小斜角肌应用解剖学探究及其临床意义.docVIP

小斜角肌应用解剖学探究及其临床意义 　作者：尹望平，方有生，陈德松 【摘要】 [目的]研究小斜角肌的解剖学特点，为手术治疗胸廓出口综合征(TOS)提供形态学依据。[方法]在32具64侧常规福尔马林固定的成人尸体标本上，于头戴式2.5倍放大镜下，对小斜角肌的起止点，内外缘的长度，小斜角肌的神经支配，血供来源及其与臂丛下干的关系进行了仔细的观察;取10侧小斜角肌标本作HE染色，了解小斜角肌有无独立的肌膜及与中斜角肌间的关系。[结果]小斜角肌出现率为84.4%(54侧);臂丛下干从小斜角肌的中下部跨过;小斜角肌与中斜角肌之间有独立的肌膜将两者分开。小斜角肌的神经支配主要来自C7前根。小斜角肌的血供有2种类型：(1)从锁骨下动脉直接发出的分支，占63%;(2)来自颈深动脉(肩胛背动脉)的分支。[结论]小斜角肌是较常存在的、独立的一块肌肉，和臂丛下干密切相关;其神经支配、血供特点可能是容易双卡和影响疗效的因素之一。 【关键词】 胸廓出口综合征; 小斜角肌; 解剖; 局部 　　Abstract: [Objective]To investigate the morphological characteristic of the scalenus minimus. [Methods]Totally 32 (64 sides) embalmed adult cadavers were dissected and studied, the morphology of scalenus minimus and its relationship to brachial plexus was observed.Ten scalenus minimus were stained by HE to study membrane of the muscles. Twenty-seven (54 sides) embalmed adult cadavers were dissected carefully to investigate its nerve and blood supply.[Results]Scalenus minimus was found in 84.4% of cadavers (54/64). Its insertion was mainly composed of tendinous tissue, which was spaned by the lower trunk of brachial plexus. Scalenus minimus supply nerve branches was from ventral rami of the cervical seven root, and vascular supply was from: (1) branches of deep cervical artery,(2) branches of subclavia artery.[Conclusion]Scalenus minimus muscle, an independent but inconstant muscle, is existed in most people and sometimes responsible for compression of brachial plexus. It is suggested that scalenus minimus muscle should be resected carefully as well as scalenus anticus and medius during surgical treatment of thoracic outlet syndrome. 　　Key words：thoracic outlet syndrome; scalenus minimus; anatomy; regional 　　臂丛和锁骨下动静脉在胸廓出口处受压而产生的症候群称为胸廓出口综合征(thoracic outlet syndrome，TOS)，其中下干型是典型的TOS[1]。致病因素包括骨性因素(如颈肋、C7横突过长)、软组织因素(如异常束带、前中斜角肌变异、小斜角肌等)，而软组织因素是主要原因[2～4]。斜角肌切断、第1肋切除或斜角肌切断联合第1肋切除是最常用的手术方法;但是术后23%左右的患者疗效不佳甚至无效;还有一定的并发症存在[5～8]。本文对与下干型TOS关系密切的小斜角肌，特别是它的神经支配、血供来源等，进行了进一步的解剖学研究，旨在为手术治疗提供更详细的形态学资料。 　　32具共64侧经福尔马林常规固定的成人尸体标本，男23具46侧，女9具18侧，作大体观测