坐骨神经桥接颈7神经根二期移位重建截瘫下肢功能的应用解剖

Applied anatomy of the sciatic nerve bridging C_7 root transfer to reconstruct the lower limber function of paraplegia

目的:为带血供的坐骨神经桥接颈7神经根二期移位重建截瘫下肢功能提供解剖学依据。方法:在动脉内灌注红色乳胶30侧成人下肢标本上,解剖观测坐骨神经营养血管的来源、分布和吻合;坐骨神经与自身躯干长度比例;选择性臀下动脉墨汁注射。结果:坐骨神经臀段营养血管来自臀下动脉,由前内侧进入,外径(1.5±0.7)mm(0.6～3.8mm);股后段来自股深动脉穿支,由前外侧进入;小腿段胫神经来自胫后动脉分支。上述节段血管在神经干表面分出升支和降支,彼此吻合,形成一个纵贯神经全长和供血丰富纵向的吻合血管链。自梨状肌下缘至内外踝连线,神经长(79.3±3.6)cm(70.0～86.0cm),梨状肌下缘至锁骨上缘中点距离为(60.6±3.1)cm(51.0～66.0cm)。选择性臀下动脉墨汁注射显示胫神经远端有墨染。结论:臀下动脉坐骨神经营养支是带血供坐骨神经移位桥接重要的供血途经。

Objective： To provide anatomical basis for the sciatic nerve with vessel bridging C7 root transfer to reconstruct the lower limber function of paraplegia. Methods： The origin,course,branches,distribution and anastomosis of nutrient vessel of sciatic nerve were observed on 30 sides of adult cadaveric lower limbs with red latex in artery. The length proportion between sciatic nerve and trunks was measured. The inferior gluteal artery was injected with ink. Results： In breech segment, the nutrient artery of sciatic nerve originated from inferior gluteal artery and entered sciatic nerve from anterior-medial, the diameter （1.5±0.7）mm （0.6 -3.8 mm）.In femoral segment, the nutrient artery originated from perforating branches of the deep femoral artery and situated on the lateral of anterior to sciatic nerve. In leg segment, the nutrient artery of sciatic nerve originated from branches of posterior tibial artery. Above mentioned nutrient vessels sent off ascending branches and descending branches along the sciatic nerve. A longitudinal vascular network was formed by the nutrient vessels with a plentiful of blood supply. The nerve length from the lower border ofpiriform muscul to the line of medial malleolus and lateral malleolus was （79.3±3.6）cm （70.0-86.0 cm） on average. The length from the lower border of piriform muscul to the middle of upper border of clavicula, sciatic nerve was （60.6±3.1）cm （51.0-66.0 cm） on average.The terminal part of tibial nerve was contaminated with dye after the inferior gluteal artery injected with ink. Conslusions：The results suggest that the inferior gluteal vessels are an important blood supply on transposition bridge of sciatic nerve with nutrient vessel.