改良后入路副神经移位修复肩胛上神经术式解剖学及临床研究

发布时间：2018-07-29 07:19

【摘要】： 目前,在臂丛神经根性撕脱伤的治疗中,副神经移位修复肩胛上神经已经被作为常规的术式,在临床上得到广泛的应用。由副神经支配的上部斜方肌,对于保持肩部外形及术后肩外展功能的恢复具有重要的作用。因此,究竟于何处切断副神经后与肩胛上神经吻合对肩外展功能恢复最有利,是研究和探讨该术式的主要目的。本文应用解剖学及组织学方法对副神经和肩胛上神经进行研究,设计了改良的后入路术式。取8具(12侧)成人尸体颈肩部标本,通过显微解剖观测副神经走行及其与肩胛上神经的关系,并进行形态学测量和组织学染色分析。结果:①副神经在胸锁乳突肌后缘上中1/3交界处穿出,向后、外、下斜行跨过颈后三角区进入斜方肌深面筋膜内,在斜方肌上缘(1.67±0.32) cm处发出1～3条分支支配斜方肌上部,其主干平行于肩胛骨脊柱缘向下走行,部分颈丛分支在斜方肌深面上中部以直接或加入副神经的方式支配斜方肌。②肩胛上神经有髓神经纤维计数为(3137±199)。改良后入路术式中副神经有髓神经纤维计数为(2120±207),副神经降支在肩胛冈与肩胛骨内侧缘交点处的有髓神经纤维数为(1340±120),两者差异有显著性(P0.05)。相比之下,前者的有髓神经纤维数目与肩胛上神经更加匹配。本研究为上述术式的开展提供理论依据,同时我们将此术式初步应用于临床,获得了比较满意的效果。
[Abstract]:At present, in the treatment of brachial plexus root avulsion, the transposition of accessory nerve to repair the suprascapular nerve has been widely used in clinic. The superior trapezius muscle innervated by the accessory nerve plays an important role in maintaining the shape of shoulder and restoring the function of shoulder abduction after operation. Therefore, the main purpose of the study is to find out where the accessory nerve should be cut off and anastomosed with the suprascapular nerve to restore the abductive function of the shoulder. The accessory nerve and suprascapular nerve were studied by anatomical and histological methods, and the modified posterior approach was designed. Eight adult cadavers (12 sides) were taken from neck and shoulder to observe the walking of the accessory nerve and its relationship with the suprascapular nerve by microdissection. The morphology and histological analysis of the accessory nerve were analyzed. Results the accessory nerve of 1 / 1 was perforated at the upper third of the posterior edge of sternocleidomastoid muscle. Outwards, the inferior oblique line crossed the posterior cervical trigonometry into the deep gluten of the trapezius muscle, and at the superior edge of the trapezius muscle (1.67 卤0.32) cm, the superior trapezius muscle was innervated with 1 or 3 branches. The number of myelinated nerve fibers of the suprascapular nerve of the trapezius muscle was (3137 卤199), and the number of myelinated nerve fibers in the middle of the deep face of the trapezius muscle was innervated directly or by adding the accessory nerve to the central part of the cervical plexus. The number of myelinated nerve fibers of the suprascapular nerve was (3137 卤199). In the modified posterior approach, the number of myelinated nerve fibers in the accessory nerve was (2120 卤207), and the number of myelinated nerve fibers in the descending branch of the accessory nerve was (1340 卤120) at the intersection of the scapular ganglion and the medial margin of the scapular bone. The difference between the two groups was significant (P0.05). In contrast, the number of myelinated nerve fibers in the former matched more with the suprascapular nerve. This study provides a theoretical basis for the development of the operation, and we have applied it to clinical practice with satisfactory results.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2008
【分类号】：R322;R651.3

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