后入路副神经移位至肩胛上神经的应用解剖

Applied anatomy for transfer of the spinal accessory nerve to the suprascapular nerve

目的对斜方肌内的神经支配进行解剖学观察，为寻找副神经移位到肩胛上神经的最佳移位点和移位方式提供解剖依据。方法选用成人尸体标本10具20侧，观察副神经在斜方肌内的行径及分支。并取不同水平副神经、肩胛上神经横断面制病理切片，计数各神经断面的神经纤维数，进行比较。结果副神经在锁骨上2～3cm进入斜方肌内，在肩胛冈中点前上方3—4em处，有来自颈丛的交通支加入后形成终末支。副神经的神经纤维计数：入斜方肌处（A点）为（1245±46）条，颈丛的交通支汇入前（B点）为（830±36）条，汇入后（C点）为（1074±38）条。结论（1）副神经在与颈丛交通支合干后H－G段内的各断点，是副神经的最佳移位点。（2）后进路副神经移位术不影响斜方肌上部神经支配，充分利用了颈丛交通支，且缩短了神经再生距离，值得推广。

Objective Anatomical study of trapezius muscle innervations in order to find the best point for transfer of the spinal accessory nerve to the suprascapular nerve. Methods Observation of right and left trapezius muscle innervations in ten cadavers. Study the course and branches of accessory nerve within the trapezius muscle.Resection and cross-sectional biopsy of accessory and suprascapular nerves at different levels. Counting and comparing the number of nerve fibers at different levels in both nerves. Results The accessory nerve enters trapezius muscle within the deep fascia and run posterior just 2-3cm above the clavicle. At the level of the midpoint of the spine of the scapula 3-4cm above and anterior, it unites with the cervical branch of the cervical plexus, then crosses medial to the spine of the scapula with straight course down to the lower trapezius. The number of nerve fibers in cross section at point A （just entering the muscle） was 1245 ± 46, in point B （just before union with cervical branch） was 830 ± 36 and in point C （posterior approach incision） was 1074 ± 38. Conclusion （1） The part of accessory nerve after union and just above the spine of the scapula is the best point for transfer. （2） We recommend Posterior approach of accessory nerve transfer as the anatomy is constant; Operation is simple and does not affect the upper trapezius muscle innervations. Also it gives us a full use of the cervical branch and shortens the nerve regeneration.