肋间神经移位腋神经的解剖学研究

Anatomic study of iutercostal to axillary nerve transfer

目的为利用肋间神经移位腋神经恢复肩外展功能提供解剖学依据。方法对30侧成人尸体标本中第三至第六肋间神经自腋中线至锁骨中线的长度和相应肋间神经自腋中线起点处穿过皮下隧道至四边孔腋神经缝合口处的距离（在肩外展45°和90°两种情况下）进行比较。结果在肩外展45。时第三肋间至第六肋间自腋中线到锁骨中线的选取长度与相应肋间自腋中线自皮下隧道至四边孔距离差值分别为（3．89±0．85）cm、（4．14±1．15）cm、（2．99±1．33）cm和（0．25±1．49）cm。在肩外展90°时，差值分别为（2．54±0．87）cm、（2．37±1．51）cm、（1．04±1．74）cm和（-1．59±1．95）cm。结论第三、第四、第五、第六肋间选取自腋中线至锁骨中线经皮下隧道至四边孔与腋神经直接缝合是可行的。其中若选用第六肋间神经作为移位神经直接修复腋神经，可适度增加肋间神经或腋神经游离长度，以实现肩外展90°情况下的无张力缝合。

Objective To provide the anatomical basis for intercostal to axiUary nerve transfer to restore shoulder abduction. Methods Thirty sides of thoracic walls of human cadaver specimens were used. The intercostal nerves Ⅲ to Ⅵ were dissected to measure the lengths of the intercostal nerves from the midaxillary line to the midelavicular line. Meanwhile the distances from the relevant intercostal space to the quadrilateral foramen （with 45° of shoulder abduction and 90° of shoulder abduction） through the subcutaneous tunnel were also measured. Resets The differences between the length of the intercostal nerve m to and the distance from the relevant intercostal space to the quadrilateral foramen were （3.89 ± 0.85） cm, （ 4.14 ± 1.15） cm, （2.99 ± 1.33） cmand （0.25± 1.49） cm with 45° of shoulder abduction, and （2.54±0.87） cm, （2.37 ± 1.51） cm, （1.04 ± 1.74） cm and （ - 1.59 ± 1.95） cm with 90° of shoulder abduction. Conclusion It is feasible to perform direct coaptation between the axillary nerve and the intercostal nerves Ⅲ to V at the quadrilateral foreman without nerve graft. To achieve tension-free coaptation of intercostal nerve Ⅵ and the axillary nerve at 90° of shoulder abduction, extra-length of the intercostal nerve Ⅵor axillary nerve should be obtained.