副神经脊髓根颅外段的解剖学

Anatomic study of the extracranial spinal accessory nerve

目的：解剖观测副神经脊髓根颅外段（简称副神经）的走形,为临床提供可靠的解剖学依据.方法：利用显微解剖方法,观测副神经的走行.结果：副神经出颈静脉孔时,58.06％位于颈内静脉浅面,37.10％位于其深面,4.84％从其主干分叉处穿过;二腹肌后腹下缘处,83.87％的副神经位于颈内静脉浅面,16.13％位于其深面;副神经自胸锁乳突肌前缘中上1/4交界处进入该肌深面,随后副神经主干行于该肌深面或从其肌腹内穿过,于该肌后缘中上1/3交界处穿出;副神经主干迂曲向外下越过枕三角,在斜方肌前缘中下1/5交界处进入该肌深面;斜方肌深面,副神经先向外下方走行一段距离后,转向内下方走行,形成终末支进入该肌肌腹,故副神经在斜方肌深面走行近似“？”;副神经走行双侧差异无统计学意义.结论：颈静脉孔处结扎颈内静脉时,注意副神经从颈内静脉中间穿出的类型;胸锁乳突肌前缘和后缘处寻找副神经可分别以二腹肌后腹和耳大神经作为参考标志.

Objective： To observe the extracranial spinal accessory nerve （the spinal accessory nerve to abbreviate） by dissection in order to provide a reliable anatomical basis for clinical application. Methods： Microdissection was used to obtain the course. Results： The spinal accessory nerve ran superficially to the internal jugular vein in 58.06 %, deep to the internally jugular vein in 37.10%, passing through the bifurcation of the internal jugular vein in 4.84% in the site of the jugular foramen; The spinal accessory nerve ran superficially to the internal jugular vein in 83.87 %, deep to the internal iugular vein in 16.13% in the site of the inferior border of the posterior belly of digastric muscle; The spinal accessory nerve entered the depth of the sternocleidomastoid muscle at approximately the junction of the upper and middle one fourth of the anterior border of the sternocleidomastoid muscle. It ran in the depth of the sternocleidomastoid muscle or through the muscle belly of sternocleidomastoid muscle. It emerged in the posterior triangle at approximately the junction of the upper and middle one third of the posterior border of the sternocleidomastoid muscle; The spinal accessory nerve had a sinuous course with the direction of extrinsic and below passing through the occipital triangle. It entered the depth of anterior border of trapezius at approximately the junction of the lower and middle fifth directly; The spinal accessory nerve ran extero-inferiorly distance followed by turning to intero-inferiorly and entering to the muscle belly finally. The course of the spinal accessory nerve in the depth of the trapezius was approximately in the form of ＂？＂; There was no statistical significance in the course of the spinal accessory nerve between two sides. Conclusion： Ligated the internal jugular vein in the jugular foramen, efforts should be made to protect the spinal accessory nerve, especially the type passing through the internal jugular vein; At the anterior and posterior border of the sternocleidomastoid muscle, the spinal accessory nerve can be found at the inferior border of the posterior belly of digastric muscle and great auricular nerve separately.