中斜角肌内缘腱性束带的形态及其临床意义

Applied anatomy on the tendon band of middle scalene muscle

目的：探讨中斜角肌内缘腱性束带与臂丛受压的关系，为临床诊治提供解剖学基础。方法：３０具成人尸体标本，观察中斜角肌内缘腱性束带的位置及其与臂丛下干的关系。结果：中斜角肌内缘腱性束带出现率为８０％，其长度为３１．５±１．５１ｍｍ、宽度为６．１±２．４ｍｍ、厚度为０．６±０．１ｍｍ。腱性束带起自第７颈椎横突上方，止于第１肋内侧缘（锁骨下动脉沟内侧端处），其形态为一条扁带形弦带，张于第１肋内侧缘上。束带与臂丛下干相交处距第１肋上面高度为４．１±１．５ｍｍ；臂丛下干的合成点与束带的关系有３种类型：Ⅰ型（束带外合干型）占１６％；Ⅱ型（束带上合干型）占３０％；Ⅲ型（束带内合干型）占５４％。结论：Ⅰ型构成对臂丛下干压迫，是导致胸廓出口综合征的主要病因之一，Ⅱ型也可以引起此征，以手术切除束带，解除压迫为最佳治疗手段。

Objective: To investigate the etiology of thoracic outlet syndrome(TOS) from the view of anatomy and provide anatomy basis for its therapy. Methods: The shape and location of the tendom band on the medial edge of middle scalene muscle, the relationship between the brachiplex and the tendon band were observed on 30 adult cadavers.Results: The incidence of the tendon band was 80%.The length, width and thickness of the tendon band was 31.5± 1.51 mm, 6.1±2.4 mm and 0.6±0.1 mm separately.This tendon band originated from the upper part of the trasverse pocess of C 7, ended at the medial edge of the first rib (themedial ter minal of subclavian groove), and intersected with the inferior trunk of brachiplex at 4.1±1.5 mm above the first rib.The relationship of the tendon band and inferior trunk of brachiplex could be divided into three types such as type Ⅰ(intersected extraband, accounted for 16%), type Ⅱ(intersected above the band, accounted for 30%) and type Ⅲ(intersected intraband, accounted for 54%).Conclusions: The compression from the type Ⅰand Ⅱ band might be the reason of thoracic outlet syndrome.Its sever should be the best therapy.