Tubbs R Shane, Salter E George, Custis James W, Wellons John C, Blount Jeffrey P, Oakes W Jerry
Department of Cell Biology, University of Alabama at Birmingham; and Pediatric Neurosurgery, Children's Hospital, Birmingham, Alabama 35233, USA.
J Neurosurg. 2006 May;104(5):792-5. doi: 10.3171/jns.2006.104.5.792.
There is insufficient information in the neurosurgical literature regarding the long thoracic nerve (LTN). Many neurosurgical procedures necessitate a thorough understanding of this nerve's anatomy, for example, brachial plexus exploration/repair, passes for ventriculoperitoneal shunt placement, pleural placement of a ventriculopleural shunt, and scalenotomy. In the present study the authors seek to elucidate further the surgical anatomy of this structure.
Eighteen cadaveric sides were dissected of the LTN, anatomical relationships were observed, and measurements were obtained between it and surrounding osseous landmarks. The LTN had a mean length of 27 +/- 4.5 cm (mean +/- standard deviation) and a mean diameter of 3 +/- 2.5 mm. The distance from the angle of the mandible to the most proximal portion of the LTN was a mean of 6 +/- 1.1 cm. The distance from this proximal portion of the LTN to the carotid tubercle was a mean of 3.3 +/- 2 cm. The LTN was located a mean 2.8 cm posterior to the clavicle. In 61% of all sides the C-7 component of the LTN joined the C-5 and C-6 components of the LTN at the level of the second rib posterior to the axillary artery. In one right-sided specimen the C-5 component directly innervated the upper two digitations of the serratus anterior muscle rather than joining the C-6 and C-7 parts of this nerve. The LTN traveled posterior to the axillary vessels and trunks of the brachial plexus in all specimens. It lay between the middle and posterior scalene muscles in 56% of sides. In 11% of sides the C-5 and C-6 components of the LTN traveled through the middle scalene muscle and then combined with the C-7 contribution. In two sides, all contributions to the LTN were situated between the middle scalene muscle and brachial plexus and thus did not travel through any muscle. The C-7 contribution to the LTN was always located anterior to the middle scalene muscle. In all specimens the LTN was found within the axillary sheath superior to the clavicle. Distally, the LTN lay a mean of 15 +/- 3.4 cm lateral to the jugular notch and a mean of 22 +/- 4.2 cm lateral to the xiphoid process of the sternum.
The neurosurgeon should have knowledge of the topography of the LTN. The results of the present study will allow the surgeon to better localize this structure superior and inferior to the clavicle and decrease morbidity following invasive procedures.
神经外科文献中关于胸长神经（LTN）的信息不足。许多神经外科手术需要全面了解该神经的解剖结构，例如臂丛神经探查/修复、脑室腹腔分流管置入路径、脑室胸膜分流管的胸膜置入以及斜角肌切断术。在本研究中，作者试图进一步阐明该结构的手术解剖学。
对18侧尸体的胸长神经进行解剖，观察其解剖关系，并测量其与周围骨性标志之间的距离。胸长神经的平均长度为27±4.5厘米（平均值±标准差），平均直径为3±2.5毫米。从下颌角到胸长神经最近端的距离平均为6±1.1厘米。从胸长神经的这个近端到颈动脉结节的距离平均为3.3±2厘米。胸长神经位于锁骨后方平均2.8厘米处。在所有侧别中，61%的胸长神经C-7成分在腋动脉后方的第二肋水平与胸长神经的C-5和C-6成分汇合。在一个右侧标本中，C-5成分直接支配前锯肌的上两个肌齿，而不是与该神经的C-6和C-7部分汇合。在所有标本中，胸长神经走行于腋血管和臂丛神经干的后方。在56%的侧别中，它位于中斜角肌和后斜角肌之间。在11%的侧别中，胸长神经的C-5和C-6成分穿过中斜角肌，然后与C-7成分汇合。在两侧，胸长神经的所有成分都位于中斜角肌和臂丛神经之间，因此没有穿过任何肌肉。胸长神经的C-7成分始终位于中斜角肌的前方。在所有标本中，胸长神经在锁骨上方的腋鞘内被发现。在远端，胸长神经位于颈静脉切迹外侧平均15±3.4厘米处，位于胸骨剑突外侧平均22±4.2厘米处。
神经外科医生应了解胸长神经的局部解剖结构。本研究结果将使外科医生能够更好地在锁骨上下定位该结构，并降低侵入性手术后的发病率。
