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目的研究肩胛上神经体表定位,为肩背部微创手术及神经阻滞提供解剖学基础。方法选用广东医学院解剖教研室的中国成人尸体标本16具,解剖和观测32侧肩胛上神经主干的位置、行程及与肩胛上、下孔的关系,确定肩胛上神经的体表定位。所设定位点均为解剖部位的体表垂线点,设A点为肩胛上孔切迹处最凹处体表定位点,B点为肩胛下孔内下缘切迹最凹处体表定位点,C点为肩胛冈上缘脊柱端与肩胛骨内侧缘交汇处体表定位点,D点为肩峰后角外侧端体表定位点,肩胛上神经主干AB线与CD连线交汇处为体表0点,F点为肩胛下角体表定位点,B点垂直OD连线交汇处为体表G点。分别用游标卡尺测量相关数据,并计算出OD/CD、DG/DF值。结果分别测得CD(125.9±12.6)mm、OD(49.2±7.2)mm、DF(185.0±12.8)mm、DG(45.2±7.4)mm、OD/CD=0.39±0.05、DG/DF=0.25±0.02。结论肩胛上神经主干行程体表定位相当于AB线,在AB线平行外移1 cm与锁骨后缘、肩峰内侧缘和肩胛冈上缘所构成的冈上窝三角区域为微创入路的安全区。上关节支神经阻滞入针点在CD连线的外侧端2/5交界处,与CD线成角约50°进针给药;下关节支神经阻滞入针点在DF连线的肩峰端约1/4交界处,与DF线垂直进针给药。
Objective To study the location of suprascapular nerve surface and provide anatomic basis for minimally invasive surgery and nerve block on the shoulder and back. Methods Sixteen Chinese adult cadavers were selected from Department of Anatomy, Guangdong Medical College. The anatomic location and the distance of the suprascapular superiority trunk and the relationship with the suprascapular superior or inferior scapular were anatomized and observed to determine the suprascapular nerve surface location. Set the site are anatomical points of the body surface vertical line, set point A for the scapular notch at the most concave body surface positioning point, B point for the lower edge of the subscapular notch the most concave body surface The point of fixation, C point for the scapular upper edge of the spine and the scapular medial edge of the confluence of the body surface positioning point, D point for the acromion of the lateral end of the body surface positioning point, suprascapular nerve trunk AB line and the intersection of CD is 0 point on the body surface, F point for the subscapular subsurface positioning point, B point vertical connection of the OD point for the body surface G point. Measured respectively with vernier caliper related data, and calculate the OD / CD, DG / DF value. Results The mean CD (125.9 ± 12.6) mm, OD (49.2 ± 7.2) mm, DF (185.0 ± 12.8) mm, DG (45.2 ± 7.4) mm, OD / CD = 0.39 ± 0.05, 0.02. Conclusion The suprascapular nerve trunk stroke location is equivalent to the AB line, which is a minimally invasive approach in the triangular region of supraspinatus formed by the parallel displacement of 1 cm on the AB line and the posterior border of the clavicle, the medial edge of the acromion and the superior margin of the scapular ganglion Safe place. Upper branch of the nerve block into the needle at the CD connection at the outer end of 2/5 junction, and CD line angle of about 50 ° into the needle; inferior articular nerve block into the needle point in the DF connection shoulder Peak about 1/4 junction, and DF line injection needle.