桡神经肱三头肌肌支的解剖学研究  

An anatomical study of radial nerve branches to triceps brachii muscle

作　　者：姜宗圆[1] 王涛[1] 杨剑云[1] 顾玉东[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》2003年第3期189-192,共4页Chinese Journal of Hand Surgery

摘　　要：目的　明确桡神经肱三头肌肌支在上臂的解剖学特征。方法　成人上肢标本 3 6侧 ,自腋部至上臂内侧解剖桡神经干 ,测量肱三头肌各肌支的发出点、入肌点和长度 ,各肌支的直径和面积比。观察及测量各肌支的无损伤分离长度。结果　桡神经肱三头肌肌支按其分布分为Ⅰ、Ⅱ、Ⅲ型 ,分别占47.2 2 % ( 17/3 6)、2 2 .2 2 % ( 8/3 6)和 3 0 .5 6% ( 11/3 6)。长头肌支长 [( 4 6.82± 10 .0 8)mm , x±s ,下同 ] ,发出点距背阔肌腱止点下缘近端 ( 7.3 6± 2 .68)mm ,入肌点距背阔肌腱止点下缘远端 ( 3 9.46± 6.42 )mm。内、外侧头肌支长 ( 66.0 8± 3 0 .98)mm和 ( 65 .81± 3 0 .65 )mm。长头肌支和内、外侧头肌支的无损伤分离长度是 ( 4 8.93± 9.2 7)mm、( 4 4.2 2± 11.65 )mm和 ( 4 4.64± 9.0 4)mm。无损伤分离最高点平面各肌支与主干面积比为 ( 0 .13± 0 .0 7)mm、( 0 .2 6± 0 .14 )mm和 ( 0 .12± 0 .0 7)mm。结论　长头肌支发出点较固定 ,至入肌点距离较短 ,无损伤分离平面高 ,其近端可与同侧第 3～ 6肋间神经直接缝合 ,适合于肋间神经移位重建肱三头肌功能。Objective To determine the anatomical features of the radial nerve branches innervating the triceps brachii muscle in the upper arm. Methods Thirty-six adult cadaver upper extremities were carefully dissected. The radial nerve trunk was identified from the axillary to the upper arm. The origination point, insertion site, length, ratio of diameter and area of muscular branches were measured. The length of atraumatic detachment of each branch was also checked. Results The pattern of branches innervating the triceps brachii muscle was classified into three types: type I 47.22%(17/36),type II 22.22%(8/36),and type III 30.56%(11/36).The length of the branch to the long head of triceps muscle was (46.82 ± 10.08) mm. The distance between the origination and the site proximal to the inferior border of the insertion of lattismus dorsi muscle was (7.36 ± 2.68) mm, and the distance between the insertion and the site distal to the inferior border of the insertion of lattismus dorsi muscle was (39.46 ± 6.42) mm. The length of the branches to medial head and lateral head of triceps muscle was (66.08 ± 30.98) mm,(65.81±30.65) mm. The atraumatic detachment length of the branch to the long head, medial head and lateral head of triceps muscle was (48.93 ± 9.27) mm,(44.22 ± 11.65) mm, and (44.64 ± 9.04) mm, respectively. The area ratio of the 3 respective branch at the highest level by atraumatic detachment to the trunk was (0.13 ± 0.07), (0.26 ± 0.14) and (0.12 ± 0.07), respectively. Conclusion The branch to the long head had constant origination point, shorter distance of the insertion site and higher level of atraumatic detachment, the proximity of which can be anastomosed with the third to sixth intercostal nerve at the same side directly. It was suitable for the intercostal nerves transfer for the repair of paralysis of the triceps muscle.

关 键 词：解剖学 臂丛根性撕脱伤 神经移位术 上臂 肱三头肌肌支 桡神经 

分 类 号：R323.71[医药卫生—人体解剖和组织胚胎学]