【摘要】 目的　研究副神经移位到肩胛上神经以恢复臂丛神经损伤患者肩外展功能的后进路术式。方法　选用陈旧尸体 10具 2 0侧 ,新鲜尸体 4具 8侧 ,解剖观测在肩胛冈上缘水平副神经和肩胛上神经的关系。设计后进路副神经移位到肩胛上神经的新术式 ,并试用于临床。结果　肩胛上神经 10 0 % (2 8/ 2 8)位于肩胛横韧带深侧的肩胛上切迹内 ,位置恒定 ;副神经降支行于斜方肌深面、筋膜下 ,在肩胛冈上缘水平位于肩胛骨内侧缘 [(10 .42± 4.2 4)mm , x±s,下同 ] ,在该水平与肩胛上神经的最近距离为 (4.94± 1 2 2 )cm。游离切断后 ,可与肩胛上神经在无张力下直接拉拢缝合。临床试用于 10例病人 ,均顺利完成副神经移位到肩胛上神经的手术。术后检查斜方肌上部肌力无明显影响。结论　后进路副神经移位到肩胛上神经的术式是安全的、可行的更多还原

【Abstract】 ObjectiveTo introduce a new surgical procedure for restoratio n of shoulder abduction in brachial plexus injury, which is transfer of the desc ending branch of spinal accessory nerve to the suprascapular nerve viaa posterio r approach.MethodsAnatomic study was carried out using 10 embal med and 4 fres h adult cadavers. Totally 28 sides of shoulder area were dissected. The courses, adjacent structures, relationships of the spinal accessory nerve and suprascapu lar nerve at the level of the scapular spine were observed. Based on the anatomi c study, spinal accessory nerve transfer to suprascapular nerve via posterior ap proach in an incision above the superior margin of the scapular spine was design ed. This method was applied clinically in 10 cases. The preliminary results were reported. ResultsAnatomical position of the suprascapular ner ve is relatively constant. 100%(28/28) of the nerves dissected were found under the suprascapular transverse ligament in the suprascapular notch. The descending branch of the sp inal accessory nerve runs beneath the trapezius muscle. At the level of the scap ular spine, it is located 10.42±4.24 mm medial to the medial border of the scap ula. The distance from the accessory nerve to the suprascapular nerve at that le vel is 4.94±1.22 cm. After dissection in an incision above the superior margin of the scapular spine, the proximal segment of accessory nerve can be easily tra nsferred and coapted to the suprascapular nerve without any tension. In 10 clini cal cases, accessory nerve transfer to the suprascapular nerve through posterior approach was successfully carried out. Direct end-to-end anastomosis was done w ithout any tension. Postoperatively, muscle strength of the upper portion trapez ius was unaffected. ConclusionIn the posterior approach, the a natomical positi on of the descending branch of the spinal accessory nerve and suprascapular nerv e is relatively constant. These two nerves are easily dissected via this approac h. This is a safe and reliable procedure for neurotization of the suprascapular nerve.更多还原