Uz Aysun, Apaydin Nihal, Bozkurt Murat, Elhan Alaittin
Department of Anatomy, Ankara University School of Medicine, Ankara, Turkey.
J Shoulder Elbow Surg. 2007 Mar-Apr;16(2):240-4. doi: 10.1016/j.jse.2006.05.003. Epub 2006 Nov 9.
The purpose of this study is to determine the surgical anatomy and innervation pattern of the branches of the axillary nerve and discuss the clinical importance of the presented findings. We dissected 30 shoulders in 15 fixed adult cadavers under a microscope through anterior and posterior approaches. The axillary nerve was examined in 2 segments in relation to the underlying subscapularis muscle. The axillary nerve gave off no branches in the first segment in 85% of cases. When the posterior approach was used, the axillary nerve and its branches were observed to be in a triangular-shaped area. The mean distance from the posterolateral corner of the acromion to the axillary nerve and its branches was 7.8 cm. In all cases, the posterior branch of the axillary nerve gave off its first muscular branch to innervate the teres minor. The joint branch of the axillary nerve was observed to branch out in 3 different patterns. The acromial and clavicular parts of the deltoid muscle were observed to be innervated from the anterior branch of the axillary nerve in all cases. The posterior part of the deltoid muscle was observed to be innervated in 3 different patterns. The posterior part of the deltoid was innervated from the branch or branches coming only from the posterior branch in 70% of cases, from the anterior and posterior branches in 26.7% of cases, and from the anterior branch in 3.3% of cases. The findings of this study are useful for identifying each of the branches of the axillary nerve and have implications for surgeries related with selective innervation.
本研究的目的是确定腋神经分支的手术解剖结构和神经支配模式，并探讨所呈现结果的临床重要性。我们在显微镜下通过前后入路对15具固定的成年尸体的30个肩部进行了解剖。在与肩胛下肌相关的两个节段中检查了腋神经。在85%的病例中，腋神经在第一节段未发出分支。当采用后入路时，腋神经及其分支位于一个三角形区域内。从肩峰后外侧角到腋神经及其分支的平均距离为7.8厘米。在所有病例中，腋神经后支发出其第一支肌支支配小圆肌。观察到腋神经的关节支以3种不同模式分支。在所有病例中，三角肌的肩峰部和锁骨部均由腋神经前支支配。三角肌后部有3种不同的支配模式。在70%的病例中，三角肌后部仅由后支发出的分支支配，在26.7%的病例中由前支和后支支配，在3.3%的病例中由前支支配。本研究结果有助于识别腋神经的各个分支，并对与选择性神经支配相关的手术具有指导意义。
