Department of Anatomy, Second Faculty of Medicine, Charles University, Plzenska 130/221, 150 06 Prague 5, Czech Republic.
Department of Anatomy, Second Faculty of Medicine, Charles University, Plzenska 130/221, 150 06 Prague 5, Czech Republic; Department of Health Care Studies, College of Polytechnics, Tolsteho 16, 586 01 Jihlava, Czech Republic.
Ann Anat. 2022 Oct;244:151976. doi: 10.1016/j.aanat.2022.151976. Epub 2022 Jul 3.
The anatomy of the brachial plexus has been a subject of interest to many researchers over time resulting in an inconsistent amount of data. Previously, our team had published two evidence-based studies on the anatomical variations involving the brachial plexus, therefore the aim of this study was to analyze the findings regarding the infraclavicular part of the brachial plexus with the use of meta-analytic techniques to complete the comprehensive series.
Major scientific databases were extensively searched to compile anatomical studies investigating the morphology of the infraclavicular part of the brachial plexus. Extracted data were classified based on our proposed classification system and subsequently analyzed with the use of random effects meta-analysis to state the pooled prevalence estimates of the distinct variation patterns.
A total of 75 studies (4772 upper limbs) were selected for the meta-analysis. The branches of the lateral cord, including the lateral pectoral nerve and musculocutaneous nerve, resembled their usual origin in 76.8% (95% CI 50-96%) and 98.8% (95% CI 98-100%), respectively. The medial pectoral nerve, medial brachial cutaneous nerves, medial antebrachial cutaneous nerve and ulnar nerve emerging from the medial cord were observed originating from their usual origins in 90.9% (95% CI 68-100%), 90.7% (95% CI 73-100%), 87.9% (95% CI 67-99%) and 97.7% (95% CI 94-100%), respectively. Lastly, nerves branching from the posterior cord, including the superior and inferior subscapular nerves, thoracodorsal nerve, axillary nerve and radial nerve, originated as per textbook description in 90.7% (95% CI 80-98%), 76.1% (95% CI 61-89%), 90.1% (95% CI 84-95%), 79.8% (95% CI 68-90%) and 99.0% (95% CI 96-100%), respectively. Moreover, the usual origin of the median nerve from the lateral and medial cord via the corresponding roots was encountered in 89.7% (95% CI 84-95%) of cases.
The nerves originating from the infraclavicular part of the brachial plexus exhibit a wide spectrum of possible origins. However, the usual patterns were significantly the most common types present in more than three quarters of cases. Especially clinicians might profit from the enhanced understanding of the brachial plexus anatomy presented herein, since we offer a strong guide for handling the anatomically challenging pathologies in this specific area.
臂丛神经的解剖结构一直是许多研究人员感兴趣的课题，导致数据不一致。此前，我们的团队已经发表了两篇关于臂丛神经解剖结构的循证研究，因此本研究的目的是使用荟萃分析技术分析臂丛神经锁骨下部分的发现，以完成全面的系列研究。
广泛搜索主要的科学数据库，以汇编研究臂丛神经锁骨下部分形态的解剖学研究。根据我们提出的分类系统对提取的数据进行分类，然后使用随机效应荟萃分析对不同变异模式的汇总流行率估计进行分析。
共有 75 项研究（4772 条上肢）被纳入荟萃分析。外侧束的分支，包括外侧胸肌神经和肌皮神经，分别以 76.8%（95%CI 50-96%）和 98.8%（95%CI 98-100%）的比例类似于其常见起源。从中侧束发出的内侧胸肌神经、内侧臂皮神经、内侧前臂皮神经和尺神经，观察到它们起源于 90.9%（95%CI 68-100%）、90.7%（95%CI 73-100%）、87.9%（95%CI 67-99%）和 97.7%（95%CI 94-100%）的常见起源。最后，从后束发出的神经，包括上、下肩胛下神经、胸背神经、腋神经和桡神经，按照教科书的描述起源于 90.7%（95%CI 80-98%）、76.1%（95%CI 61-89%）、90.1%（95%CI 84-95%）、79.8%（95%CI 68-90%）和 99.0%（95%CI 96-100%）。此外，在 89.7%（95%CI 84-95%）的病例中，正中神经通过相应的根从外侧和内侧束发出。
发自臂丛锁骨下部分的神经起源有广泛的可能性。然而，通常的模式是明显最常见的类型，占四分之三以上的病例。特别是临床医生可能会从本文提供的臂丛神经解剖学增强理解中受益，因为我们为处理该特定区域具有挑战性的解剖病理学提供了强有力的指导。
