锁骨中点内上方阻滞臂丛神经的解剖学

Anatomical basis for nerve block of the brachial plexus via superomedial to midpoint of the clavicle

目的：为临床麻醉工作者提供锁骨中点上方阻滞入路方法。方法：在经10％甲醛溶液固定的60侧头颈、上肢标本及锁骨中点矢状切断面标本上测量臂丛的长度、第1肋上面臂丛神经3束汇合处的直径，确定臂丛阻滞进针点、进针方向、进针角度、进针深度、确定锁骨下动脉的保护角度。结果：臂丛神经的长度为108．09mm±12．49mm；第1肋上面臂丛神经3束汇合处的直径为16．40mm±2．10mm；进针路径（即进针点至锁骨中点上缘）距离为25．45mm±0．42mm；保护锁骨下动脉的夹角为12．85°±0．59°。结论：锁骨中点向内10mm向上23mm处即为进针点，以140°（即进针点的垂线与进针路径呈的夹角）斜向外下至锁骨中点上缘为进针路径，以保护锁骨下动脉的角度为12．85°行臂丛神经穿刺术。该臂丛神经阻滞术，阻滞效果好，可有效避免气、血胸等并发症的发生。

Objective： To provide the morphological basis for blocking the brachial plexus via superomedial to midpoint of the clavicle. Methods： Length of the brachial plexus, diameter of the junction of three cords of the brachial plexus above the first rib were measured on sixteen fixed cadavers, in order to identify the optimal point, direction, angle and depth of needling on account that the subclavian artery was prevented. Results： The length of the brachial plexus was 108. 09 mm±12. 49 mm. The diameter of the junction of three cords of the brachial plexus above the first rib was 16.40 mm±2. 10 mm. The distance of needling pathway was 25. 45 mm±0. 42 mm. The optimal angle that could protect the subclavian artery was 12.85°±0.59°. Conclusion： The needle can be inserted at the point that 10 mm inwards and 23 mm upwards to the midpoint of the clavicle, and run inferolaterally （meaning at 140° that identify as the angle between the vertical line through the needling point and the needling pathway） toward superior border of the midpoint of the clavicle. The angle is 12.85° to protect the subclavian artery. This approach is effective to complete block the brachial plexus without complications such as pneumothorax and hemothorax.