目的 了解副神经与胸锁乳突肌后缘封套筋膜的解剖关系，为颈后三角手术中避免损伤副神经提供更为安全可靠的策略。 方法 福尔马林固定的成人大体标本21具（42侧），显露胸锁乳突肌和颈后三角，紧贴胸锁乳突肌后缘剪开封套筋膜，观察胸锁乳突肌后缘封套筋膜的完整性、致密性，以及封套筋膜与副神经的解剖关系，副神经是否容易辨识、分离。 结果 胸锁乳突肌后缘封套筋膜完整、致密，副神经与封套筋膜之间无直接接触、纤维连接或其他组织。在胸锁乳突肌后缘剪开封套筋膜后，18具标本双侧不能直接看到副神经，副神经与封套筋膜之间隔以脂肪组织，钝性分离脂肪后较易寻找副神经；另3具标本双侧能直接看到副神经。所有副神经位于耳大神经以上，与耳大神经距离（12.6±5.2）mm。 结论 胸锁乳突肌后缘的封套筋膜完整致密，与副神经无密切联系；在颈后三角手术中锐性打开后寻找副神经较为容易，术野清晰。
Abstract
Objective To explore the anatomical relationship between the accessory nerve and the investing fascia of the posterior border of the sternocleidomastoid, so as to provide a safe and reliable method for avoiding injury of accessory nerve in the posterior cervical triangle surgery. Methods Twenty-one formalin-fixed adult cadavers were dissected to expose the sternocleidomastoid and the posterior cervical triangle. The investing fascia of the posterior edge of sternocleidomastoid was cut and observed to identify its integrity and compactness. The anatomical relationship between the investing fascia and the accessory nerve was observed to identify whether the accessory nerve could be easily identified and separated from the tissue structure. Results The posterior investing fascia covering sternocleidomastoid muscle was intact and dense. There was no direct contact, fiber connection or other tissues between the accessory nerve and the investing fascia. After the investing fascia was cut and opened at the posterior edge, the accessory nerve could not be observed directly on both sides in the 18 specimens. The accessory nerve was separated from the investing fascia by adipose tissue. In other 3 specimens, the accessory nerve could be seen directly after cutting open investing fascia. There was no direct contact or fibrous connection between the accessory nerve and the investing fascia in all specimens. All accessory nerves were located above the great auricular nerve with a distance of (12.6±5.2) mm. Conclusions The investing fascia of the posterior edge of the sternocleidomastoid is intact and dense without significant connection with the accessory nerve. It is easy to identify accessory nerve after sharp dissection with clear surgical field in the posterior cervical triangle surgery.
关键词
副神经 /
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颈后三角 /
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封套筋膜 /
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解剖
Key words
Accessory nerve /
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Posterior cervical triangle /
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Investing /
fascia /
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Anatomy
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基金
四川省教育厅科研项目（16ZB2076）；发育与再生四川省重点实验室项目（SYS15-010）
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