【作者】 刘刚；

【导师】 尹维田；

【作者基本信息】 吉林大学 ， 外科学， 2012， 硕士

【摘要】 目的:报道肌皮神经卡压征一例，并通过对常人尸体解剖，对肌皮神经进行形态学研究，得出肌皮神经易卡压点的解剖学变化。方法对1例肌皮神经卡压的症状、体征、诊断、治疗进行报道，在4例成人（2男、2女，年龄不计，尸体由白求恩医学院基础教研室提供）共8侧双上肢标本上解剖观测：肌皮神经易卡压点形态解剖学研究，肌皮神经各肌支、入肌点、出肌点至喙突距离等。体位变化对测量长度影响。对肌皮神经喙肱肌入肌点及前臂外侧皮神经肘部穿出点的神经性状及周围腱膜组织与神经的关系进行观察，并用摄像器材进行拍摄备份。对肌皮神经喙肱肌入肌点、出肌点不同体位变化时与喙突、胸小肌下缘的距离测量得到的数据，结果判断：对测量指标进行分析、比较，证明体位变化对测量指标的影响意义。（测量指标越长，肌皮神经张力越大，易形成卡压。证明上肢体位变化是肌皮神经的卡压因素其一。）统计学处理：采用SPSS13.0软件分析数据，计算资料采用x±s表示。两组计量资料的比较采用t检验。结果:临床病例报道证实肌皮神经在肌皮神经喙肱肌入肌点可形成卡压，解剖观察发现喙肱肌入肌点、前臂外侧皮神经穿出点易卡压。上肢内收、外展位时，喙肱肌入肌点至喙突距离分别为：（8.74±1.24）cm、（10.49±1.29）cm，距离改变差异有统计学意义（t=2.765，P<0.05)，喙肱肌出肌点至喙突距离分别为：（10.74±1.23）cm、（12.52±1.32）cm，距离改变差异有统计学意义（t=2.786，P<0.05）。结论:通过临床病例证实肌皮神经喙肱肌入肌点可发生卡压，肌皮神经喙肱肌入肌点及前臂外侧皮神经肘前穿出点，这两个部位较易有腱膜组织卡压。上肢体位变化是肌皮神经的卡压因素其一。通过对肌皮神经易卡点进行精确的解剖学研究，使我们对肌皮神经卡压鉴别诊断和诊断方面有了更深层的认识；同时解剖学研究证实上肢体位变化是肌皮神经的卡压因素其一，我们能够指导病人日常生活或体力劳动时避免因体位因素引起肌皮神经卡压，过度的训练导致喙肱肌肥大也能引起肌皮神经卡压。进行肌皮神经易卡点周围毗邻组织的解剖研究，能够选择手术的最佳入路，彻底松解卡压的肌皮神经，并讨论注意事项。正中神经与肌皮神经之间存在着交通支，并起着一定的功能，手术时应注意加以保护，肌皮神经解剖变异学研究使我们不拘泥于传统的解剖学，对于指导临床医学也有重要的临床意义。更多还原

【Abstract】 Objective: Reported that the musculocutaneous nerve entrapment levy onecase, autopsy and through the right of ordinary people, and musculocutaneousnerve morphology obtained muscle-cutaneous nerve entrapment point ofanatomical changes.Methods:1cases of the musculocutaneous nerveentrapment symptoms, signs, diagnosis, treatment coverage. anatomy andobservation both upper extremitries of four adults (eight sides), studying morphology ofmusculocutaneous nerve,the distance of musclor branches、point of afferensmuscles、point of efferens muscles of musculocutaneous nerve to coronoidprocess, ect. the effect of body position change to measure length.Musculocutaneous nerve coracobrachialis muscle into muscle points and thelateral antebrachial cutaneous nerve elbow piercing point neural traits and therelationship of surrounding aponeurosis organization and neural observationand camera equipment to shoot the backup. Judgment: the measure to analyze,compare, and to prove the significance of the position change measure.(Measure of the longer, the greater the tension of the musculocutaneous nerve,and is easy to form entrapment. Proof of the upper limb postural changemusculocutaneous nerve entrapment factor one.) Statistical analysis:musculocutaneous nerve coracobrachialis muscle into the muscle point, thepoint of muscular position change with the coracoid pectoralis minor muscleunder the edge of the distance measurement data obtained by the SPSS statistical package to calculate the sample mean and standard deviationS. Themeasured data x±s.Results: The clinical case reports confirm that the musculocutaneous nervemusculocutaneous nerve coracobrachialis muscle into muscle can form theentrapment.point of afferens muscles of musculocutaneous nerve to coracobrachialis muscleand Nerve piercing point at elbow of cutaneous antebrachii lateralis nervefacility formed stamped. The sudden distance close in the upper limbs, thedistance of point of afferens coracobrachialis muscles to coronoid process are：（8.74±1.24）cm、（10.49±1.29）cm. Distance change are statistically significantfrom the data(t=2.765，P<0.05). the distance of point of efferens coracobrachialismuscles to coronoid process are：（10.74±1.23）cm、（12.52±1.32）cm, Distancechange are statistically significant from the data (t=2.786，P<0.05).Conclusions: Musculocutaneous nerve coracobrachialis muscle into musclepoints can occur entrapment confirmed by clinical cases. facility formedstamped place of musculocutaneous nerve are point of afferens coracobrachialismuscles and Nerve piercing point at elbow of cutaneous antebrachii lateralisnerve. The change of body position of upper is one of the factors ofmusculocutaneous nerve facility formed stamped.更多还原