Refining the course of the thoracolumbar nerves: A new understanding of the innervation of the anterior abdominal wall
Refining the course of the thoracolumbar nerves: A new understanding of the innervation of the anterior abdominal wall
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DOI：
10.1002/ca.20621
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发表时间：
2008-05-01
期刊：
影响因子：
2.4
通讯作者：
Taylor, G. I.
中科院分区：
文献类型：
--
作者：
Rozen, W. M.;Tran, T. M. N.;Taylor, G. I.
以前对支配前腹壁的胸腰段脊神经的描述不一致。随着涉及或可能损伤这些神经的现代手术和麻醉技术，对该解剖结构的精确过程和可变性的更好理解变得越来越重要。通过对尸体的研究和文献回顾，描述了腹前神经的走行。解剖20具尸体半腹壁，以绘制前腹壁神经的路线。解剖包括五个标本的神经及其分支的起源的全面跟踪。描述了所有神经的分支模式和过程。所有支配腹前壁的胸腰段神经均为多段混合神经，在腹横平面（TAP）内广泛分支和沟通。这种交通可能发生在多个位置，包括前外侧的大分支交通（肋间丛），以及与旋髂深动脉（DCIA）（TAP丛）和腹壁下深动脉（DIEA）（腹直肌鞘丛）一起运行的丛。腹直肌受T6-L1段的神经支配，L1有恒定的分支。T10的分支始终支配脐。因此，TAP或腹直肌鞘内的单个神经的识别或损伤不太可能涉及单个节段神经。对这种解剖结构的理解可能有助于解释TAP阻滞麻醉和DIEA穿支皮瓣乳房再造后的临床结局和预防并发症。
Previous descriptions of the thoracolumbar spinal nerves innervating the anterior abdominal wall have been inconsistent. With modern surgical and anesthetic techniques that involve or may damage these nerves, an improved understanding of the precise course and variability of this anatomy has become increasingly important. The course of the nerves of the anterior abdominal is described based on a thorough cadaveric study and review of the literature. Twenty human cadaveric hemi-abdominal walls were dissected to map the course of the nerves of the anterior abdominal wall. Dissection included a comprehensive tracing of nerves and their branches from their origins in five specimens. The branching pattern and course of all nerves identified were described. All thoracolumbar nerves that innervate the anterior abdominal wall were found to travel as multiple mixed segmental nerves, which branch and communicate widely within the transversus abdominis plane (TAP). This communication may occur at multiple locations, including large branch communications anterolaterally (intercostal plexus), and in plexuses that run with the deep circumflex iliac artery (DCIA) (TAP plexus) and the deep inferior epigastric artery (DIEA) (rectus sheath plexus), Rectus abdominis muscle is innervated by segments T6-L1, with a constant branch from L1. The umbilicus is always innervated by a branch of T10. As such, identification or damage to individual nerves in the TAP or within rectus sheath is unlikely to involve single segmental nerves. An understanding of this anatomy may contribute to explaining clinical outcomes and preventing complications, following TAP blocks for anesthesia and DIEA perforator flaps for breast reconstruction.