颈神经后支的应用解剖研究

Anatomic study of the cervical dorsal rami nerve

目的:为临床诊治颈神经后支卡压提供解剖学基础。方法:对20例(40侧)成人尸体头颈标本颈神经后支分支的走行、分布及其与周围组织结构的解剖关系进行观测。结果:①C2颈神经后内侧深支支配头下斜肌和头半棘肌。②C3—8颈神经后支自脊神经分出,行向后内,分别经颈神经后支骨纤维孔和管,然后穿颈半棘肌与回旋肌间的腱性交叉纤维,分布于项部肌肉、颈椎关节突关节及枕项部皮肤。③颈神经后支骨纤维孔的壁:下壁为同序数颈椎横突后结节上缘;上壁为上位颈椎横突下缘及肋间软组织;内侧壁为同序数椎骨上关节突外缘;外侧壁为横突间肌和横突间韧带的内缘。④颈神经后支骨纤维管壁:内侧壁为同序数关节突腰部外面;外侧壁为颈半棘肌的腱纤维;上壁为同序数椎骨的上关节突;下壁为同序数椎骨下关节突基部。结论:颈神经后支穿行的骨纤维孔、骨纤维管及项部肌肉的腱性交叉纤维是造成颈神经后支卡压的解剖学基础。

Objective：To provide anatomic basis for the diagnosis and treatment of the compression syndrome in cervical dorsal rami nerve.Method：Ramification course and distribution of cervical dorsal rami nerve and its anatomic relationship with the adjacent were observed on 20 adult embalmed cadaver （40sides）.Result：（1）The deep ramus of the medial branch of C2 dorsal ramus supplied the obliguus capitis inferior muscle and semispinalis capitis muscle. （2）C3--8 dorsal rami arises from the spinal nerves,passed through osseofibrous aperture and the osseofibrous canal,passed through the tendinous decussating fibers of the semispinalis neck muscle and the circle muscle, and then supplied the nuchal muscles,the cervical zygapophysial joints and the occipital and nuchal skin. （3）The walls of the osseofibrous aperture of the cervical dorsal rami nerve： The inferior wall was the superior margin of the posterior tubercle of the same ordinal cervical vertebral transverse process; The superior wall was the inferior margin of the above cervical vertebral transverse process,and the soft tissue between the ribs; The medial wall was the lateral margin of the superior articular process of the ordinal cervical vertebrae; The lateral wall was the muscle between the transverse processes and the medial margin of the ligament between the transverse processes.（3）The walls of the osseofibrous canal of the cervical dorsal rami nerve： The medial wall was the external surface of the waist of the transverse processes; The lateral wall was the tendinous fibers of the semispinalis neck muscle; The superior wall was the superior articular process of the same ordinal cervical vertebrae; The inferior wall was the inferior articular process of the same ordinal cervical vertebrae.Conclusion：The osteo-fibrous apertures,osteo-fibrous canal and the tendinous decussating fibers of the nuchal muscles passed through by cervical dorsal rami might be the anatomic basis of the cervical dorsal rami compression syndrome.