Thoracic origin of a sympathetic supply to the upper limb: the 'nerve of Kuntz' revisited
Thoracic origin of a sympathetic supply to the upper limb: the 'nerve of Kuntz' revisited
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DOI：
10.1046/j.1469-7580.2001.19960675.x
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发表时间：
2001-12-01
影响因子：
2.4
通讯作者：
Satyapal, KS
中科院分区：
文献类型：
--
作者：
Ramsaroop, L;Partab, P;Satyapal, KS
了解上肢交感神经支配的起源在外科交感神经切除术中是很重要的。在第一胸神经的腹侧支与第二肋间神经相连的不恒定的胸内支，靠近第一胸神经的大分支至臂丛的点，被称为“Kuntz神经”（Kuntz，1927）。随后，各种交感神经元间的联系下降到第五肋间隙被报道，也被描述为昆茨神经。本研究的目的是确定：（1）Kuntz神经的发生率、位置和走行;（2）Kuntz神经与第二胸神经节的关系;（3）Kuntz神经在星状神经节缺失时的变异;（4）比较原始胸内支与其他肋间水平交感神经变异;（5）比较Kuntz神经与第二胸神经节的关系。对32例胎龄18周至足月胎儿和18例成人尸体的上5肋间隙交感神经链和体神经进行了显微解剖。共99侧，其中60侧（左侧32侧，右侧28侧）第一胸神经有交感神经支配。其中46例仅局限于第1肋间隙。34例第1肋间隙的Kuntz神经（原始胸内支）有明显的交感神经联系，12例肉眼可见交感神经联系缺失。在其余肋间隙中，未观察到连接肋间神经的胸内支。在神经节、节间节段和肋间神经之间观察到额外的交感神经贡献（不包括交通支）作为额外的交通支。Kuntz的eponym神经应限于描述第一肋间隙的胸内支。这些变异交感神经通路中的任何一个都可能是交感神经切除术后症状复发的原因。
An understanding of the origin of the sympathetic innervation of the upper limb is important in surgical sympathectomy procedures. An inconstant intrathoracic ramus which joined the 2nd intercostal nerve to the ventral ramus of the 1st thoracic nerve, proximal to the point where the latter gave a large branch to the brachial plexus, has become known as the 'nerve of Kuntz' (Kuntz, 1927). Subsequently a variety of sympathetic interneuronal connections down to the 5th intercostal space were reported and also described as the nerve of Kuntz. The aim of this study was to determine: (1) the incidence, location and course of the nerve of Kuntz; (2) the relationship of the nerve of Kuntz to the 2nd thoracic ganglion; (3) the variations of the nerve of Kuntz in the absence of a stellate ganglion; (4) to compare the original intrathoracic ramus with sympathetic variations at other intercostal levels; and (5) to devise an appropriate anatomical classification of the nerves of Kuntz.Bilateral microdissection of the sympathetic chain and somatic nerves of the upper 5 intercostal spaces was undertaken in 32 fetuses (gestational age, 18 wk to full term) and 18 adult cadavers. The total sample size comprised 99 sides.Sympathetic contributions to the first thoracic nerve were found in 60 of 99 sides (left 32, right 28). Of these, 46 were confined to the 1st intercostal space only. The nerve of Kuntz (the original intrathoracic ramus) of the 1st intercostal space had a demonstrable sympathetic connection in 34 cases, and an absence of macroscopic sympathetic connections in 12. In the remaining intercostal spaces, intrathoracic rami uniting intercostal nerves were not observed. Additional sympathetic contributions (exclusive of rami communicantes) were noted between ganglia, interganglionic segments and intercostal nerves as additional rami communicantes. The eponym nerve of Kuntz should be restricted to descriptions of the intrathoracic ramus of the 1st intercostal space. Any of these variant sympathetic pathways may be responsible for the recurrence of symptoms after sympathectomy surgery.