Verenna Anne-Marie A, Alexandru Daniela, Karimi Afshin, Brown Justin M, Bove Geoffrey M, Daly Frank J, Pastore Anthony M, Pearson Helen E, Barbe Mary F
Department of Anatomy and Cell Biology, Temple University School of Medicine, Philadelphia, Pennsylvania, United States; Delaware County Community College, Media, Pennsylvania, United States.
Department of Neurological Surgery, University of California Irvine School of Medicine, Orange, California, United States.
J Brachial Plex Peripher Nerve Inj. 2016 May 10;11(1):e21-e28. doi: 10.1055/s-0036-1583756. eCollection 2016.
Knowledge of the relationship of the dorsal scapular artery (DSA) with the brachial plexus is limited. We report a case of a variant DSA path, and revisit DSA origins and under-investigated relationship with the plexus in cadavers. The DSA was examined in a male patient and 106 cadavers. In the case, we observed an unusual DSA compressing the lower plexus trunk, that resulted in intermittent radiating pain and paresthesia. In the cadavers, the DSA originated most commonly from the subclavian artery (71%), with 35% from the thyrocervical trunk. Nine sides of eight cadavers (seven females) had two DSA branches per side, with one branch from each origin. The most typical DSA path was a subclavian artery origin before passing between upper and middle brachial plexus trunks (40% of DSAs), versus between middle and lower trunks (23%), or inferior (4%) or superior to the plexus (1%). Following a thyrocervical trunk origin, the DSA passed most frequently superior to the plexus (23%), versus between middle and lower trunks (6%) or upper and middle trunks (4%). Bilateral symmetry in origin and path through the brachial plexus was observed in 13 of 35 females (37%) and 6 of 17 males (35%), with the most common bilateral finding of a subclavian artery origin and a path between upper and middle trunks (17%). Variability in the relationship between DSA and trunks of the brachial plexus has surgical and clinical implications, such as diagnosis of thoracic outlet syndrome.
肩胛背动脉（DSA）与臂丛神经关系的相关知识有限。我们报告一例DSA路径变异的病例，并重新审视DSA的起源以及在尸体中研究较少的与臂丛神经的关系。对一名男性患者和106具尸体的DSA进行了检查。在该病例中，我们观察到一条异常的DSA压迫臂丛神经下干，导致间歇性放射痛和感觉异常。在尸体中，DSA最常见的起源于锁骨下动脉（71%），35%起源于甲状颈干。八具尸体（七名女性）的九侧每侧有两个DSA分支，每个起源各有一个分支。最典型的DSA路径是起源于锁骨下动脉，然后在上臂丛神经干和中臂丛神经干之间穿过（40%的DSA），相比之下，在中臂丛神经干和下臂丛神经干之间穿过的占23%，在臂丛神经下方穿过的占4%，在臂丛神经上方穿过的占1%。起源于甲状颈干后，DSA最常从臂丛神经上方穿过（23%），相比之下，在中臂丛神经干和下臂丛神经干之间穿过的占6%，在上臂丛神经干和中臂丛神经干之间穿过的占4%。在35名女性中的13名（37%）和17名男性中的6名（35%）观察到起源和通过臂丛神经的路径存在双侧对称性，最常见的双侧表现是起源于锁骨下动脉且在上臂丛神经干和中臂丛神经干之间的路径（17%）。DSA与臂丛神经干之间关系的变异性具有手术和临床意义，如胸廓出口综合征的诊断。
