中华手外科杂志
中華手外科雜誌
중화수외과잡지
CHINESE JOURNAL OF HAND SURGERY
2012年
5期
300-302
,共3页
楚彬%胡韶楠%陈亮%宋捷
楚彬%鬍韶楠%陳亮%宋捷
초빈%호소남%진량%송첩
肋间神经%臂丛%腋神经%解剖学,局部%肋间神经移位术
肋間神經%臂叢%腋神經%解剖學,跼部%肋間神經移位術
륵간신경%비총%액신경%해부학,국부%륵간신경이위술
Intercostal nerves%Brachial plexus%Axillary nerve%Anatomy,regional%Intercostal nerve neurotization
目的 为利用肋间神经移位腋神经恢复肩外展功能提供解剖学依据.方法对30侧成人尸体标本中第三至第六肋间神经自腋中线至锁骨中线的长度和相应肋间神经自腋中线起点处穿过皮下隧道至四边孔腋神经缝合口处的距离(在肩外展45°和90°两种情况下)进行比较.结果 在肩外展45°时第三肋间至第六肋间自腋中线到锁骨中线的选取长度与相应肋间自腋中线自皮下隧道至四边孔距离差值分别为(3.89±0.85) cm、(4.14± 1.15)cm、(2.99± 1.33) cm和(0.25±1.49)cm.在肩外展90°时,差值分别为(2.54±0.87) cm、(2.37± 1.51)cm、(1.04± 1.74) cm和(-1.59± 1.95)cm.结论 第三、第四、第五、第六肋间选取自腋中线至锁骨中线经皮下隧道至四边孔与腋神经直接缝合是可行的.其中若选用第六肋间神经作为移位神经直接修复腋神经,可适度增加肋间神经或腋神经游离长度,以实现肩外展90°情况下的无张力缝合.
目的 為利用肋間神經移位腋神經恢複肩外展功能提供解剖學依據.方法對30側成人尸體標本中第三至第六肋間神經自腋中線至鎖骨中線的長度和相應肋間神經自腋中線起點處穿過皮下隧道至四邊孔腋神經縫閤口處的距離(在肩外展45°和90°兩種情況下)進行比較.結果 在肩外展45°時第三肋間至第六肋間自腋中線到鎖骨中線的選取長度與相應肋間自腋中線自皮下隧道至四邊孔距離差值分彆為(3.89±0.85) cm、(4.14± 1.15)cm、(2.99± 1.33) cm和(0.25±1.49)cm.在肩外展90°時,差值分彆為(2.54±0.87) cm、(2.37± 1.51)cm、(1.04± 1.74) cm和(-1.59± 1.95)cm.結論 第三、第四、第五、第六肋間選取自腋中線至鎖骨中線經皮下隧道至四邊孔與腋神經直接縫閤是可行的.其中若選用第六肋間神經作為移位神經直接脩複腋神經,可適度增加肋間神經或腋神經遊離長度,以實現肩外展90°情況下的無張力縫閤.
목적 위이용륵간신경이위액신경회복견외전공능제공해부학의거.방법대30측성인시체표본중제삼지제륙륵간신경자액중선지쇄골중선적장도화상응륵간신경자액중선기점처천과피하수도지사변공액신경봉합구처적거리(재견외전45°화90°량충정황하)진행비교.결과 재견외전45°시제삼륵간지제륙륵간자액중선도쇄골중선적선취장도여상응륵간자액중선자피하수도지사변공거리차치분별위(3.89±0.85) cm、(4.14± 1.15)cm、(2.99± 1.33) cm화(0.25±1.49)cm.재견외전90°시,차치분별위(2.54±0.87) cm、(2.37± 1.51)cm、(1.04± 1.74) cm화(-1.59± 1.95)cm.결론 제삼、제사、제오、제륙륵간선취자액중선지쇄골중선경피하수도지사변공여액신경직접봉합시가행적.기중약선용제륙륵간신경작위이위신경직접수복액신경,가괄도증가륵간신경혹액신경유리장도,이실현견외전90°정황하적무장력봉합.
Objective To provide the anatomical basis for intercostal to axillary nerve transfer to restore shoulder abduction.Methods Thirty sides of thoracic walls of human cadaver specimens were used.The intercostal nerves Ⅲ to Ⅵ were dissected to measure the lengths of the intercostal nerves from the midaxillary line to the midclavicular line.Meanwhile the distances from the relevant intercostal space to the quadrilateral foramen (with 45° of shoulder abduction and 90° of shoulder abduction) through the subcutaneous tunnel were also measured.Results The differences between the length of the intercostal nerve Ⅲ to Ⅵ and the distance from the relevant intercostal space to the quadrilateral foramen were (3.89 ± 0.85) cm,(4.14 ± 1.15) cm,(2.99 ±1.33) cm and (0.25± 1.49) cm with 45° of shoulder abduction,and (2.54 ±0.87) cm,(2.37 ± 1.51) cm,(1.04 ± 1.74) cm and (-1.59 ± 1.95) cm with 90° of shoulder abduction.Conclusion It is feasible to perform direct coaptation between the axillary nerve and the intercostal nerves Ⅲ to Ⅴ at the quadrilateral foreman without nerve graft.To achieve tension-free coaptation of intercostal nerve Ⅵ and the axillary nerve at 90° of shoulder abduction,extra-length of the intercostal nerve Ⅵ or axillary nerve should be obtained.
