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背景:腋神经损伤临床较为常见,治疗方法不尽一致,效果也各不相同,多要牺牲相邻一条神经功能来进行神经修复。目的:介绍用肱三头肌长头支转位修复腋神经的解剖学特点和临床应用效果。设计:以神经干走行方向纵向观察研究。地点和对象:资料收集于广州医学院附属市一人民医院,采用灌注成人尸体标本16具及本院收治的6例患者。方法:采用灌注成人尸体标本16具,常规解剖显露腋神经和肱三头肌长头支,主要观察腋神经和桡神经肱三头肌支的分支数量、毗邻关系以及测量各神经支的口径。根据解剖学特点,前瞻性地应用于临床6例,术后进行随访,定期检查腋神经肌力。主要观察指标:解剖观察结果和临床应用效果。结果:肱三头肌长头支与腋神经相隔于长头本身,转位方便,其横径与腋神经前、后支横径相近,便于吻合。临床应用6例,术后经随访6～16个月,4级以上肌力5例,3级肌力1例,伸肘无影响。结论:桡神经肱三头肌长头支转位修复腋神经,术式简便,容易操作,适用于臂丛部分损伤、肱三头肌正常的腋神经瘫的修复。
Background: The clinical manifestations of axillary nerve injury are relatively common, the treatment methods are not consistent, the effect is also different, to sacrifice a neighboring nerve function to repair nerves. OBJECTIVE: To introduce the anatomic features and clinical application of triceps brachii with long head branch for repair of axillary nerve. Design: Longitudinal observation of the direction of nerve stem walking. Location and Subject: The data were collected from a People’s Hospital affiliated to Guangzhou Medical College. Sixteen patients were injected with 16 adult cadaver specimens and admitted to our hospital. Methods: Sixteen adult cadaver specimens were perfused. The axillary nerve and the triceps brachii were dissected regularly to observe the branches, the adjacent relations and the caliber of each nerve branch of axillary nerve and radial nerve triceps. According to the anatomical characteristics, 6 cases were prospectively applied in clinical practice. After follow-up, axillary nerve strength was checked regularly. MAIN OUTCOME MEASURES: Anatomical observations and clinical effects. Results: Triceps brachii and the axillary nerve separated from the long head itself, the translocation convenient, the diameter and axillary nerve before and after the branch diameter similar to facilitate anastomosis. Clinical application of 6 cases, 6 to 16 months after follow-up, 4 above the level of muscle strength in 5 cases, 3 grade 1 muscle strength, elbow extension had no effect. Conclusion: The triceps brachial triceps branch of the radial nerve translocates and fixes the axillary nerve. The operation method is simple and easy to operate. It is suitable for partial brachial plexus injury and triceps arm repair of axillary nerve palsy.