摘要
目的对胸背神经的外侧束和腋神经穿越四边孔后支配的三角肌肌支进行显微解剖研究，并应用于临床，为臂丛神经损伤后功能重建提供新的方法。方法取 17具成人尸体，在手术显微镜下对 31侧胸背神经外侧束和腋神经三角肌肌支进行解剖，观察其可应用长度、直径及分支情况，并取神经标本经 HE染色、石蜡切片，对有髓神经纤维进行计数。临床上进行 3例手术。例 1将胸背神经外侧束与四边孔内切断的腋神经三角肌肌支吻合。例 2在例 1术式基础上，用胸背神经内侧束支配的部分背阔肌重建屈肘功能。例 3将背阔肌按内、外侧束的支配区域，剪切成两部分，移位的同时重建屈肘、屈指功能。结果胸背神经在入背阔肌处开始分为内、外侧束，外侧束明显较内侧束粗大。外侧束在背阔肌内可利用的长度平均为 58.2 mm，直径平均为 1.46 mm，有髓纤维数平均为 1 519根， 90.4％的外侧束可再分为 2支或 3支。腋神经三角肌肌支直径平均为 2.31 mm，有髓纤维数平均为 2 341根， 61.3％的三角肌肌支可再分为 3支， 32.3％的三角肌肌支可再分为 2支。 3例术后情况 :例 1三角肌肌力为 4级；例 2三角肌肌力为 4级，屈肘时肌力为 4级；例 3屈肘、屈指时肌力均达到 4级。结论应用胸背神经双分支的解剖基础，将胸背神经外侧束与腋神经三角肌?
Objective To study the lateral branch of thoracodorsal nerve and the deltoid branch of axillary nerve under microscope for clinical application in the reconstruction of brachial nerve injury. Methods 31 lateral branches and deltoid branches of axillary nerve on 17 cadaver specimens were studied on topography under the light microscope(× 5) to observe the length, diameter, and the number of branches. The number of fibers was counted on the HE- stained section of the nerves. Three cases were performed: In operationⅠ , the lateral branch of thoracodorsal nerve was connected with the deltoid branch of axillary nerve. In operationⅡ , on the base of the first operation, the medial branches of the thoracodorsal nerve partially the latissimus dorsi was reconstructed for recovery of the flexion function of the elbow. In operationⅢ , the latissimus dorsi was section into two parts according to the innervation of the medial and lateral branches of the thoracodorsal, and the two branches of the thoracodorsal were transplanted in a dislplaced position for the restoration of flexion function of the elbow and the fingers. Results Thoracodorsal nerves have 2 branches near dorsal aspect of the latissimus dorsi. The lateral branch is thicker with the average length of 58.2 mm avaliable for the reconstruction purpose; the diameter is in average of 1.46 mm, the number of fibers is in average of 1 519; 90.4％ of the lateral branches redivided into 2 or 3 branches. The diameter of the deltoid branch of axillary nerve is 2.31 mm in average and 61.3％ give 3 branches; 32.3％ 2 branches; the number of fibers is in average of 2 341. Clinically the reconstruction operation is successful. In operationⅠ the strength of the deltoid muscle recovered to grade 4; in operationⅡ the strength of the deltoid muscle and elbow- flexing is reached grade 4 and in operationⅢ the strength of elbow- and finger- flexion recovered to grade 4. Conclusion Reconstruction of two muscular groups of the latissimus dorsi with loss of nerve innervation is effective by the application of double branch potential of the thoracodorsal nerve.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2001年第2期77-79,共3页
Chinese Journal of Orthopaedics
