肌皮神经解剖位置及走行特征的超声影像学研究  

A ultrasound imaging study of anatomical position and running features of musculocutaneous nerve

作　　者：种皓[1] 郗扬 周雁[1] 李文军[2] CHONG Hao;XI Yang;ZHOU Yan;LI Wen-jun(Department of Anesthesiology,Beijing Jishuitan Hospital,Beijing,100035,China)

机构地区：[1]北京积水潭医院麻醉科,100035 [2]北京积水潭医院手外科,100035

出　　处：《中国骨与关节杂志》2018年第12期912-918,共7页Chinese Journal of Bone and Joint

基　　金：首都临床特色应用研究(Z141107002514087)

摘　　要：目的本研究使用高频超声观察从腋窝至前臂外侧皮神经穿出筋膜处,肌皮神经(musculocutaneous nerve,MCN)的超声影像学特征、位置及分支情况,为MCN相关手术及麻醉提供参考。方法选择333例于我院手外科就诊行手及前臂手术,麻醉方法为腋入路臂丛神经阻滞的患者进入本次研究。将超声探头垂直于肢体长轴放置,采集胸大肌和肱二头肌交界部的横断面图像,记录MCN的形态、回声强度、位置等信息,并沿肱二头肌走行方向向远端移动探头,观察MCN肌支分支形成情况,直至MCN穿出筋膜形成前臂外侧皮神经,观察记录MCN的超声解剖学特征。结果 MCN通常显示为1个或2个圆形或椭圆形的低回声结构外被高回声外膜,部分患者MCN显示为单个高回声蜂巢状结构。MCN大部分位于腋鞘外,本组333例中MCN穿行于喙肱肌内75例,占22.5%;MCN位于喙肱肌及肱二头肌之间的筋膜层内179例,占53.8%;MCN位于腋鞘内71例,占21.3%;与正中神经伴行走行于腋动脉外侧者8例,占2.4%;此8例在腋窝处未见明确的MCN,但向远端滑动探头找到支配喙肱肌的神经。该情况男3例vs.女5例;(P=0.009),其它各种位置情况男女比较差异无统计学意义(P>0.05)。超声下可见MCN的第一支肌支穿行位置距离喙突的距离为(8.2～15.1) cm,平均10.3 cm;MCN分出肌支者2支11例,占3.4%、3支者109例,占33.5%,4支者205例,占63.1%。MCN穿深筋膜形成前臂外侧皮神经的位置距离喙突为(15.5～21.7) cm,平均18.8 cm。结论使用高频超声观察MCN的形态、分支、走行发现存在很大变异。腋窝处胸大肌外侧缘及肱二头肌交汇处MCN位置存在走行于腋鞘内、穿行于喙肱肌间及缺如3种变异情况,并非如传统解剖书上所描述只走行于喙肱肌及肱二头肌之间的筋膜层内。MCN通常分出3～4支肌支,在上臂远端穿深筋膜形成其终支前臂外侧皮神经。Objective To observe the ultrasonic imaging characteristics, position and branching of the musculocutaneous nerve (MCN)from the popliteal fossa to the formation of lateral cutaneous nerve of the forearm by high-frequency ultrasonography, providing references for MCN-related surgery and anesthesia. Methods A total of 333 patients who underwent distal operation of the forearm and upper limbs were enrolled in this study. The anesthesia method was brachial plexus block. The ultrasound probe was placed perpendicular to the junction of the pectoralis major and biceps brachii, and cross-sectional images were taken. The MCN's morphology, echo intensity, and position were recorded, and the probe was moved distally along the biceps abduction direction to observe the MCN muscle branch formation until the MCN pierced the fascia and formatingthe forearm lateral cutaneous nerve, meanwhile observed and recorded the ultrasonic anatomy of the MCN. Results MCNs usually showed 1 or 2 round or oval hypoechoic structures and were embedded in a relatively hyperechoic background. Some of the patients' MCNs showed a single hyperechoic honeycomb structure. Most of the MCNs were located outside the axillary sheath. Seventy-five patients' (22.5%)MCNs crossed in the coracobrachialis muscle; 179 patients' (53.8%)MCNs located in the fascia layer between the coracobrachialis muscle and biceps brachii; 71 patients' (21.3%)MCNs were found in the axillary sheath, and were accompanied by the medial nerves on the lateral side of the axillary artery; 8 patients (2.4%)had no MCN found in the axillary fossa. The incidence of musculocutaneous nerve deficiency in women was higher than that in men (3 male vs. 5 female, P=0.009), and there were no significant differences between men and women in other positions (P>0.05). The nerves innervating the coracobrachialis muscle were seen slightly away from the upper arm. Under ultrasound, the mean distance from the first muscle branch of the MCN to the coracoid process was 10.3 cm (range: 8.2-15.1 cm). The numbe

关 键 词：肌皮神经 超声检查 臂丛 

分 类 号：R323.4[医药卫生—人体解剖和组织胚胎学] R445.1[医药卫生—基础医学]