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目的探讨副神经行程及与周围毗邻结构关系。方法选取2002年7月—2005年5月行颈淋巴清扫且进行术中副神经测量的病例136例(共163侧),根据术前有无颈部手术史分为2组。行颈淋巴清扫的同时测量记录副神经出肌点与耳大神经出肌点、锁骨中点、胸锁关节距离;副神经入斜方肌点与锁骨中点距离。结果副神经出肌点均于耳大神经出肌点上方穿出,无手术史组二者距离(x-±s,下同)为(0.61±0.35)cm,男女差异无统计学意义(P>0.05),与有手术史组(0.95±0.63)cm相比,则差异有统计学意义(P<0.05)。88.2%(112/127)均在耳大神经上方1.0 cm之内穿出,11.8%(15/127)在1.0~2.0 cm之间穿出。67.7%(86/127)副神经在入斜方肌前接受颈丛来的神经交通支。副神经出肌点到胸锁关节距离及锁骨中点距离男女性别上差异均有统计学意义(P<0.05),但与有无手术史无关。副神经入斜方肌点到锁骨中点距离为(4.96±0.78)cm,在有无手术史及男女性别上差异均无统计学意义(P>0.05)。结论无颈部手术史者以副神经出肌点-耳大神经距离及副神经入斜方肌点-锁骨中点距离均可准确定位寻找副神经。对有颈部手术史者及耳大神经损伤者可联合运用副神经出肌点到胸锁关节及锁骨中点距离或副神经入斜方肌点-锁骨中点距离定位寻找副神经。
Objective To explore the relationship between the accessory nerve and the adjacent structures. Methods From July 2002 to May 2005, 136 patients (163 sides) who had undergone neck dissection and paracentesis were divided into two groups based on the history of neck surgery. At the same time of cervical lymph node dissection, the distance between the parasympanic muscle and the great auricular muscle, the midpoint of the clavicle and the sternoclavicular joint were recorded. The distance between the accessory nerve into the trapezius and the midpoint of the clavicle was measured. Results All the branches of the accessory nerve were punctuated above the points of the great auricular nerve. There was no significant difference between men and women in the distance between the two groups (x- ± s, the same below) (0.61 ± 0.35 cm) > 0.05). There was a significant difference (P <0.05) when compared with the surgical history group (0.95 ± 0.63) cm. 88.2% (112/127) were found within 1.0 cm above the auricular nerve and 11.8% (15/127) were between 1.0 and 2.0 cm. 67.7% (86/127) of the accessory nerves received cervical traffic from the cervical plexus before entering the trapezius. There were significant differences in the distance from the accessory nerve root to the sternoclavicular joint and the middle point of the clavicle (P <0.05), but not with or without surgical history. The distance between the accessory nerve into the trapezius and the midpoint of the clavicle was (4.96 ± 0.78) cm. There was no significant difference in the presence or absence of surgery and the sex between men and women (P> 0.05). Conclusions The history of neck surgery can be accurately located in order to find the accessory nerve by the distance of the accessory nerve meristem, the auricular nerve and the accessory nerve into the trapezius midpoint. For those who have a history of neck surgery and large auricular nerve injury, the accessory nerve can be used in combination with the midpoint of the sternoclavicular joint and clavicle or the accessory nerve into the trapezius muscle - the midpoint of the clavicle to find the accessory nerve.