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目的 对大圆肌进行应用解剖学研究 ,为临床应用大圆肌重建肩肘功能提供依据。方法 对 44侧陈旧性上肢标本 ,解剖并观察大圆肌的行径、血管神经蒂的长度及其入肌点。对 8例臂丛神经损伤者 ,行大圆肌移位重建肩外展功能 4例 ,伸肘功能 2例 ,屈肘功能 2例。结果 大圆肌肌腹上缘长 6～18cm ,下缘长 11～ 18cm。肌肉起点为肌性者占 63 .6% ,半腱半肌性者 3 6.4% ;肌肉止点为腱性者占79 .5 % ,半腱半肌性者 2 0 .5 %。神经血管蒂入肌处在肌肉上缘腹侧面中段 ,距止点距离 4.6～ 7.8cm。72 .7%的血供来自旋肩胛动脉 ,2 0 .5 %来自胸背动脉 ,6.8%来自肩胛下动脉。自起点至入肌点可分离长度 2 .1～ 7.6cm ,直径 1.0～ 2 .9mm。若分离至腋动脉 ,长度达 6.6～ 18.1cm。神经支配来自肩胛下神经下支 ,至入肌点的长度为 3 .43～ 10 .90cm ,直径 0 .86～ 2 .11mm。血管神经蒂呈多级分支。 4例重建肩外展功能者 ,外展由术前的 46.2 5°改善至 10 1.2 5° ;2例重建屈肘功能者 ,屈肘由术前 0°至术后 90° ;2例重建伸肘功能者 ,伸肘由术前 -65°至术后 0°。结论 大圆肌的血管神经蒂有足够的长度可供移位 ,以重建肩外展、屈肘、伸肘功能。
Objective To study the application of anatomy of the great meridian to provide the basis for the clinical application of reconstruction of shoulder and elbow. Methods The old upper limbs of 44 sides were dissected and observed. In 8 cases of brachial plexus injury, the great circular muscle displacement reconstruction shoulder abduction in 4 cases, 2 cases of elbow extension function, elbow flexion in 2 cases. Results The dorsal margin of the dorsal gyrus was 6 ~ 18cm in length and 11 ~ 18cm in length. Muscle start point for the muscle accounted for 63.6%, semi-tendon semignomer 3 6.4%; muscle stop point for the tendon accounted for 79.5%, semitendofacial muscle 20%. Neurovascular pedicle into the muscle in the upper edge of the ventral surface of the muscle, from the point of distance 4.6 ~ 7.8cm. Seventy-seven percent of the blood supply came from the spinocoronary artery, 20.5% from the thoracic dorsal artery, and 6.8% from the subscapular artery. From the beginning to the point of muscle into the detachable length of 2 .1 ~ 7.6cm, diameter 1.0 ~ 2 .9mm. If separated to the axillary artery, the length of 6.6 ~ 18.1cm. Nerve innervation from the inferior branch of the inferior scapulae, into the muscle point length of 3.43 ~ 10 .90 cm, diameter 0.86 ~ 2.11mm. Vascular nerve pedicle was multi-level branch. 4 cases of reconstruction of shoulder abduction function, abduction from 46.2 5 ° preoperative to 10 1.2 5 °; 2 cases of elbow flexion, elbow flexion from 0 ° before surgery to 90 ° after surgery; 2 cases of reconstruction Elbow function, elbow stretching from preoperative -65 ° to 0 ° after surgery. CONCLUSIONS: The great vessels have long enough length for transposition to reconstruct shoulder abduction, elbow flexion and extension elbow.