选择进胸取膈神经移位路径的应用解剖学研究  

An applied anatomical study of choosing transfer course of phrenic nerve harvested from thoracic cavity

作　　者：赵新[1] 张高孟[1] 劳杰[1] 张丽银[1] 王涛[1] 

机构地区：[1]复旦大学华山医院手外科,上海200040

出　　处：《中华手外科杂志》2002年第1期13-15,共3页Chinese Journal of Hand Surgery

基　　金：上海市领先学科基金资助项目 (95 Ⅲ 1 )

摘　　要：目的　为选择进胸取膈神经移位治疗臂丛神经根性损伤的移位路径提供解剖学依据。方法　对 2 9侧尸体标本 ,观测进胸获取膈神经、经不同路径移位可到达的上臂部位。结果　进胸取膈神经经肋间引出胸腔作移位时 ,经第二肋间腋前线处引出的膈神经远端 ,距肱骨内外髁连线的距离最近 ,平均为上臂长度的 3 8.6% (左侧 )和 5 2 .4% (右侧 )。膈神经从颈部抽出经胸腔外移位时 ,沿臂丛神经行径置于锁骨后方的膈神经远端 ,距上臂内髁的距离最近 ,平均为上臂长度的 2 5 .9% (左侧 )和 3 9.0 % (右侧 )。结论　上述两种路径分别为进胸取膈神经经肋间和经胸腔外移位 。Objective To provide anatomical data for choosing transfer course of phrenic nerve harvested from thoracic cavity in treatment of brachial plexus root avulsion. Methods 29 cadaveric specimens were involved in the study. The distances in the arm where the phrenic nerve harvested from the thoracic cavity and transferred by different courses can reach were determined. Results When the phrenic nerve was transferred from the thoracic cavity to the arm by the intercostal space, it was along a course by a hole on the anterior axillary line of the 2nd intercostal space that the distal stump of the phrenic nerve can reach its most distal range in the arm, which was on average 10.6 cm (38.6 percent of the length of the humerus) on the left side, and 14.2 cm (52.4 percent of the length of the humerus) on the right side, superior to the lateral and medial humerus epicondyles line. When the phrenic nerve in its full length was withdrawn out from the thoracic cavity by the superior aperture of thorax and transferred to the arm, it was along the same course of the brachial plexus that the distal stump of the phrenic nerve can reach its most distal range in the arm, which was on average 7.1 cm (25.9 percent of the length of the humerus) on the left side, and 10.5 cm (39.0 percent of the length of the humerus) on the right side, superior to the medial humerus epicondyle. Conclusions The two courses mentioned above are the shortest ones for transferring the phrenic nerve harvested in thoracic cavity to the arm by a way through the intercostal space or outside the thoracic cavity, respectively.

关 键 词：臂丛神经根性撕脱伤 进胸取膈神经移位术 手术路径 解剖学 

分 类 号：R622.3[医药卫生—整形外科]