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首页> 外文期刊>Neurosurgery >Faseicular Topography of the Suprascapular Nerve in the C5 Root and Upper Trunk of the Brachial Plexus: A Microanatomic Study From a Nerve Surgeon's Perspective
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Faseicular Topography of the Suprascapular Nerve in the C5 Root and Upper Trunk of the Brachial Plexus: A Microanatomic Study From a Nerve Surgeon's Perspective

机译：臂丛神经C5根和上躯干的肩cap上神经的束状地形：从神经外科医生的角度的微观解剖学研究。

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摘要

In patients with supraclavicular injuries of the brachial plexus, the suprascapular nerve (SSN) is frequently reconstructed with a sural nerve graft coapted to C5. As the C5 cross-sectional diameter exceeds the graft diameter, inadequate positioning of the graft is possible.OBJECTIVE: To identify a specific area within the C5 proximal stump that contains the SSN axons and to determine how this area could be localized by the nerve surgeon, we conducted a microanatomic study of the intraplexal topography of the SSN. METHODS: The right-sided C5 and C6 roots, the upper trunk with its divisions, and the SSN of 20 adult nonfixed cadavers were removed and fixed. The position and area occupied by the SSN fibers inside C5 were assessed and registered under magnification. RESULTS: The SSN was monofascicular in all specimens and derived its fibers mainly from C5. Small contributions from C6 were found in 12 specimens (60%). The mean transverse area of C5 occupied by SSN fibers was 28.23%. In 16 specimens (80%), the SSN fibers were localized in the ventral (mainly the rostroventral) quadrants of C5, a cross-sectional area between 9 o'clock and 3 o'clock from the surgeon's intraoperative perspective.CONCLUSION: In reconstruction of the SSN with a sural nerve graft, coaptation should be performed in the rostroventral quadrant of C5 cross-sectional area (between 9 and 12 o'clock from the nerve surgeon's point of view in a right-sided brachial plexus exploration). This will minimize axonal misrouting and may improve outcome.
机译：在臂丛神经的锁骨上锁神经损伤患者中，肩cap上神经（SSN）经常通过与C5相适应的腓肠神经移植重建。目的：确定C5近端残端中包含SSN轴突的特定区域，并确定神经外科医师如何定位该区域，我们对SSN的丛状地形进行了微解剖学研究。方法：去除并固定右侧C5和C6根，上部树干及其分支以及20具成年非固定尸体的SSN。在放大倍数下评估并记录了C5内部SSN纤维所占据的位置和面积。结果：SSN在所有标本中都是单束状的，其纤维主要来自C5。在12个样本中发现了C6的少量贡献（60％）。 SSN纤维占据的C5的平均横截面积为28.23％。在16个标本中（80％），SSN纤维位于C5的腹侧（主要是腹腔腹）象限，从术中术中的角度来看，其截面积在9点至3点之间。对于腓肠神经的SSN，应在C5横截面的腹侧腹象限（从神经外科医生的角度在右侧臂丛神经探查术中9点至12点之间）进行接合。这样可以最大程度地减少轴突的误导并改善结局。

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