游离股薄肌移植在臂丛神经损伤中的应用解剖学研究  

Study on applied anatomy of free gracilis muscle transplantation in brachial plexus injury

作　　者：林晓岗[1] 顾立强[2] 谢颍涛[1] 相大勇[1] 尹博[1] 

机构地区：[1]南方医科大学南方医院创伤骨科,广州在读硕士510515 [2]中山大学附属第一医院显微创伤骨科

出　　处：《中华创伤骨科杂志》2006年第4期349-352,共4页Chinese Journal of Orthopaedic Trauma

基　　金：广东省科技攻关项目(2002C31003)

摘　　要：目的为臂丛神经损伤行游离股薄肌移植术提供形态学依据。方法经甲醛防腐固定成人尸体下肢标本30侧。显露闭孔神经前支,沿其走行追踪各分支。自起止点完整游离、解剖20侧带主要神经血管蒂的股薄肌,仔细解剖、分离肌门处的分支,修洁神经、血管,显露肌支的各终支,观察各终支的形态及分布,沿终支向肌支近侧分离。用游标卡尺(精确度为0.02mm)、直尺(精确度为1mm)、圆规和量角器对各神经肌支及其终支的位置、长度及入肌点进行测量。结果支配股薄肌的神经恒定地来自闭孔神经前支内侧神经束,股薄肌支干内的神经束有1～4条,各束并行无交叉混合,入肌前分为股薄肌前、后支,共发出4～11支[(8.4±1.5)支]终末神经分支入肌,其中前支发出2～5支[(2.7±0.8)支],后支发出2～8支[(5.7±1.2)支]终末神经分支入肌,后支的终末神经分支数目大于前支(P=0),且前支与后支的入肌点在股薄肌短轴(矢状面)上的分布差异有极显著性意义(P=0)。前、后支各有其相对应的神经束(组)。肌内血管、神经及肌纤维相互平行走行。结论在共血管蒂的基础上分离神经束,并在股薄肌远端根据其分布支配区将肌肉及肌腱劈开而分为两个独立的功能单位具有可行性。Objective To provide morphological basis for free gracilis muscle transplantation to manage brachial plexus injuries. Methods Thirty leg specimens from human corpses were fixed and preserved by formaldehyde. The anterior branch of the obturator nerve was exposed to trace each of its sub-branches. Twenty complete gracilis muscles were procured with the main arterial pedicle and nerve trunk. The final braches at the muscle hilum were carefully dissected and separated. All the final branches were revealed to observe their shapes and distribution, and then dissected and separated proximally. The position, length and insertion of all muscle nerves and their final branches were measured with a vernier caliper （accuracy： 0.02 mm）, a straightedge （accuracy： 1 mm）, a compass and a protractor. Results The gracilis muscles were innervated by the interior fasciculus of anterior branch of the obturator nerve. The gracilis muscle had a single motor nerve that was composed of one to four fasciculi which ran parallel to each other. Before entering the muscle, the gracilis never trunk divided into anterior and posterior subdivisions, which in turn further divided into 4 to 11 （8. 4 ±1.5 ） terminal nerve branches, which ultimately innervated the muscle. The anterior subdivision had 2 to 5（2.7 ±0. 8） terminal nerve branches to the gracilis, whereas there were 2 to 8 （5.7 ± 1.2） terminal nerve branches in the posterior subdivision. In all the specimens, the branches arising from the posterior subdivision were more than that from the anterior （ P = 0）. There were statistical differences between the anterior and posterior subdivisions in the distribution of the terminal nerve insertions at the minor axis （sagittal plane） of the gracilis （ P = 0）. The anterior and posterior subdivisions had their corresponding fasciculi. The intramuscular vessels and nerves ran parallel to the muscle fibers. Conclusion It is feasible to separate the fasciculi and divide the distal end of gracilis longitudinally in

关 键 词：解剖学 神经 股薄肌 臂丛 肌肉移植术 

分 类 号：R651.3[医药卫生—外科学]