Patel Arjun N, Squires Greg T, Sherrier Matthew C, Daley Dane N, Kubalak Steven W, Eriksson Evert A
From the Department of Surgery (A.N.P., E.A.E.), Department of Anesthesia and Perioperative Medicine (G.T.S.), Department of Orthopaedics and Physical Medicine & Rehabilitation (M.C.S., D.N.D.), and Department of Regenerative Medicine and Cell Biology (S.W.K.), Medical University of South Carolina, Charleston, South Carolina.
J Trauma Acute Care Surg. 2025 Jul 17. doi: 10.1097/TA.0000000000004749.
Traditional intercostal nerve anatomy teaching describes nerves crossing directly across the costal margin. Significant variability in costal margin bony anatomy has been described. Our cadaveric study evaluated variability, branching, and coursing patterns of intercostal nerves at the costal margin.
Cadaveric dissections were performed evaluating the branching anatomy and course of intercostal nerves, specifically of ribs 7 to 9, at the costal margin because of the highly variable rib anatomy and neural innervation of abdominal wall musculature in this region. Experienced chest wall surgeons evaluated this anatomy using a standardized dissection and assessment to quantify the location and branches of the nerves.
The intercostal nerves and costal margins of 12 hemithoraces were dissected (n = 12). All seventh, eighth, and ninth nerve gave rise to a diaphragmatic branch. The seventh nerve arborized at the costochondral junction in 25% of hemithoraces. The eighth nerve arborized at the costochondral junction in 42% of hemithoraces and continued arborizing at the ninth rib tip in 33%. The ninth nerve arborized at the costochondral junction in 60% of hemithoraces and continued arborizing at the ninth rib tip in 90%. When the eighth rib directly attached to the sternum (42%), the seventh nerve entered the 7/8 interchondral groove, and the eighth nerve directly crossed then ascended along the costal margin giving off abdominal wall musculature branches. When the seventh rib directly attached to the sternum with the eighth rib joining to form the costal margin (58%), the seventh nerve directly crossed then ascended along the costal margin with similar branching.
The seventh, eighth, and ninth intercostal nerves arborize at the costal margin (costochondral junction) to provide branches into the diaphragm and abdominal wall musculature with additional arborization at the lower rib tips. The seventh and eighth intercostal nerve location is variable based on their associated bony anatomy at the costal margin.
Diagnostic Test; Level II.
传统的肋间神经解剖学教学描述神经直接穿过肋缘。已描述肋缘骨解剖结构存在显著变异。我们的尸体研究评估了肋缘处肋间神经的变异、分支和走行模式。
进行尸体解剖，评估肋间神经的分支解剖结构和走行，特别是第7至9肋在肋缘处的情况，因为该区域肋骨解剖结构和腹壁肌肉的神经支配高度可变。经验丰富的胸壁外科医生使用标准化的解剖和评估方法来量化神经的位置和分支。
解剖了12个半侧胸廓的肋间神经和肋缘（n = 12）。所有第7、8和9肋间神经均发出膈支。第7肋间神经在25%的半侧胸廓中在肋软骨结合处分支。第8肋间神经在42%的半侧胸廓中在肋软骨结合处分支，并在33%的半侧胸廓中在第9肋尖继续分支。第9肋间神经在60%的半侧胸廓中在肋软骨结合处分支，并在90%的半侧胸廓中在第9肋尖继续分支。当第8肋直接附着于胸骨时（42%），第7肋间神经进入第7/8软骨间沟，第8肋间神经直接穿过然后沿肋缘上升并发出腹壁肌肉分支。当第7肋直接附着于胸骨且第8肋与之相连形成肋缘时（58%），第7肋间神经直接穿过然后沿肋缘上升并具有类似的分支。
第7、8和9肋间神经在肋缘（肋软骨结合处）分支，为膈肌和腹壁肌肉提供分支，并在较低的肋尖处有额外分支。第7和第8肋间神经的位置因其在肋缘处相关的骨解剖结构而可变。
诊断试验；II级。
