臂丛损伤患者腑神经修复的解剖和临床研究

发布时间：2018-03-13 10:41

本文选题：臂丛神经　切入点：腋神经　出处：《广西医科大学》2012年硕士论文　论文类型：学位论文

【摘要】：目的：(一)结合临床资料和尸体解剖探讨臂丛神经损伤中四边孔处腋神经损伤的发病机率,为提高神经转位修复腋神经的临床效果提供理论依据。(二)对肱三头肌肌支和腋神经进行显微解剖为后入路肱三头肌肌支转位修复腋神经进一步提供解剖学依据。方法：(一)临床资料：40例臂丛神经损伤并有神经转位修复腋神经适应症的患者,后入路对其四边孔和腋神经探查。(二)解剖15具30侧福尔马林浸泡的成人尸体标本,观察腋神经与四边孔结构的关系以及对肱三头肌肌支显微解剖。结果：(一)临床资料：12例(30%)腋神经损伤。尸体解剖学：腋神经在四边孔处移动范围小,仅有1cm上下活动范围。26例(87%)四边孔内存在腱性纤维。当前下半脱位时,腋神经张力增大；前屈、后伸时,腋神经紧贴关节囊、腱性纤维、肱三头肌长头肌腱,并与之产生磨擦。(二)肱三头肌肌支解剖学特点：从内→外数分别是长头支、内侧头上支、内侧头下支、外侧头上支。长头支横径2.15±0.44mm,长度BC19.64±4.72mm。内侧头上支横径1.65±0.41mm、长度BC49.80±8.93mm；内侧头下支横径1.87±0.32mm、长度BC85.14±6.75mm；外侧头上支横径1.75±0.31mm、长度BC43.55±9.17mm。结论：(一)臂丛神经损伤患者常合并四边孔处腋神经损伤,拟行神经转位修复腋神经时,有必要探查其是否损伤。(二)桡神经肱三头肌肌支任一支都可作为供体转位修复腋神经,应优先选用长头支。
[Abstract]:Objective to explore the incidence of axillary nerve injury at the foramen quadrilateral in brachial plexus injury by combining with clinical data and autopsy. In order to improve the clinical effect of transposition of nerve to repair axillary nerve. (2) microanatomy of triceps brachii muscle branch and axillary nerve provides anatomic basis for posterior transposition of triceps brachii muscle branch to repair axillary nerve. Methods (1) Clinical data of 40 patients with brachial plexus nerve injury and indications of nerve transposition to repair axillary nerve were retrospectively analyzed. (2) Fifteen adult cadavers with 30 sides of formalin immersion were dissected by posterior approach. The relationship between axillary nerve and quadrangular foramen and microanatomy of triceps brachii muscle branch were observed. Results (1) Clinical data: 12 cases (30 cases) axillary nerve injury. Cadaveric anatomy: axillary nerve moved in a small range at the foramen quadrangularis, with only 1 cm above and below the area of activity. 26 cases had tendon fibers in the quadrilateral foramen. At present, there are tendinous fibers in the quadrilateral foramen. Increased tension of axillary nerve; anterior flexion, extension, axillary nerve close to the capsule of the joint, tendinous fiber, triceps brachii longhead tendon, and produce friction with it. (II) Anatomical characteristics of triceps brachii muscle branch: from the inner part of the triceps muscle. 鈫扵he transverse diameter of the long head branch is 2.15 卤0.44 mm, the length of the long head branch is BC19.64 卤4.72 mm, the transverse diameter of the medial superior head branch is 1.65 卤0.41 mm, the length is BC49.80 卤8.93 mm, the transverse diameter of the medial inferior head branch is 1.87 卤0.32 mm, the length is BC85.14 卤6.75 mm, the transverse diameter of the lateral superior head branch is 1.75 卤0.31 mm and the length of BC43.55 卤9.17 mm. Conclusion (1) the patients with brachial plexus injury often have axillary nerve injury at the quadrangular foramen, and when the nerve transposition is to repair the axillary nerve, It is necessary to explore whether it is damaged. (2) any branch of triceps brachii muscle branch of radial nerve can be used as donor to repair axillary nerve, and long head branch should be selected first.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R651.3;R322

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