健侧颈_(7)与受区神经匹配性的解剖研究

Anatomic study on the matching between contralateral C_(7) and recipient nerves

目的通过研究健侧颈7与受区神经的匹配性,以便合理利用健侧颈7,更好地恢复患肢功能。方法 12具24侧甲醛(10%福尔马林)固定过的成年尸体标本,解剖出臂丛神经后,分别测量颈7神经根及其前后股、颈8、胸1神经根、下干、前臂内侧皮神经、腋神经前支、正中神经及尺神经的直径。再分别切取上述神经长约1 cm的标本,通过组织学研究,测量他们的神经束横截面积总和(S)和神经纤维总数(N)。最后对上述结果进行比较。结果尺神经直径比颈7前股和正中神经细,尺神经与颈7后股粗细相当;胸1神经较颈7后股直径粗,颈8神经较颈7前股直径粗,下干较颈7直径粗。尺神经较正中神经和颈7神经纤维总数少,但与颈7前股或后股神经纤维数量基本相等;颈7较下干神经纤维总数少,颈7前股比颈8神经纤维总数少,但颈7前股或后股与胸1神经纤维数量基本相等;腋神经较前臂内侧皮神经纤维多。尺神经较正中神经面积小,但与颈7前股或后股神经束面积基本相等;颈7神经总面积比尺神经大,比下干神经束面积小,颈7前股较颈8神经束面积小,但颈7前股或后股与胸1神经面积基本相等;腋神经横截面积大于前臂内侧皮神经。结论不论是从神经粗细,神经纤维数量多少,还是从神经束总面积来评定,健侧颈7移位下干,颈7前后股移位颈8、胸1神经根,颈7后股移位尺神经,都不会引起动力神经纤维的浪费;但颈7全干或颈7前股移位尺神经,将因神经粗细或神经纤维数量不匹配而浪费颈7的动力神经。

Objective To study the matching between contralateral C_(7) and recipient nerves in order to make rational use of contralateral C_(7) and better recover the function of affected limb.Methods The brachial plexus was dissected from 24 sides of 12 adult cadavers fixed with formaldehyde(10%formalin).The diameters of C_(7) nerve root,anterior and posterior divisions of C_(7),C8 and T1 nerve root,lower trunk,medial forearm cutaneous nerve,anterior branch of axillary nerve,median nerve and ulnar nerve were measured.The specimens with the length of about 1 cm of the above nerves were cut respectively.The total cross-sectional area(S)and the total number of nerve fibers(N)were measured by histological study.Finally,the above results are compared.Results The diameter of ulnar nerve was thinner than that of anterior division of C_(7) and median nerve,and the thickness of ulnar nerve was equal to that of posterior division of C_(7);the diameter of T1 was thicker than that of posterior division of C_(7),the diameter of C8 was thicker than that of anterior division of C_(7),and the diameter of lower trunk was thicker than that of C_(7).The number of ulnar nerve fibers was less than that of median nerve and C_(7),but it was almost equal to that of anterior or posterior of C_(7);the total number of nerve fibers in C_(7) was less than that in the lower trunk,the total number of C_(7) anterior division was less than that of C8,but the number of C_(7) anterior or posterior division was almost the same as that of T1 nerve root;the number of axillary nerve was more than that of medial antebrachial cutaneous nerve.The area of ulnar nerve was smaller than that of median nerve,but the area of ulnar nerve is basically equal to that of anterior or posterior division of C_(7);the total area of C_(7) nerve was larger than that of ulnar nerve and smaller than that of lower trunk;the area of anterior division of C_(7) was smaller than that of C8,but the area of anterior or posterior C_(7) was basically equal to that of T1;the area of axillary nerve was larger than that of medial antebrachial cutaneous nerve.Conclusion No matter from the nerve diameter,the number of nerve fibers,or from cross sectional area of nerve,the transfer of C_(7) to lower trunk,C_(7) anterior and posterior division to C8 or T1 nerve root or C_(7) posterior division to ulnar nerve will not cause the waste of dynamic nerve fibers;but the transfer of C_(7) whole trunk or C_(7) anterior division to ulnar nerve will waste the dynamic nerve fibers of C_(7) because of the mismatch of nerve size or the number of nerve fibers.