人膈肌内神经分支分布

Distribution of intramuscular nerves in the human diaphragm

目的:探讨人膈的神经支配和肌内神经分支分布特点。方法:改良Sihler’s肌内神经分支染色法。结果:(1)一侧膈神经入肌后一般分为3￣4支(3支型4例,4支型2例),1支(前支)向前内侧走行,支配胸部,1￣2支(前外侧支)向外侧走行,支配肋部,最后1支(后支)最粗大,向后下走行,分为后外侧支和后脚支,分别支配膈中心腱外侧叶后外侧的肋部和腰部,各级神经的分支在肌束中部密集排列成神经丛。(2)6例标本均未发现左侧或右侧膈神经越过中线至对侧。(3)2例带肋间肌的标本肉眼未见有肋间神经分支进入膈。结论:(1)左、右膈神经分布于膈,未见左右侧膈神经重叠支配和优势支配。(2)膈神经的终末分支在肌束中部密集排列形成似“肾形”的神经丛带。

Objective: To investigate the distribution and the features of the branches of intramuscular nerves of the human diaphragm. Methods: Modified Sihler's neural staining technique was used to observe the nerve branches of diaphragms. Results: (1) Each phrenic nerve trunk was divided into 3-4 primary branches after penetrating the diaphragms. One(anterior branch) run forward and innervated sternal region.One or two (anterior-lateral branch) run laterally and innervated costal region. Last one (posterior branch) run backwards and subdivided into 2 second branches, and innervated posterior costal and crus region respectively. The terminal branches arranged in the middle of muscle bundles of diaphragm and formed a intensive horizontal 'kidney-shaped' nerve plexus. (2) The branches of one side phrenic nerve did not across midline and extend into the other side. (3) The branches of intercostal nerves were not found in the fringe of costal region of diaphragm in 2 specimens including the lower intercostal muscles. Conclusions: (1) Phrenic nerve innervate diaphragm, and there are no overlaped and dominant innervations.(2) The terminal branches of phrenic nerve arrange in the middle of muscle bundles of diaphragm and form a denser horizontal 'kidney-shaped' nerve plexus.