• 復(fù)旦大學(xué)附屬華山醫(yī)院手外科（上海，200040）;

目的探討第3～6肋間神經(jīng)移位肩胛上神經(jīng)重建肩關(guān)節(jié)外展功能的可行性。 方法取15具30側(cè)成人軀干標(biāo)本，解剖測量第3～6肋間神經(jīng)自腋中線至鎖骨中線可切取長度以及自腋中線至鎖骨中點(diǎn)（擬定神經(jīng)吻合點(diǎn)）的移位距離，并進(jìn)行統(tǒng)計(jì)學(xué)比較。 結(jié)果30側(cè)標(biāo)本中，第3、4肋間神經(jīng)均可切取自腋中線至鎖骨中線范圍內(nèi)的全段神經(jīng)，且可切取長度均較移位距離長（P  lt; 0.01）。6側(cè)第5肋間神經(jīng)及16側(cè)第6肋間神經(jīng)在未到達(dá)鎖骨中線時被肋軟骨覆蓋，其中第5肋間神經(jīng)可切取長度與移位距離相似（P  gt; 0.01），第6肋間神經(jīng)可切取長度較移位距離短（P  lt; 0.01）。肩胛上神經(jīng)通過游離切斷，可翻轉(zhuǎn)至鎖骨中點(diǎn)下方2 cm以上。第5肋間神經(jīng)切取長度與肩胛上神經(jīng)翻轉(zhuǎn)長度（2 cm）之和，可超過移位距離（P  lt; 0.01），但第6肋間神經(jīng)總長度仍較移位距離短（P  lt; 0.01）。 結(jié)論第3～5肋間神經(jīng)可直接移位肩胛上神經(jīng)重建肩關(guān)節(jié)外展功能，而第6肋間神經(jīng)需增加游離切取長度范圍或采用神經(jīng)移植修復(fù)。

引用本文： 楚彬,胡韶楠,陳亮,宋捷. 肋間神經(jīng)移位肩胛上神經(jīng)的解剖學(xué)研究. 中國修復(fù)重建外科雜志, 2012, 26(9): 1095-1097. doi: 復(fù)制

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1. Terzis JK, Kostopoulos V. The surgical treatment of brachial plexus injuries in adults. Plast Reconstr Surg, 2007, 119(4): 73e-92e.
2. 官士兵, 陳德松, 方有生, 等. 副神經(jīng)移位修復(fù)臂叢損傷受區(qū)神經(jīng)選擇的探討. 中國矯形外科雜志, 2004, 12(3): 182-184.
3. Asfazadourian H, Tramond B, Dauge MC, et al. Morphometric study of the upper intercostal nerves: practical application for neurotizations in traumatic brachial plexus palsies. Chir Main, 1999, 18(4): 243-253.
4. Malungpaishrope K, Leechavengvongs S, Uerpairojkit C, et al. Nerve transfer to deltoid muscle using the intercostal nerves through the posterior approach: an anatomic study and two case reports. J Hand Surg (Am), 2007, 32(2): 218-224.
5. Samardzi? M, Rasuli? L, Grujici? D, et al. Results of nerve transfers to the musculocutaneous and axillary nerves. Neurosurgery, 2000, 46(1): 93-103.
6. Oberlin C. Brachial plexus palsy in adults with radicular lesions, general concepts, diagnostic approach and results. Chir Main, 2003, 22(6): 273-284.
7. Durand S, Oberlin C, Fox M, et al. Transfer of the first intercostal nerve to supra- and infraspinatus muscles: an anatomical study and report of the first case. J Hand Surg Eur Vol, 2009, 34(2): 196-200.
8. Rockwood CA Jr, Matsen FA III. The Shoulder. Philadelphia: WB Saunders, 1998: 233-276.
9. 官士兵, 陳德松, 方有生, 等. 后進(jìn)路副神經(jīng)移位修復(fù)肩胛上神經(jīng)術(shù)式的解剖學(xué)研究. 中華手外科雜志, 2004, 20(1): 55-57.
10. 王樹峰, 張高孟, 顧玉東, 等. 鎖骨下水平副神經(jīng)切斷移位修復(fù)肩胛上神經(jīng)的臨床觀察. 中華骨科雜志, 2000, 20(10): 594-597.
11. Chuang DC. Neurotization procedures for brachial plexus injuries. Hand Clin, 1995, 11(4): 633-645.
12. Narakas AO. Thoughts on neurotization or nerve transfers in irreparable nerve lesions. Clin Plast Surg, 1984, 11(1): 153-159.
13. Omer GE Jr, Spinner M, Van Beek LA. Management of peripheral nerve problems. 2nd Ed. Philadelphia: WB Saunders, 1998: 459-464.
14. 林浩東, 方有生, 陳德松. 胛上神經(jīng)卡壓綜合征的后入路手術(shù)應(yīng)用. 中國修復(fù)重建外科雜志, 2005, 19(11): 899-901.
15. 劉巍巍. 改良后入路副神經(jīng)移位修復(fù)肩胛上神經(jīng)術(shù)式解剖學(xué)及臨床研究. 長春: 吉林大學(xué), 2008.
16. Asfazadourian H, Tramond B, Dauge MC, et al. Morphometric study of the upper intercostal nerves: practical application for neurotisations in traumatic brachial plexus palsies. Chir Main, 1999, 18(4): 243-253.
17. El-Gammal TA, Fathi NA. Outcomes of surgical treatment of brachial plexus injuries using nerve grafting and nerve transfers. J Reconstr Microsurg, 2002, 18(1): 7-15.
  1. 1. Terzis JK, Kostopoulos V. The surgical treatment of brachial plexus injuries in adults. Plast Reconstr Surg, 2007, 119(4): 73e-92e.
  2. 2. 官士兵, 陳德松, 方有生, 等. 副神經(jīng)移位修復(fù)臂叢損傷受區(qū)神經(jīng)選擇的探討. 中國矯形外科雜志, 2004, 12(3): 182-184.
  3. 3. Asfazadourian H, Tramond B, Dauge MC, et al. Morphometric study of the upper intercostal nerves: practical application for neurotizations in traumatic brachial plexus palsies. Chir Main, 1999, 18(4): 243-253.
  4. 4. Malungpaishrope K, Leechavengvongs S, Uerpairojkit C, et al. Nerve transfer to deltoid muscle using the intercostal nerves through the posterior approach: an anatomic study and two case reports. J Hand Surg (Am), 2007, 32(2): 218-224.
  5. 5. Samardzi? M, Rasuli? L, Grujici? D, et al. Results of nerve transfers to the musculocutaneous and axillary nerves. Neurosurgery, 2000, 46(1): 93-103.
  6. 6. Oberlin C. Brachial plexus palsy in adults with radicular lesions, general concepts, diagnostic approach and results. Chir Main, 2003, 22(6): 273-284.
  7. 7. Durand S, Oberlin C, Fox M, et al. Transfer of the first intercostal nerve to supra- and infraspinatus muscles: an anatomical study and report of the first case. J Hand Surg Eur Vol, 2009, 34(2): 196-200.
  8. 8. Rockwood CA Jr, Matsen FA III. The Shoulder. Philadelphia: WB Saunders, 1998: 233-276.
  9. 9. 官士兵, 陳德松, 方有生, 等. 后進(jìn)路副神經(jīng)移位修復(fù)肩胛上神經(jīng)術(shù)式的解剖學(xué)研究. 中華手外科雜志, 2004, 20(1): 55-57.
  10. 10. 王樹峰, 張高孟, 顧玉東, 等. 鎖骨下水平副神經(jīng)切斷移位修復(fù)肩胛上神經(jīng)的臨床觀察. 中華骨科雜志, 2000, 20(10): 594-597.
  11. 11. Chuang DC. Neurotization procedures for brachial plexus injuries. Hand Clin, 1995, 11(4): 633-645.
  12. 12. Narakas AO. Thoughts on neurotization or nerve transfers in irreparable nerve lesions. Clin Plast Surg, 1984, 11(1): 153-159.
  13. 13. Omer GE Jr, Spinner M, Van Beek LA. Management of peripheral nerve problems. 2nd Ed. Philadelphia: WB Saunders, 1998: 459-464.
  14. 14. 林浩東, 方有生, 陳德松. 胛上神經(jīng)卡壓綜合征的后入路手術(shù)應(yīng)用. 中國修復(fù)重建外科雜志, 2005, 19(11): 899-901.
  15. 15. 劉巍巍. 改良后入路副神經(jīng)移位修復(fù)肩胛上神經(jīng)術(shù)式解剖學(xué)及臨床研究. 長春: 吉林大學(xué), 2008.
  16. 16. Asfazadourian H, Tramond B, Dauge MC, et al. Morphometric study of the upper intercostal nerves: practical application for neurotisations in traumatic brachial plexus palsies. Chir Main, 1999, 18(4): 243-253.
  17. 17. El-Gammal TA, Fathi NA. Outcomes of surgical treatment of brachial plexus injuries using nerve grafting and nerve transfers. J Reconstr Microsurg, 2002, 18(1): 7-15.