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右侧臂丛神经索变异及左上肢肌皮神经与正中神经之间的交通:一例独特病例。

A variation of the cords of the brachial plexus on the right and a communication between the musculocutaneous and median nerves on the left upper limb: a unique case.

作者信息

Kirazlı Özlem, Tatarlı Necati, Ceylan Davut, Hacıoğlu Hüsniye, Uygun Seda, Şeker Aşkın, Keleş Evren, Çavdar Safiye

机构信息

Department of Anatomy, Marmara University School of Medicine, Istanbul, Turkey.

Department of Neurosurgery, Dr. Lutfi Kirdar Kartal Education and Research Hospital, Istanbul, Turkey.

出版信息

J Neurol Surg A Cent Eur Neurosurg. 2013 Dec;74 Suppl 1:e176-9. doi: 10.1055/s-0032-1333416. Epub 2013 Feb 26.

Abstract

During routine anatomical dissection of the upper extremity of a 64-year-old cadaver for educational purposes, we observed variations in the brachial plexus on each side. On the right an anomaly of cord formation was present and on the left there was a communication between the musculocutaneous nerve (MCN) and median nerve (MN). On the right side the brachial plexus showed two trunks, superior (C5 and C6) and inferior (C7, C8, and T1); the middle trunk was absent. The superior trunk bifurcated into anterior and posterior divisions, the anterior division continued as the lateral cord forming the MCN. The posterior division gave off the subscapular branch. The inferior trunk trifurcated into radial, median, and ulnar nerves. The radial nerve gave off the axillary and thoracodorsal nerves. The ulnar nerve gave off the median cutaneous nerves of the arm and forearm. The median nerve received a small ascending branch from the MCN. On the right side, there was a communicating branch from the MCN to the MN in the lower third of the arm region. This communicating branch also gave rise to a muscular branch to the brachialis muscle and the lateral cutaneous nerve of forearm. No additional heads of the biceps brachii muscle were observed in either upper limb. Knowledge of the variations of the brachial plexus in humans can be valuable for operations of the shoulder joint and its repair for providing an effective block or treatment for anesthetists and also for explaining otherwise incomprehensible clinical signs for neurologists.

摘要

在对一具64岁尸体的上肢进行常规解剖用于教学目的时,我们观察到两侧臂丛神经存在变异。右侧存在索形成异常,左侧肌皮神经(MCN)与正中神经(MN)之间存在交通支。右侧臂丛神经显示有两个干,即上干(C5和C6)和下干(C7、C8和T1);中干缺如。上干分为前支和后支,前支延续为外侧索并形成肌皮神经。后支发出肩胛下支。下干分为桡神经、正中神经和尺神经。桡神经发出腋神经和胸背神经。尺神经发出臂和前臂的内侧皮神经。正中神经从肌皮神经接收一小支升支。在右侧,在臂部区域下三分之一处有一条从肌皮神经至正中神经的交通支。该交通支还发出一支至肱肌的肌支和前臂外侧皮神经。在两侧上肢均未观察到肱二头肌的额外头。了解人类臂丛神经的变异对于肩关节手术及其修复、为麻醉师提供有效的阻滞或治疗以及为神经科医生解释难以理解的临床体征可能具有重要价值。

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