Vathana Torpon, Larsen Mikko, de Ruiter Godard C W, Bishop Allen T, Spinner Robert J, Shin Alexander Y
Department of Orthopedic Surgery, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Clin Anat. 2007 Nov;20(8):899-904. doi: 10.1002/ca.20545.
An anatomic study of the distal spinal accessory nerve (SAN) to determine the number of myelinated axons and feasibility of posterior harvest for direct neurotization of distal targets was performed. Ten fresh human cadavers were studied. A supraclavicular approach was performed followed by a posterior approach. The relationship of the SAN to bony landmarks (T1 spinous process, acromioclavicular joint, posterolateral corner of the acromium, and angle at the superior medial border of the scapula) as well as maximal harvestable length was recorded. After posterior dissection, the SAN was mobilized and the ability to reach both anterior infraclavicular and posterior targets was assessed. Axon counts were also performed at the proximal, mid, and distal points along the course of the nerve. The posteriorly harvested SAN was identified reliably with respect to bony landmarks. When harvested posteriorly, the SAN could reach the infraclavicular part of the brachial plexus (i.e., terminal branches), and posteriorly, the suprascapular nerve (SSN) both proximal and distal to the suprascapular ligament, the latter for selective reinnervation of the infraspinatus branch. The average number of myelinated fibers at the proximal end of the nerve was 1,328 axons, at the mid-way point was 1,021 axons, and at terminal end of the nerve was 817 axons. Harvest of the SAN from a posterior approach based on these landmarks is feasible, allowing direct transfer of the nerve to the infraclavicular brachial plexus and to the SSN both proximal and distal to the suprascapular ligament, without the use of interposition nerve grafts.
进行了一项关于远端副神经（SAN）的解剖学研究，以确定有髓轴突的数量以及后入路获取用于远端靶点直接神经化的可行性。研究了10具新鲜人体尸体。先采用锁骨上入路，然后采用后入路。记录了SAN与骨性标志（T1棘突、肩锁关节、肩峰后外侧角和肩胛骨上内侧缘的角度）的关系以及最大可获取长度。后入路解剖后，游离SAN并评估其到达锁骨下前方和后方靶点的能力。还在神经行程的近端、中点和远端进行了轴突计数。相对于骨性标志，后入路获取的SAN能够可靠地识别。后入路获取时，SAN可到达臂丛神经的锁骨下部分（即终末分支），以及后方的肩胛上神经（SSN），包括肩胛上韧带近端和远端的部分，后者用于选择性地重新支配冈下肌分支。神经近端的有髓纤维平均数量为1328条轴突，中点为1021条轴突，神经末端为817条轴突。基于这些标志从后入路获取SAN是可行的，无需使用神经移植即可将神经直接转移至锁骨下臂丛神经以及肩胛上韧带近端和远端的SSN。
