内窥镜诊治臂丛神经血管受压征入路的解剖学研究

Anatomic study of the approach for endoscopic treatment of brachial plexus compression syndrome

目的探讨用内窥镜诊治臂丛神经血管受压征的可行性，寻找到达第１肋骨前中斜角肌止点的最佳入路。方法取陈旧尸体２０具４０侧，新鲜尸体１５具３０侧。在锁骨下距胸锁关节４ｃｍ处作１ｃｍ长的皮肤横切口，测量自入路点到达第１肋骨前、中斜角肌止点的距离，解剖肋锁间隙的组织结构及入路的毗邻关系。结果自皮肤至第１肋骨的入路中无血管神经通过，内窥镜自锁骨下静脉、动脉，臂丛神经下干与第１肋骨之间间隙可顺利到达前、中斜角肌止点。结论该手术入路是内窥镜到达前、中斜角肌在第１肋骨止点的最佳入路。

Objective To open up a new therapeutic way in the field of peripheral nerve, an optimal approach reaching the insertion of anterior and middle scalene muscle on the first rib was found, and anatomic basis for endoscopic treatment of brachial plexus compression syndrome was given. Methods 20 fixed and 15 fresh cadavers were dissected to measure the distance from the part to the insertions of anterior and middle scalene muscle on the first rib. The structures in the costoclavicular space and the relationship between the approach and its surroundings was observed. Results The optimal approach was the infraclavicular 1 cm transverse incision 4 cm from sternoclavicular articulation. By this approach, endoscopy could smoothly reach the insertions of the anterior and middle scalene muscle on the first rib. There was no injury of nerves and vessels through the approach. Conclusions The approach is the best one for endoscopy reaching the insertions of anterior and middle scalene muscle on the first rib. It is both safe and reliable. It establishes a firm foundation for further investigating of cutting anterior and middle scalene muscle by endoscopy.