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 .

An Anatomical Study on Innervation of Trapezius Muscle

Purpose:In order to acknowledge the effect of radical neck dissection on shoulder function,an anatomical study on innervation of trapezius muscle has been carried out.Based on character of the inervation,some new operative modality were explored to improve the postoperative shoulder function.Methods:22 sides neck dissection were performed on 16 adult cadavers to observe the innervation of the trapezius muscle.Results:68.18% accessory nerve receive the communication of branches from cervical plexus anterior to the posterior border of sternomastoid muscle,most of these branches come from C 3,C 4.Among these branches,about 88.37% branches run superior to prevertebral fascia,every cervical plexus have the branches to levator scapulae and all of these were beneath the prevertebral fascia.Conclusions:The accessory nerve and the branches of cervical plexus double innervated Trapezius muscle.The anatomical findings support our modified operative options that preserving the branches to trapezius muscle from C 3,C 4 and(or)transposition anastomosis of accessory nerve with branches of cervical plexus to levator scapulae muscle during neck dissection to improve shoulder function.