摘要
目的探讨第3～6肋间神经移位肩胛上神经重建肩关节外展功能的可行性。方法取15具30侧成人躯干标本,解剖测量第3～6肋间神经自腋中线至锁骨中线可切取长度以及自腋中线至锁骨中点(拟定神经吻合点)的移位距离,并进行统计学比较。结果 30侧标本中,第3、4肋间神经均可切取自腋中线至锁骨中线范围内的全段神经,且可切取长度均较移位距离长(P<0.01)。6侧第5肋间神经及16侧第6肋间神经在未到达锁骨中线时被肋软骨覆盖,其中第5肋间神经可切取长度与移位距离相似(P>0.01),第6肋间神经可切取长度较移位距离短(P<0.01)。肩胛上神经通过游离切断,可翻转至锁骨中点下方2 cm以上。第5肋间神经切取长度与肩胛上神经翻转长度(2 cm)之和,可超过移位距离(P<0.01),但第6肋间神经总长度仍较移位距离短(P<0.01)。结论第3～5肋间神经可直接移位肩胛上神经重建肩关节外展功能,而第6肋间神经需增加游离切取长度范围或采用神经移植修复。
Objective To investigate the feasibility of the 3rd-6th intercostal nerve transfer to the suprascapular nerve for reconstruction of shoulder abduction. Methods Fifteen thoracic walls （30 sides） were collected from human cadavers. The 3rd-6th intercostal nerve length which can be dissected between the midaxillary line and midclavicular line, and the transfer distance between the midaxillary line and midpoint of the clavicular bone （prepared point for neurotization） were measured. Results In 30 sides of specimens, the 3rd and 4th intercostal nerves could be obtained between the midaxillary line and midclavicular line, the available length of which was significantly greater than the transfer distance （P 〈 0.01）. Six sides of the 5th intercostal nerve and 16 sides of 6th intercostal nerve were covered by the costal cartilage before reaching the midclavicular line. The available length of the 5th intercostal nerve was similar to the transfer distance （P 〉 0.01）, while the available length of the 6th intercostal nerve was significantly less than transfer distance （P 〈 0.01）. The suprascapular nerve could be dissociated and turned to the clavicular bone of more than 2 cm. The whole length of the available 5th intercostal nerve length and the turning length （2 cm） of suprascapular nerve was significantly greater than the transfer distance （P 〈 0.01）, but for the 6th intercostal nerve, the whole length was still less than transfer distance （P 〈 0.01）. Conclusion It could be an alternative method to use the 3rd, 4th, and 5th intercostal nerve transfer to the suprascapular nerve for reconstruction of shoulder abduction. And for the 6th intercostal nerve, longer dissociated length may be required for direct coaptation or using a graft for nerve repair.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2012年第9期1095-1097,共3页
Chinese Journal of Reparative and Reconstructive Surgery
