寰枢关节错位与胸锁乳突肌和斜方肌疼痛的解剖关系的初步研究

The pilot study of anatomy relationship between atlanto- axial joint misalignment with sternocleidomastoid and trapezius muscles pain

目的观察寰枢椎与副神经及第2颈神经的解剖关系,以及观察胸锁乳突肌和斜方肌的神经支配特点,为寰枢关节错位致胸锁乳突肌和斜方肌疼痛提供解剖学依据。方法对3具共6侧成年人颈部尸体标本进行解剖,观察寰椎横突与副神经、寰枢外侧关节与第2颈神经前支、寰枢椎椎间孔外韧带的解剖结构,以及观察胸锁乳突肌和斜方肌的神经支配特点,测量副神经与寰椎横突尖的最短距离。结果(1)胸锁乳突肌和斜方肌均受副神经和颈丛(第2~4)神经支配,并且副神经与颈丛神经存在交通支联系。(2)副神经走行在寰椎横突前方,二者关系密切,副神经与寰椎横突尖的距离为4.84~7.60 mm(左侧)和3.22~6.80 mm(右侧)。(3)寰枢椎存在椎间孔外韧带,该韧带与第2神经相连,并附着在寰椎横突。(4)第2颈神经前支贴着寰枢外侧小关节向前走行。结论寰枢关节错位可能会刺激副神经及第2颈神经或其前支,从而引起胸锁乳突和斜方肌紧张、疼痛。

Objective To observe the anatomic relationship of atlanto-axial joint with the accessory nerve and the second cervical nerve, and to observe the innervation of sternocleidomastoid and trapezius muscle, providing the anatomy basis of sternocleidomastoid and trapezius muscles’pain caused by atlanto-axial joint misalignment. Methods Three adult cadaveric neck specimens（6 sides） underwent dissection. The anatomic relationship of atlas transverse process with accessory nerve and lateral atlantoaxial joint with second cervical nerve’anterior branch, the anatomy of atlanto-axial joint’extraforaminal ligament, and the innervation of sternocleidomastoid and trapezius muscle were observed. The minimum distance between atlas transverse process tip and accessory nerve was measured. Results （1）Sternocleidomastoid and trapezius muscles were innerved by both accessory nerve and cervical nerve （2th^4th）, and accessory nerve had communicating branch with cervical nerve. （2）Accessory nerve was situated anteriorly to the transvers process of the atlas, and a close anatomic relationship between them could be observed. The minimum distance between the tip of atlas transverse process and accessory nerve was 4.84~7.60 mm （left side） and 3.22~6.80 mm（right side）. （3） Extraforaminal ligament existed in the atlanto-axial joint intervertebral foramen, which was in contact with the second cervical nerve and adhered to atlas transverse process. （4）The anterior branch of second cervical nerve travelled forward in contact with lateral atlantoaxial joint. Conclusion Atlanto-axial joint misalignment may stimulate the accessory nerve and thesecondcervicalnerveor its anterior branch, which may cause sternocleidomastoid,trapezius muscle tension and pain.