肋间神经移位经后路直接修复腋神经前支的解剖学研究

Transferring intercostal nerves to the anterior branch of axillary nerve through a posterior approach

目的研究上位肋间神经转位经后路修复腋神经前支的解剖学基础。方法取15具30侧福尔马林固定的成人上半身标本，解剖并观察腋神经在三角肌内的神经分布；游离并测量第Ⅲ、Ⅳ、V、Ⅵ肋间神经自肋骨与肋软骨交界处至腋中线翻转处的长度和各腋中线翻转处经后路至腋神经前支的距离。结果支配三角肌的腋神经支主要分为前、后两支，前支支配三角肌前4／5的肌纤维，后支支配三角肌后1／5的肌纤维。第Ⅲ、Ⅳ、V、Ⅵ肋间神经，自肋骨肋软骨交界处到腋中线肋间神经翻转处的平均长度分别为（11．41±0．35）cm、（15．81±1．12）cm、（16．54±1．18）cm和（16．85±0．90）cm，自腋中线肋间神经翻转处到腋神经前支皮下遂道的距离分别为（11．53±0．47）cm、（12．24±0．65）cm、（13．22±1．15）cm和（13．82±1．02）cm。结论除第Ⅲ肋间神经外，可应用第Ⅳ、V、Ⅵ肋间神经中的任意两条组合，自腋中线翻转经后路直接修复腋神经前支。

Objective To provide anatomical evidence for restoring the deltoid function by transferring 2 intercostal nerves to the anterior branch of the axillary nerve through a posterior approach. Methods Fifteen adult human cadavers embalmed by formalin were used. Microsurgical longitudinal contradisseetion of the axillary nerves by tracing their terminal braehes was conducted. The lengths of the 3rd, 4th, 5th and 6th intercostal nerves from the eostochondral junction to the midaxillary line were recorded. The distance from the pivot point at the midaxillary line to the anterior branch of the axillary nerve was recorded as the tunnel length. Results The axillary nerve to the deltoid muscle is divided into 2 branches mostly. The anterior branch of the axillary nerve innervates about 4/5 of the deltoid muscle. The distances from the eostochondral junctions of the 3rd, 4th, 5th and 6th intercostal nerves to the pivot points average 11.41 ± 0. 35 cm, 15.81 ± 1.12 cm, 16. 54 ± 1.18 cm and 16. 85 ±0. 90 cm, respectively. The tunnel distances of the 3rd, 4th, 5th and 6th intercostal nerves average 11.53 ±0.47 cm, 12.24 ±0. 65 cm, 13.22 ± 1.15 cm and 13.82 ± 1.02 cm, respectively. Conclusion Transfer of any two of the 4th, 5th and 6th （except the 3rd） intercostal nerves to the anterior branch of the axillary nerve through a posterior approach can be an alternative method for reconstruction of the deltoid muscle.