带血管肋间神经与髂腰肌支吻接重建屈髋功能应用解剖

Applied anatomic study on functional reconstruction of stepping forward with vascularized intercostal nerves suturing to iliopsoas nerve

目的:为带血管的肋间神经与髂腰肌支吻接重建屈髋功能提供解剖学基础。方法:在30侧成人标本上对支配髂肌、腰大肌的神经进行解剖和观察。结果:支配腰大肌的神经纤维主要来源于L2,其次是L3,肌支纤维在L2神经干的外上部走行,部位较恒定。髂肌肌支则在股神经合干起始处发出,神经纤维主要来源于L4,其次为L3及L2。结论:将肋间神经转位从背侧手术入路与L2神经根前支外上部端侧吻接,或经腹手术入路于股神经起始部与髂肌肌支吻接术式具有可行性。

Objective: To study the anatomy of the iliopsoa nerves and provide the anatomical basis of function reconstruction of stepping forward for the obsolete paraplegia patients. Methods: The anatomy study was made on 30 sides in adult cadavers. Results: (1) The nerve fibers to psoas major originated chiefly from L2, secondly from L3, and arose at the lateral-superior of the root of L2; (2) The nerve fibers to iliacus derived from L4, secondly from L3 and L2, and originated nearly the femoral nerve. Conclusions: The vascularized intercostal nerves can be transferred by a back road to suture with the root of L2, or by a belly road to suture with the nerve of iliacus near the femoral nerve, which make the iliopsoas regain innervation.