副神经移位膈神经的人体解剖学研究

Anatomic research on the transposition of accessory nerve to phrenic nerve

目的 了解副神经及膈神经的解剖特点、位置关系及内部运动神经纤维含量,为副神经移位膈神经重建高位颈髓损伤后患者呼吸功能提供解剖学依据.方法 选取20具（38侧）福尔马林固定的成人尸体标本,解剖并观察副神经、膈神经的走形特点,测量副神经及膈神经的长、宽及厚度,副神经舌骨水平至膈神经颈部起点及终点的距离.利用免疫组化方法对膈神经及副神经不同位置进行切片染色,对比纤维含量.结果 副神经发出胸锁乳突肌支后主干的宽度为（1.55±0.11）～（1.61±0.46）mm,厚度为（0.53±0.18）～（0.57±0.24）mm;膈神经的宽度为（1.44±0.27）～（1.45±0.27）mm,厚度为（0.47±0.13）～（0.55±0.24）mm;副神经的长度为（9.48±1.02）cm,副神经舌骨水平与膈神经起始点及膈神经与锁骨交点的距离分别为（3.19±1.23）cm和（8.71±0.75）cm;膈神经的长度为（6.45±0.86）cm;副神经发出胸锁乳突肌支后运动神经纤维含量为（917±234）～（1104±254）条,膈神运动神经纤维含量为（836±311）～（1443±526）条.结论 副神经及膈神经的宽度、厚度及运动神经纤维含量均相似,且副神经的长度可保证与膈神经无张力直接吻合,从解剖学及免疫组化的角度来讲,副神经是重建高位颈髓损伤呼吸功能理想的移位神经.

Objective To comprehend the anatomic characteristics and correlations between the accessory nerve and the phrenic nerve in the adult corpses. Methods The bilateral accessory nerves,phrenic nerves, and their branches of 20 adult corpses （38 sides ） were underwent exposure. The morphologic data of the accessory nerves and the phrenic nerves above clavicle were measured. In addition,the minimal and maximal distances from several points on the accessory nerve to the full length of the phrenic nerve above clavicle were measased. Then, the number of motor nerve fibers on different locations of the nerves utilizing the method of immunohistochemistry were counted and compared. Result The accessory nerves after sending out the sternocleido-mastoid muscular branches were similar in the morphologic data with the phrenic nerves. Meanwhile, the accessory nerve had a coiled appearance within this geometrical area.The possibly minimal distance between the accessory nerve and phrenic nerve was （3.19±1.23） cm, and the possibly maximal distance between the starting point of accessory nerve and the end of the phrenic nerve above clavicle was （8.71±0.75） cm. Conclusions The accessory nerve and the phrenic nerve are similar in the anatomic evidences and the number of motor nerve fibers. And the length of accessory nerve is sufficiently long to connect with phrenic nerve as needed. It is possible to suture them without strain directly.