斜方肌各亚部神经分布和神经入肌点定位

The innervation of compartments of trapezius and location of nerve entering point

目的为斜方肌各亚部的临床应用提供形态学基础。方法①观察30具成尸斜方肌各亚部的神经来源,并定位神经入肌点。②用6具尸体的斜方肌行Sihler’s肌内神经染色,观察肌内神经分布。结果①斜方肌降部入肌点约在斜方肌前缘的上3/4与下1/4交界处,水平部入肌点在锁骨肩峰端外侧缘中点与第7颈椎棘突上缘连线的中点,升部入肌点在肩胛冈内侧端结节与第4胸椎棘突上缘连线的中点。②斜方肌受副神经和颈丛(C2-4)斜方肌支支配,副神经主干在颈后三角和斜方肌降部深面发出1～3支一级分支到斜方肌降部,颈丛斜方肌支加入副神经主干一起在斜方肌水平部深面发出4～6支一级分支到斜方肌水平部,在斜方肌升部深面发出2～5支一级分支到斜方肌升部。斜方肌各亚部的肌腹中部均有一终未神经分支密集区,它们连成一条连续的约呈"S"形的神经分支带。结论斜方肌的降部仅由副神经支配,斜方肌的水平部和升部由副神经与颈神经双重支配。

Objective To provide the morphological basis for clinical application of compartments of trapezius. Methods （1） The innervation of compartments of trapezius was observed and the nerve entering point （NEP） was located in 30 cadavers. （2）12 trapezius of 6 cadavers were stained using the modified sihler＇s neural staining technique to observe the intramuscular nerve patterns. Results （1） The NEP of the descending part was constant at the junction of the superior 3/4 and inferior 1/4 of the anterior border of the trapezius. The NEP of the transverse part was constant at the midpoint of the line from the superior border of spinous process of the 7th cervical vertebrae （C7） to the midpoint of lateral border of acromion end of the clavicle. The NEP of the ascending part was constant at the midpoint of the line from the superior border of spinous process of the 4th thoracic vertebrae （T4） to the tubercle at medial end of spine of scapula. （2） The trapezius was innervated by both the spinal accessory nerve （SAN） and the trapezius branches of the cervical plexus （C2-4） （TBCP）. The SAN gave off 1-3 primary branches to descending part in both the posterior triangle of the neck and the deep of the descending part. The SAN and the TBCP which merged with the SAN gave off 4-6 primary branches to the transverse part in the deep of the transverse part, and gave off 2-5 primary branches to the ascending part in the deep of the ascending part. Intramuscular nerve of trapezius gave off terminal neural branches, which came into being an dense region of neural branches in each compartmental middle, then formed an continuous neural branch cingulum like ＂S＂ in the middle of trapezius. Conclusions Descending part of trapezius is innervated by the SAN, whereas the transverse and ascending parts of trapezius are innervated by both the SAN and the TBCP.