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首页> 外文期刊>The Internet Journal of Surgery >Communication Between Median And Musculocutaneous Nerve And Accessory Head Of Biceps Brachii: A Case Report
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Communication Between Median And Musculocutaneous Nerve And Accessory Head Of Biceps Brachii: A Case Report

机译:中位数和肌肉皮神经和辅助部件的通信BICEPS BRACHII:案例报告

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Communication between different branches of the brachial plexus is a common phenomenon that has several clinical and surgical implications. Forty-eight upper extremities were dissected to investigate the communication between median and musculocutaneous nerves. The cadavers were fixed in a mixture of four fixatives through femoral canulation. Communications were observed in two of the left arms. Their points of origin and course were evaluated. One of the biceps brachii muscles possessed an accessory head originating from the anterior surface of the left humerus. These anatomical variations are of crucial importance in brachial plexus block in the upper arm. Introduction Variations in the formation and branching pattern of the brachial plexus are well documented (Williams et al., 1999; Ken, 1918; Linell, 1921; Poynter, 1920). Some of these variations include prefixed and postfixed brachial plexus. In the former, the brachial plexus receives contribution from the ventral ramus of the 4 th cervical spinal nerve, but contribution from the ventral ramus of the 1 st thoracic spinal nerve is reduced or absent. In the postfixed type of formation, the 2 nd thoracic nerve gives a contribution while a contribution from the 5 th spinal nerve is reduced or absent (Williams et al., 1999). This is against the normal pattern in which the brachial plexus is formed by the ventral rami of the 5 th to 8 th cervical spinal nerves and a ventral ramus of the 1 st thoracic spinal nerve.The median nerve is formed by union of two roots from the lateral (C5,6,7) and medial (C8, T1) cords (Pansky, 1984; Snell, 1995) while the musculocutaneous nerve (C5,6,7) arises from the lateral cord of the brachial plexus. According to Tountas and Bergaman (1993), the musculocutaneous nerve arises from the lateral cord in 90.5%, from the lateral and posterior cord in 4%, from the medial cord in 2% and has two separate bundles from the medial and lateral cords in 1.4%. Sometimes it sends a branch back to the median nerve in the brachium (Williams et al., 1999; Arora and Dhingra, 2005). Williams et al. (1999) stated that some fibers of the median nerve may run in the musculocutaneous nerve leaving it to join their main trunk. Crossing over of nerve fibres between the median nerve and the ulnar nerve in the forearm has been described as Martin-Gruber connections (Nakashima, 1993; Taams, 1997; Shu & Chantelot, 1999). These connections occur mostly in the forearm and have been implicated to cause confusion in the assessment of nerve injuries, carpal tunnel syndrome, cubital tunnel syndrome and leprosy neuropathy (Buschbacher, 1999).In present study we present abnormal communications between musculocutaneous and median nerves among Nigerian cadavers and discuss their surgical implications. Case Report During a routine dissection of twenty-four (24) formalin-fixed cadavers (23 males & 1 female) for medical students training at Igbinedion University, Okada, Nigeria, abnormal communications between the median and musculocutaneous nerves were unilaterally observed on the left brachia of two adult male cadavers. The cadavers were fixed by femoral canulation and injection of a fluid containing 10% formalin, liquid phenol, methylated spirit and glycerol. They were kept in storage tanks containing weak formalin solution for the period of 3 months before commencement of routine dissection. They are normally returned back to the weak formalin solution after dissection to prevent hardening and maceration. In one of the cadavers (Figure 1), the abnormal branch of the musculocutaneous nerve was found originating approximately at the mid point level of the brachial region distal to the insertion of the coracobrachialis muscle. It coursed inferiorly between the biceps brachii and brachialis muscles for about 4.2cm and joined the median nerve 8.7cm superior to the base of the cubital fossa. Giving its accessory branch and the nerve to the biceps brachii and brachialis muscle, the musculoc
机译:臂丛丛的不同分支之间的通信是具有几种临床和外科手术的常见现象。解释了四十八个上肢,以调查中位数和肌肉外神经之间的沟通。尸体通过股甘蔗茎固定在四个固定剂的混合物中。在两个左臂中观察到通信。他们的起源点和课程评估了。其中一个二头肌Brachii肌肉具有源自左肱骨前表面的配件头。这些解剖学变化在上臂中的臂丛丛块中至关重要。引言臂丛丛的形成和分支模式的变化有很好的记录(Williams等,1999; Ken,1918; Linell,1921; Poynter,1920)。这些变化中的一些包括前缀和后固定的臂丛神经。在前者中,臂丛丛从第四个颈脊神经的腹侧Ramus接受贡献,但是从1个胸椎神经的腹侧ramus的贡献减少或不存在。在后固定类型的形成中,2个ND胸神经产生贡献,同时减少了5世脊神经的贡献(Williams等,1999)。这是针对正常模式,其中臂丛丛由第5至第8至第8宫颈神经的腹侧rami和1个胸脊神经的腹侧ramus形成。中位神经由两个根部的联盟形成横向(C5,6,7)和内侧(C8,T1)帘线(Pansky,1984; Snell,1995),而肌肉皮神经(C5,6,7)由臂丛神经的侧帘线产生。根据Tountas和Bergaman(1993),肌肉皮神经从横向帘线中出现90.5%,从4%的后帘线,从内侧帘线中的2%,有两个单独的内侧和侧帘线束1.4%。有时它会将分支送回奶酪中的神经(Williams等,1999; Arora和Dhingra,2005)。威廉姆斯等人。 (1999)表示,中位神经的一些纤维可能在肌肉外神经中跑,让它加入他们的主干。在前臂中的中位神经和尺骨之间穿过神经纤维已被描述为马丁 - Gruber连接(Nakashima,1993; Taams,1997; Shu&Chantelot,1999)。这些连接主要发生在前臂中,并涉及对神经损伤的评估,腕管综合征,立方体隧道综合征和麻风病(Buschacher,1999)的评估中引起混淆。目前研究我们呈现肌肉皮肤和中位神经之间的异常通信尼日利亚尸体讨论了他们的手术意义。在Igbintion大学的医学生培训的医学生殖学生培训的常规解剖中案件报告,在Igbintion大学培训,尼日利亚冈田,中位数和肌肉外神经之间的异常通信在左侧观察到两个成年男性尸体的煎锅。尸体由股票茎固定,并注射含有10%福尔马林,液体酚,甲基化精神和甘油的流体。在常规解剖开始前3个月,它们保存在含有弱福尔马林溶液的储罐。在解剖后,它们通常返回弱福尔马林溶液以防止硬化和浸渍。在其中一个尸体(图1)中,发现肌肉外神经的异常分支始于沿着插入鳞状区域的远端的臂出部的中点水平。它在二头肌Brachii和Brachialis肌肉之间递增约4.2厘米,并加入了上升的神经8.7cm,优于尺寸窝的基础。将其配件分支和神经置于二头肌brachii和brachialis肌肉,musculoc

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