细说臂丛神经阻滞--培训课件.pptx

细说臂丛神经阻滞 佛山市禅城区中心医院 李志鹏 内容提要 1 肌间沟神经阻滞的那些“坑” 2 肩胛骨骨折的患者如何进行神经阻滞镇痛？ 3 前臂内侧皮神经联合肌皮神经阻滞 臂从神经解剖 臂丛神经解剖 1 胸长神经 2 肩胛背神经 3 肩胛上神经 4 锁骨下肌神经 5 正中神经外侧根 6 肌皮神经 7 胸外侧神经 8上肩胛下神经 9 下肩胛下神经 10 胸背神经. 11 腋神经 12 桡神经 13 胸内侧神经 14 正中神经内侧根 15 尺神经 16 前臂内侧皮神经 17 臂内侧皮神经 18正中神经 19肋间臂神经 20颈长肌、斜角肌支 臂丛神经解剖 1 胸长神经 2 肩胛背神经 3 肩胛上神经 4 锁骨下肌神经 5 正中神经外侧根 6 肌皮神经 7 胸外侧神经 8上肩胛下神经 9 下肩胛下神经 10 胸背神经. 11 腋神经 12 桡神经 13 胸内侧神经 14 正中神经内侧根 15 尺神经 16 前臂内侧皮神经 17 臂内侧皮神经 18正中神经 19肋间臂神经 20颈长肌、斜角肌支 胸长神经 The long thoracic nerve The long thoracic nerve (external respiratory nerve of Bell; posterior thoracic nerve) supplies the serratus anterior muscle. This nerve characteristically arises from the anterior rami of three spinal nerve roots: the fifth, sixth, and seventh cervical nerves (C5-C7) although the root from C7 may be absent. The roots from C5 and C6 pierce through the scalenus medius, while the C7 root passes in front of the muscle. The nerve descends through the cervicoaxillary canal behind (posterior to) the brachial plexus and the axillary artery and vein, resting on the outer surface of the serratus anterior. It extends along the side of the thorax to the lower border of that muscle, supplying filaments to each of its digitations (finger-like projections LTN was clearly visible in all anatomical specimens and volunteers using HRUS and could be followed until the second slip of the serratus anterior muscle from the supraclavicular region. In anatomical specimens, dissection confirmed,HRUS findings. For all volunteers, consensus was obtained. The mean nerve diameter was 1.6mm± 0.3 (range 1.1 – 2.1mm) after the formation of the main trunk. Fig. 2 a Example of sonographic finding of the LTN within the interscalene triangle in ventromedial transverse view (Abbreviations used: C5-C8 = cervical roots, ScA = anterior scalene muscle, SM=middle scalene muscle, SP = posterior scalene muscle); b Example of sonographic finding at the most distal point visible from the supraclavicul