运用术中神经电图确定斜方肌神经支配的临床研究

Intraoperative Electroneurography for Understanding the Innervation of Trapezius Muscle

目的:通过术中神经电图明确颈丛斜方肌支及副神经对斜方肌的动力支配作用。方法:在术中直接刺激暴露的副神经及C2-C4神经干,在斜方肌的上中下三部分分别记录肌肉收缩时产生的复合肌肉动作电位,以确定副神经及颈丛斜方肌支对斜方肌的支配作用及其范围。结果:副神经对斜方肌的各部分都具有动力支配作用,而一部分颈丛斜方肌支对斜方肌也存在不恒定的动力支配作用,其中C2主要是通过加入副神经的方式支配斜方肌的,C3、C4则多为独立支配斜方肌。结论:斜方肌接受副神经及颈丛斜方肌支的双重动力支配作用,如根治性颈清扫术中保护颈丛斜方肌支,则可能在一定程度上改善患者术后肩功能。

Objective： To utilize intraoperative Electroneurograghy to understand the innervation of trapezius muscle. Methods ： We stimulated the accessory nerve and C2 - C4 branches of the patients who underwent the radical neck dissection directly, and registered the compound muscle action potentials through pairs of needle electrodes placed in each of the three parts of the trapezius muscle. Results： We obtained visible and recordable contractions from all the accessory nerves and some of the C2 - C4 branches. The C2 contributed innervated trapezius muscle by the communication to the accessory nerve, and C3 , C4 contributed independently. Conclusion： Trapezius muscle was motor innervated by both accessory nerve and C2 - C4 branches, and protected the cervical branches during radical neck dissection was necessary.