颈丛至副神经分支的应用解剖研究  

An anatomic study of the branch from cervical plexus into the accessory nerve

作　　者：薛明强[1] 沙轲[1] 谭桢[1] 王静威[1] 龚平[1] 

机构地区：[1]广西医科大学附属第一医院创伤骨科和手外科,南宁530021

出　　处：《中华显微外科杂志》2015年第5期461-463,共3页Chinese Journal of Microsurgery

基　　金：广西壮族自治区卫生厅重点科研课题（桂卫重200739）

摘　　要：目的 明确颈丛汇入副神经的分支（交通支）来源以及神经纤维性质. 方法 成人尸体10具20侧,男7具14侧,女3具6侧,解剖观察颈丛至副神经的分支的来源.临床臂丛神经损伤病例10例,男性,在锁骨上臂丛探查切口中切取锁骨上神经的标本;在后入路副神经移位术中,电刺激副神经主干及颈丛交通支,观察斜方肌远端肌肉收缩情况,切取残留副神经终末支和颈丛交通支做标本;将各神经标本行乙酰胆碱酯酶（AchE）免疫组化染色,观察各神经染色结果,判断其性质. 结果 10例20侧颈丛交通支均来源于第4颈神经根.术中电刺激副神经主干,10例斜方肌中下部均明显收缩,电刺激颈丛交通支,2例刺激后斜方肌下部轻度收缩,余8例未见斜方肌收缩.10例锁骨上神经为AchE染色阴性,10例副神经终末支AchE染色为混合性,10例颈丛至副神经的分支AchE染色均呈阴性. 结论 第4颈神经根较恒定的发出交通支汇入至副神经,参与斜方肌支配,该交通支为感觉性神经纤维.Objective To identify whether the branches of cervical nerve roots joined into the accessory nerve trunk or not.Methods In 10 adult cadavers （7 males and 3 females, including 20 laterals of brachial plexus nerves）, we observe source of cervical plexus branches to the accessory nerve anatomically.In 10 clinical cases of males with brachial plexus nerve injures, in the supraclavicular approach of brachial plexus exploration, the part of the supraclavicular cutaneous nerve for histological specimen were cut off;in the posterior approach, electrical stimulation of the trunk and branches of cervical plexus were performed to observed istaltrapezius muscle contraction.After accessory nerve transfer, the residual terminal accessory nerve and branch of cervical plexus were taked for histological specimens;and observed and judged of each nerve sample by acetylcholinesterase （AchE） immunohistochemical staining.Results In 10 of 20 lateral cases, cervical plexus communicating branches were derived from the fourth cervical nerve root.The intraoperative electrical stimulation of the accessory nerve trunk, 10 cases of distal trapezius muscle were significantly shrink;electrical stimulation of the cervical plexus branch, 2 cases after stimulation of the mild distal trapezius contraction, the remaining 8 cases without trapezius muscle contraction.10 cases of supraclavicular nerve staining for AchE were negative, 10 cases of accessory nerve terminal branches of AchE staining were mixed,10 cases of branch AchE cervical plexus to the accessory nerve staining were negative.Conclusion The branches of the fourth cervical nerve root constantly joins into the accessory nerve, participating in the trapezius muscle inner vation, the fibers of the branches are sensorial fibers.

关 键 词：颈丛 副神经 斜方肌 应用解剖 

分 类 号：R651.3[医药卫生—外科学]