副神经的临床应用解剖学研究

An Anatomic Observation on the Spinal Accessory Nerve for Clinical Application

目的 :通过尸体解剖 ,观察副神经的行程及其分支支配 ,为更合理的利用副神经移位治疗臂丛神经损伤提供解剖学依据。方法 :显微解剖 30侧颈肩部人体标本 ,观测副神经在颈后三角区以及斜方肌深面的主干行程、分支部位及其毗邻和肌支支配情况。结果 :副神经在胸锁乳突肌后缘乳突下方 (5 .2± 1.8)cm处穿出 ,向后、外、下斜行跨过颈后三角区 ,在锁骨中点后方 (5 .0± 1.6 )cm处进入斜方肌深面筋膜内 ,在斜方肌的深面副神经仍呈单干向下走行 ,沿途发出 3～ 6个分支支配斜方肌 ,在肩胛冈下方 (5 .0± 1.5 )cm副神经不同平面分出的终支水平进入斜方肌。结论 :在肩胛冈下方不同平面选择性的切断副神经移位治疗臂丛损伤而保留斜方肌上部的神经支配和部分功能是可行的。

Objective:To study the spinal accessory nerve innervation for the trapezius muscle,and determine the course of accessory nerve in order to provide a reliable anatomical basis for treatment of brachial plexus injury by transfer of accessory nerve and improve the postoperative functional restoration of the paralyzed limb.Methods:30 cadaver neck dissections were carried out and the course of the accessory nerve and the innervation for the trapezius muscle were examined.Results:The spinal accessory nerve exited from the posterior border of the sternocleidomastoid muscle at (5.2±1.8)cm under the mastoid process,then followed an oblique course in the posterior triangle,entried into the anterior border of the trapezius muscle at (5.0±1.6)cm posterior from the midpoint of the clavicle bone,and ended into terminal muscular branches at a distance of (5.0±1.5)cm below the scapular spine.All along its course it followed a constant course and gave off 3～6 muscular branches,deep to the trapezius muscle.The course of the nerve was in the form of a question mark'?'.Conclusion:The character of the accessory nerve indicates that it is feasible to preserve partial function of the trapezius muscle by dissecting the nerve at selected degrees to transfer for the treatment of brachial plexus injury.