胸背神经移位与肱二头肌肌支吻接重建屈肘功能的应用解剖  

Applied anatomy of reconstructing the elbow bending function by anastomosising the thoracodorsal nerve with the biceps branch of musculocutaneous nerve

作　　者：张振伟[1] 廖坚文[1] 卓浩[1] 古纪欢[1] 林冷[1] 周可[1] 陈泽华[1] 庄加川[1] 张家俊[1] 詹伟鹏 

机构地区：[1]深圳市手外科中心深圳市沙井人民医院手外科,广东深圳518104

出　　处：《中国临床解剖学杂志》2003年第6期583-585,共3页Chinese Journal of Clinical Anatomy

基　　金：广东省科技攻关项目 (99B0 670 3G)

摘　　要：目的 :为胸背神经移位与肱二头肌肌支吻接重建屈肘功能提供应用解剖学基础。方法 :取 15具 ( 3 0侧 )成人尸体 ,对肌皮神经肱二头肌肌支和胸背神经及其伴行动脉进行解剖 ,观测其走行、可应用长度、横径及分支情况 ,并取神经标本经石蜡切片、HE染色 ,对有髓神经纤维进行计数。在 2具 ( 4侧 )新鲜尸体上模拟设计手术入路。结果 :( 1)定上肢外展 60°时胸锁关节与喙突间连线中外 1/3交界处锁骨下缘为测量点。肌皮神经肱二头肌肌支发出点距测量点距离平均为 13 .1cm ,强行分离长度平均为 5 .0cm。胸背神经 1～ 3肌支距测量点平均距离分别为 :9.2、11.1、12 .3cm。 ( 2 )肱二头肌肌支发出点与胸背神经各肌支发出点的横径、束数和有髓纤维数等数值相仿。 ( 3 )在新鲜尸体上设计上肢外展 60°锁骨中点下缘至上臂上段内侧正中切口与背阔肌前缘斜行切口 ,操作简易 ,创伤较小。结论Objective: To provide anatomic basis for reconstructing the elbow bending function by anastomosising the thoracodorsal nerve with the biceps branch of musculocutaneous nerve. Methods: Bieps branch of musculocutaneous nerve and the thoracodorsal nerve with their accompanied arteries were dissected on 30 sides of 15 adult corpses. The thoracodorsal nerves' courses, applicable lengths, diameters and its branches were observed, and the nerve fibers were counted after stained with HE. Operation approaches were designed on two fresh corpses (four sides). Results: (1) The measuring point is at 1/3 outer of the line between articulatio sternoclavicularis and the processus coracoideus. The average distance between the starting point of the biceps branch of musculocutaneous nerve and the measuring point is 13.1 cm. The average distance of the forced separation is 5.0 cm. The average distance between the 3 biceps branchs of musculocutaneous nerve to the measuring point is: 9.2 cm; 11.1 cm and 12.3 cm separately. (2) The start points of the biceps branch of musculocutaneous nerves and the thoracodorsal nerves have about the same diameter, amount of nerve bunches and the nerve fibers. (3)A new operation approach were designed on fresh corpses as: Cut from the lower part of the mid-point of the collarbone to the middle the inner side of the upper arm and cut in the front edge of the muscle latissimus dorsi with a position of upper limb extends with an angle of 60°.The advantages of this method are simple and less invasive. Conclusion: To reconstruct the elbow bending function by anastomosising the thoracodorsal nerve with the biceps branch of musculocutaneous nerve is clinical applicable.

关 键 词：臂丛 功能恢复 神经移位 

分 类 号：R622.3[医药卫生—整形外科]