肋間神經移位肩胛上神經的解剖學研究_《中國修復重建外科雜志》

作者：

楚彬 , 胡韶楠 , 陳亮 , 宋捷

復旦大學附屬華山醫院手外科（上海，200040）;

關鍵詞：

肋間神經移位術肩胛上神經神經修復解剖學研究

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目的探討第3～6肋間神經移位肩胛上神經重建肩關節外展功能的可行性。方法取15具30側成人軀干標本，解剖測量第3～6肋間神經自腋中線至鎖骨中線可切取長度以及自腋中線至鎖骨中點（擬定神經吻合點）的移位距離，并進行統計學比較。結果30側標本中，第3、4肋間神經均可切取自腋中線至鎖骨中線范圍內的全段神經，且可切取長度均較移位距離長（P lt; 0.01）。6側第5肋間神經及16側第6肋間神經在未到達鎖骨中線時被肋軟骨覆蓋，其中第5肋間神經可切取長度與移位距離相似（P gt; 0.01），第6肋間神經可切取長度較移位距離短（P lt; 0.01）。肩胛上神經通過游離切斷，可翻轉至鎖骨中點下方2 cm以上。第5肋間神經切取長度與肩胛上神經翻轉長度（2 cm）之和，可超過移位距離（P lt; 0.01），但第6肋間神經總長度仍較移位距離短（P lt; 0.01）。結論第3～5肋間神經可直接移位肩胛上神經重建肩關節外展功能，而第6肋間神經需增加游離切取長度范圍或采用神經移植修復。

引用本文： 楚彬,胡韶楠,陳亮,宋捷. 肋間神經移位肩胛上神經的解剖學研究. 中國修復重建外科雜志, 2012, 26(9): 1095-1097. doi: 復制

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4.	Malungpaishrope K, Leechavengvongs S, Uerpairojkit C, et al. Nerve transfer to deltoid muscle using the intercostal nerves through the posterior approach: an anatomic study and two case reports. J Hand Surg (Am), 2007, 32(2): 218-224.
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6.	Oberlin C. Brachial plexus palsy in adults with radicular lesions, general concepts, diagnostic approach and results. Chir Main, 2003, 22(6): 273-284.
7.	Durand S, Oberlin C, Fox M, et al. Transfer of the first intercostal nerve to supra- and infraspinatus muscles: an anatomical study and report of the first case. J Hand Surg Eur Vol, 2009, 34(2): 196-200.
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10.	王樹峰, 張高孟, 顧玉東, 等. 鎖骨下水平副神經切斷移位修復肩胛上神經的臨床觀察. 中華骨科雜志, 2000, 20(10): 594-597.
11.	Chuang DC. Neurotization procedures for brachial plexus injuries. Hand Clin, 1995, 11(4): 633-645.
12.	Narakas AO. Thoughts on neurotization or nerve transfers in irreparable nerve lesions. Clin Plast Surg, 1984, 11(1): 153-159.
13.	Omer GE Jr, Spinner M, Van Beek LA. Management of peripheral nerve problems. 2nd Ed. Philadelphia: WB Saunders, 1998: 459-464.
14.	林浩東, 方有生, 陳德松. 胛上神經卡壓綜合征的后入路手術應用. 中國修復重建外科雜志, 2005, 19(11): 899-901.
15.	劉巍巍. 改良后入路副神經移位修復肩胛上神經術式解剖學及臨床研究. 長春: 吉林大學, 2008.
16.	Asfazadourian H, Tramond B, Dauge MC, et al. Morphometric study of the upper intercostal nerves: practical application for neurotisations in traumatic brachial plexus palsies. Chir Main, 1999, 18(4): 243-253.
17.	El-Gammal TA, Fathi NA. Outcomes of surgical treatment of brachial plexus injuries using nerve grafting and nerve transfers. J Reconstr Microsurg, 2002, 18(1): 7-15.

1. Terzis JK, Kostopoulos V. The surgical treatment of brachial plexus injuries in adults. Plast Reconstr Surg, 2007, 119(4): 73e-92e.
2. 官士兵, 陳德松, 方有生, 等. 副神經移位修復臂叢損傷受區神經選擇的探討. 中國矯形外科雜志, 2004, 12(3): 182-184.
3. Asfazadourian H, Tramond B, Dauge MC, et al. Morphometric study of the upper intercostal nerves: practical application for neurotizations in traumatic brachial plexus palsies. Chir Main, 1999, 18(4): 243-253.
4. Malungpaishrope K, Leechavengvongs S, Uerpairojkit C, et al. Nerve transfer to deltoid muscle using the intercostal nerves through the posterior approach: an anatomic study and two case reports. J Hand Surg (Am), 2007, 32(2): 218-224.
5. Samardzi? M, Rasuli? L, Grujici? D, et al. Results of nerve transfers to the musculocutaneous and axillary nerves. Neurosurgery, 2000, 46(1): 93-103.
6. Oberlin C. Brachial plexus palsy in adults with radicular lesions, general concepts, diagnostic approach and results. Chir Main, 2003, 22(6): 273-284.
7. Durand S, Oberlin C, Fox M, et al. Transfer of the first intercostal nerve to supra- and infraspinatus muscles: an anatomical study and report of the first case. J Hand Surg Eur Vol, 2009, 34(2): 196-200.
8. Rockwood CA Jr, Matsen FA III. The Shoulder. Philadelphia: WB Saunders, 1998: 233-276.
9. 官士兵, 陳德松, 方有生, 等. 后進路副神經移位修復肩胛上神經術式的解剖學研究. 中華手外科雜志, 2004, 20(1): 55-57.
10. 王樹峰, 張高孟, 顧玉東, 等. 鎖骨下水平副神經切斷移位修復肩胛上神經的臨床觀察. 中華骨科雜志, 2000, 20(10): 594-597.
11. Chuang DC. Neurotization procedures for brachial plexus injuries. Hand Clin, 1995, 11(4): 633-645.
12. Narakas AO. Thoughts on neurotization or nerve transfers in irreparable nerve lesions. Clin Plast Surg, 1984, 11(1): 153-159.
13. Omer GE Jr, Spinner M, Van Beek LA. Management of peripheral nerve problems. 2nd Ed. Philadelphia: WB Saunders, 1998: 459-464.
14. 林浩東, 方有生, 陳德松. 胛上神經卡壓綜合征的后入路手術應用. 中國修復重建外科雜志, 2005, 19(11): 899-901.
15. 劉巍巍. 改良后入路副神經移位修復肩胛上神經術式解剖學及臨床研究. 長春: 吉林大學, 2008.
16. Asfazadourian H, Tramond B, Dauge MC, et al. Morphometric study of the upper intercostal nerves: practical application for neurotisations in traumatic brachial plexus palsies. Chir Main, 1999, 18(4): 243-253.
17. El-Gammal TA, Fathi NA. Outcomes of surgical treatment of brachial plexus injuries using nerve grafting and nerve transfers. J Reconstr Microsurg, 2002, 18(1): 7-15.

《中國修復重建外科雜志》

肋間神經移位肩胛上神經的解剖學研究

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《中國修復重建外科雜志》

肋間神經移位肩胛上神經的解剖學研究

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

摘要全文圖表視頻參考文獻施引文獻補充材料