧。在腋窝胸大肌后缘第二肋水平做1.5cm长皮肤横切口,采取不同体位,于不同角度测量自入路切口点到第一肋表面前中斜角肌止点的距离,解剖肋锁间隙、入路周围的组织结构及相互的毗邻关系,选择安全器械入路。结果侧卧位,上肢外展上举120°、前倾30°,取胸大肌后缘第二肋水平1.5cm皮肤横切口,器械沿胸壁向胸锁关节外侧6.5cm处插入7.8cm左右,顺利到达第一肋表面前中斜角肌止点,自皮肤至第一肋的走行中不伤及血管、神经。结论该手术入路是器械到达第一肋表面前中斜角肌止点的安全入路。

Anatomic study of the approach for endoscopic treatment of brachial plexus compression syndrome

Objective To investigate the feasibility of endoscopy in diagnosis and treatment of compressed peripheral nerves. Methods An 1.5 cm transverse incision posterior to the margin of pectoralis major along the second rib was made in 2 old and 9 fresh cadaver specimens. The distance from the incision to the insertions of anterior and middle scalene muscle on the first rib was measured at various angles. The structures surrounding the approach was observed and measured to find a safer approach for endoscopic treatment of brachial plexus compression syndrome. Results With the upper limb hyperabducted at 120 degrees, anteriorly tilting at 30 degrees, through an 1.5 cm transverse incision made posteriorly to the margin of pectoralis major and along the second rib, the apparatus was inserted toward the point 6.5 cm laterally apart from the sternoclavicular articulation and 7.8 cm in depth, reaching the insertions of the anterior and middle scalene muscle on the first rib without injury to the nerves and vessels. Conclusion The approach is safe for endoscopic apparatus reaching the insertions of the anterior and middle scalene muscles on the first rib. It also provides a basis for further investigation of cutting anterior and middle scalene muscles through endoscope.