肌皮神经卡压征临床及解剖观察

发布时间：2018-07-10 14:16

本文选题：肌皮神经 + 易卡压点　；参考：《吉林大学》2012年硕士论文

【摘要】：目的:报道肌皮神经卡压征一例，并通过对常人尸体解剖，对肌皮神经进行形态学研究，得出肌皮神经易卡压点的解剖学变化。方法对1例肌皮神经卡压的症状、体征、诊断、治疗进行报道，在4例成人（2男、2女，年龄不计，尸体由白求恩医学院基础教研室提供）共8侧双上肢标本上解剖观测：肌皮神经易卡压点形态解剖学研究，肌皮神经各肌支、入肌点、出肌点至喙突距离等。体位变化对测量长度影响。对肌皮神经喙肱肌入肌点及前臂外侧皮神经肘部穿出点的神经性状及周围腱膜组织与神经的关系进行观察，并用摄像器材进行拍摄备份。对肌皮神经喙肱肌入肌点、出肌点不同体位变化时与喙突、胸小肌下缘的距离测量得到的数据，结果判断：对测量指标进行分析、比较，证明体位变化对测量指标的影响意义。（测量指标越长，肌皮神经张力越大，，易形成卡压。证明上肢体位变化是肌皮神经的卡压因素其一。）统计学处理：采用SPSS13.0软件分析数据，计算资料采用x±s表示。两组计量资料的比较采用t检验。结果:临床病例报道证实肌皮神经在肌皮神经喙肱肌入肌点可形成卡压，解剖观察发现喙肱肌入肌点、前臂外侧皮神经穿出点易卡压。上肢内收、外展位时，喙肱肌入肌点至喙突距离分别为：（8.74±1.24）cm、（10.49±1.29）cm，距离改变差异有统计学意义（t=2.765，P0.05)，喙肱肌出肌点至喙突距离分别为：（10.74±1.23）cm、（12.52±1.32）cm，距离改变差异有统计学意义（t=2.786，P0.05）。结论:通过临床病例证实肌皮神经喙肱肌入肌点可发生卡压，肌皮神经喙肱肌入肌点及前臂外侧皮神经肘前穿出点，这两个部位较易有腱膜组织卡压。上肢体位变化是肌皮神经的卡压因素其一。通过对肌皮神经易卡点进行精确的解剖学研究，使我们对肌皮神经卡压鉴别诊断和诊断方面有了更深层的认识；同时解剖学研究证实上肢体位变化是肌皮神经的卡压因素其一，我们能够指导病人日常生活或体力劳动时避免因体位因素引起肌皮神经卡压，过度的训练导致喙肱肌肥大也能引起肌皮神经卡压。进行肌皮神经易卡点周围毗邻组织的解剖研究，能够选择手术的最佳入路，彻底松解卡压的肌皮神经，并讨论注意事项。正中神经与肌皮神经之间存在着交通支，并起着一定的功能，手术时应注意加以保护，肌皮神经解剖变异学研究使我们不拘泥于传统的解剖学，对于指导临床医学也有重要的临床意义。
[Abstract]:Objective: to report a case of musculocutaneous nerve compression, and to study the morphology of musculocutaneous nerve by dissection of normal human body, and to obtain the anatomical changes of the compression point of musculocutaneous nerve. Methods the symptoms, signs, diagnosis and treatment of 1 case of musculocutaneous nerve entrapment were reported in 4 adults (2 males and 2 females, regardless of age). The cadavers were provided by the Department of basic Teaching and Research of Bethune Medical College. The anatomical observation of 8 upper limb specimens included: morphologic and anatomical study on the compression point of musculocutaneous nerve, the muscle branches of the musculocutaneous nerve, the point of entry, the distance from the point of muscle exit to the coracoid process, and so on. The change of posture affects the length of measurement. To observe the nerve characters of coracobrachial muscle entry point of musculocutaneous nerve and the exiting point of forearm lateral cutaneous nerve elbow and the relationship between the surrounding aponeurosis tissue and nerve. The data obtained from the distance between coracohumeral muscle entry point and coracoid process and the lower margin of pectoralis minor muscle were measured when the position of coracobrachial muscle of musculocutaneous nerve was changed. The results were as follows: the measurement index was analyzed and compared, and the influence of the position change on the measurement index was proved. The longer the measurement index, the greater the tension of musculocutaneous nerve and the easier to form compression. It is proved that the change of upper limb position is one of the factors of compression of musculocutaneous nerve. Statistical processing: SPSS 13.0 software was used to analyze the data and the calculated data were expressed as x 卤s. T test was used to compare the measurement data between the two groups. Results: the clinical case report confirmed that the musculocutaneous nerve could be compressed at the point of entering the coracobrachial muscle of the musculocutaneous nerve. Anatomical observation showed that the coracobrachial muscle entered the muscle point, and the point of perforating the lateral cutaneous nerve of the forearm was easily compressed. The distance between coracobrachial muscle entry point and coracoid process was (8.74 卤1.24) cm, (10.49 卤1.29) cm, the distance between beacohumeral muscle and coracoid process was (10.74 卤1.23) cm, (12.52 卤1.32) cm, the distance between beacohumeral muscle and coracoid process was (10.74 卤1.23) cm, (12.52 卤1.32) cm. Conclusion: the clinical cases proved that the musculocutaneous nerve coracobrachial muscle entry point can be compressed, the musculocutaneous nerve coracobrachial muscle entry point and the forearm lateral cutaneous nerve elbow forward exit point, these two parts are easy to have the aponeurosis tissue compression. The change of upper limb position is one of the factors of compression of musculocutaneous nerve. Through the accurate anatomical study of the musculocutaneous nerve, we have a deeper understanding of the differential diagnosis and diagnosis of the musculocutaneous nerve entrapment, and anatomical studies have proved that the change of the upper limb position is one of the compression factors of the musculocutaneous nerve. We can guide the patient to avoid the compression of musculocutaneous nerve due to postural factors in daily life or physical labor. Excessive training can also lead to the hypertrophy of coracobrachial muscle and also to the compression of musculocutaneous nerve. The anatomical study of the adjacent tissues around the curettage point of musculocutaneous nerve can select the best approach to the operation, completely release the compressed musculocutaneous nerve, and discuss the matters needing attention. There is a communicating branch between the median nerve and the musculocutaneous nerve, which plays a certain function. The anatomical variation of the musculocutaneous nerve should be protected during the operation. It also has important clinical significance for guiding clinical medicine.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R322

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