臂丛神经胸壁分支走行分布及在临床麻醉中的应用

The distribution of the branches of the brachial plexus in the chest wall and its application in clinical anesthesia

目的研究胸外科手术中涉及的臂丛神经胸壁分支走行及所需阻滞范围,探讨可行的阻滞方式。方法选择大体标本2具,空针抽取亚甲蓝注射液10ml,自锁骨中点内面进针7cm后注射液体。注射完毕后分离臂丛神经胸壁分支,观察其走行与分布。结果胸长神经支配前锯肌,该神经外径约2.1mm,长约68.1mm。胸外侧神经走行于胸肩峰动脉分叉点的内上方,在头静脉终端附近穿出锁胸筋膜,胸外侧神经上胸肌支穿过胸小肌上缘进入胸大肌。结论胸长神经和胸内外侧神经阻滞与目前临床神经阻滞方式联合应用于胸外科手术,可取得更完善的麻醉效果。

Objective To explore the nerve course and the required blocking range of the brachial plexus in the chest wall involved in thoracic surgery and to explore feasible blocking methods.Methods Two human specimens were selected,10 ml of methylene blue injection solution was extracted with an empty needle,and the liquid was injected after 7 cm of needle entry from the medial surface of the midclavicular point.After the injection was completed,the brachial plexus in the chest wall were separated and their course and distribution were observed.Results The long thoracic nerve innervates the anterior serratus muscle,which is approximately 2.1 mm in outer diameter and 68.1 mm in length.The lateral thoracic nerve travels medially above the bifurcation point of the thoracic acromion artery,penetrates the clavicothoracic fascia near the cephalic vein terminal,and the superior pectoral branch of the lateral thoracic nerve crosses the superior border of the pectoralis minor muscle into the pectoralis major muscle.Conclusion Long thoracic nerve and medial and lateral thoracic nerve block combined with current clinical nerve block in thoracic surgery can achieve better anesthesia effect.