颈襻或胸锁乳突肌支与膈神经吻接重建呼吸功能的应用解剖

Applied anatomy of anastomosis between the cervical loopor sternocleidomastoid muscular branches of the accessory nerve and the phrenic nerve for treatment of dyspnea after paraplegia

目的 :为颈襻或副神经胸锁乳突肌支与膈神经吻接术重建截瘫患者的自主呼吸功能提供解剖学基础。方法 :在 15具尸体上测量了舌下神经降支、颈神经降支和副神经胸锁乳突肌支的长度、末端的宽度、厚度及神经束的数目 ;副神经胸锁乳突肌支的末端与膈神经汇合处之间的间距 ;膈神经汇合处的宽度、厚度和神经束的数目。结果 :舌下神经降支和颈神经降支的长度分别为 (40 .0± 8.2 )mm和 (3 2 .0± 6.8)mm ;平喉结处的宽、厚度分别为 (1.9± 0 .5 )mm、(0 .8± 0 .1)mm和 (1.6± 0 .5 )mm、(0 .6± 0 .1)mm。副神经胸锁乳突肌支的长 (15 .9± 4.2 )mm ;末端宽、厚度分别为 (2 .3± 0 .7)mm和 (0 .9± 0 .2 )mm。副神经胸锁乳突肌支与膈神经汇合处之间有间距者为 80 % ,平均间距 (2 0 .2± 6.3 )mm。膈神经汇合处的宽、厚度分别为(2 .1± 0 .5 )mm和 (1.2± 0 .4)mm。结论 :舌下神经降支、颈神经降支或副神经的部分胸锁乳突肌支的长度和末端的宽、厚度均能满足与膈神经起始处行神经端—端或端—侧吻接术 ,以重建膈的自主呼吸功能。

Objective: To seek donor nerve to anastomose with the phrenic nerve for the reconstruction of autonomous breathing after paraplegia.Met hods: The ce rvical loops, sternocleido-mastoid muscular branches of the accessory nerves a nd the phrenic nerves on fifteen adult cadavers were observed and measured.Results: The length of the descending branch hypoglossal nerve and cervical nerve were 4 0.0±8.2 mm and 32.0±6.8 mm respectively. Their width, thickness and amounts of nervous bundle at the level of the laryngeal prominence were 1.9±0.5 mm and 0. 8 ±0.1 mm, 1.6±0.5 mm and 0.6±0.1 mm, 3 and 2 bundle respectively. The sternocl eido-mastoid muscular branch of the accessory nerve was 15.9±4.2 mm long. And its width and thickness at the entrance into muscle were 2.3±0.7 mm and 0.9 ±0. 2 mm respectively.The width, thickness and amounts of nervous bundle of the phre n ic nerve at its convergence point were 2.1±0.5 mm, 1.2±0.4 mm and 4.0±0.5 bun dle respectively. 80%(n=24) of the sternocledo-mastoid muscular branches of the accessory nerve had a interval (averaged 20.2±6.3 mm) with the phrenic nerves, 13% of them ( n =4) were close to it, and 7%( n =2) of them run parallel wi th it.Conclusion: These results suggest that the upper and lower roots of the cervical loop or the sternocleido-mastoid muscular branches of the accessory nerve are s uitable donors for end-to-end for end-to-side anastomoses of the phrenic ner ve at its origin or converge point.