겨드랑신경의 분지 변이와 형태계측

정인혁(In Hyuk Chung),임중혁(Joong Hyuk Yim) 대한해부학회 2000 Anatomy & Cell Biology Vol.33 No.3

겨드랑신경에서 분지되는 가지는 여러 해부학교과서에 충분히 기술되어 있지 않으며, 네모공간증후군 때 나타나는 다양 한 증상을 이해하는데도 부족함이 많다. 이 연구는 이런 점에 착안하여 한국 성인 시체의 팔 127쪽에서 팔신경얼기 뒤다발에서 신경이 일어나는 형태, 겨드랑신경의 가지가 나뉘는 유형과 가지가 나뉘는 위치 변이를 밝히기 위하여 시도하였다. 팔신경얼기 뒤다발에서 겨드랑신경, 노신경, 가슴등신경이 일어나는 유형을 가슴등신경이 갈라져 나온 곳에 따라 4가지 로 분류하였고 아래어깨밑신경이 분지되는 곳에 따라 각 유형을 다시 세분하였다. 가슴등신경이 일어난 후 노신경과 겨드랑신경이 갈라지는 경우가 42.5%로 가장 많았고, 가슴등신경이 겨드랑신경에서 갈라지는 경우가 27.6%였다. 겨드랑신경 뒷가지가 나뉘는 유형은 작은원근가지가 갈라지는 곳을 기준으로 6가지로 분류하였다. 뒷가지에서 작은원근가지가 일어난 후 어깨세모근가지와 가쪽위팔피부신경이 갈라지는 경우가 50.8%였다. 아래어깨밑신경이 겨드랑신경에서 갈라진 경우가 70.9%였다. 겨드랑신경이 팔신경얼기 뒤다발에서 갈라지는 곳은 네모공간의 어깨밑근 모서리부터 평균 61.3mm였고, 부리돌기 끝에서 겨드랑신경 줄기까지의 거리는 평균 39.9mm였다. 네모공간에서 겨드랑신경은 뒤위팔휘돌이동맥의 안쪽 에 있었고 동맥과 신경이 비슷한 높이에 있는 경우가 가장 많았다. 그리고 겨드랑신경의 가지가 나뉘는 변이와 그 임상적의미를 고찰하였다. The branches of the axillary nerve and branching pattern of the posterior cord of the brachial plexus are not fully described in the anatomy textbooks. The branching pattern of the axillary nerve is needed to understand various symptoms of quadrilateral space syndrome. We studied on the branching patterns and variation of the axillary nerve and posterior cord of brachial plexus in 127 adult cadaver arms. The axillary, radial and thoracodorsal nerves arising from the posterior cord of the brachial plexus were classified into 4 types according to the position of the thoracodorsal nerve. The most common type (42.5%) was that the three nerves directly arising from the posterior cord. The thoracodorsal nerve branched from the axillary nerve in 27.6%. The posterior branches of the axillary nerve were divided into 6 types by the arising point of the nerve to teres minor muscle. The deltoid branch and lateral superior brachial cutaneous nerve were divided after branching of nerve to teres minor muscle in 50.8%. The lower subscapular nerve was branched from the axillary nerve in 70.9%. We measured the distances from the branching point of the axillary nerve to the inferior border of the subscapularis in the quadriangular space and from the coracoid process to the axillary nerve. The length and motor point of the teres minor muscle were measured. The relationship of the axillary nerve and posterior circumflex humeral artery was observed. The axillary nerve was always medial to the artery and their superoinferior relationship was variable. The clinical significance of the branching pattern of the axillary nerve was discussed.

근육피부신경과 정중신경의 연결 및 임상적 의의

정인혁(In Hyuk Chung),윤관현(Kwan Hyun Yoon),라종주(Jong Joo Ra),김동환(Dong Hwan Kim),임중혁(Joong Hyuk Yim),시게노리 다나까(Shigenori Tanaka) 대한해부학회 1998 Anatomy & Cell Biology Vol.31 No.5

근육피부신경과 정중신경 사이의 연결 변이를 한국 사람에서 관찰하여 다른 종족의 것과 비교하고 이런 변이가 갖는 임 상적 의미를 고찰하고자 이 연구를 시도하였다. 재료로는 한국성인 팔 72쪽을 사용하였다. 72쪽 중 24예 (33.4%)에서 두 신경 사이에 연결이 있었다. 근육피부신경에서 정중신경쪽으로 연결 가지가 있는 것이 19.5%였고, 그 반대 방향으로 연결된 것이 6.9%였다. 또 연결가지가 두 개 이상 있는 경우가 5.6%였고 한 예 (1.4%)에서는 근육피부신경과 정중신경이 하나의 줄기로 합쳤다가 갈라졌다. 근육피부신경이 부리위팔근을 뚫고 가지 않는 경우가 2예 (2.8%) 있었다. 연결가지의 유무와 관계없이 근육피부신경이 부리위팔근을 뚫고서 정중신경과 같이 달리다가 다시 가쪽으로 휘어서 달리는 경우가 5.6%였다. 팔을 모은 자세에서 근육피부신경이 부리위팔근을 지나는 곳에서 휘어지는 각도는 평균 159±9.0도였고 두 신경이 함께 달리다 갈라지는 경우는 각도가 더 적어졌다. 이런 각도를 근육피부신경의 압박증상과 관련지워 그 임상적 의미에 대하여 고찰하였다. The purpose of this study was to investigate variations in the communicating branch between the musculocutaneous and the median nerves and to discuss their clinical significance. Seventy two arms from 36 Korean adults were used. Twenty four cases (33.4%) among 72 arms had communications between the musculocutaneous and the median nerves. In 19.5%, a communicating branch ran from the musculocutaneous to the median nerves and in 4.2% of these a communicating branch formed a loop. A branch running from the median to the musculocutaneous nerves was observed in 6.9%. There were more than two communicating branches between two nerves in 5.6%. The average angle between the musculocutaneous nerve proximal and distal to the coracobrachialis was 159±9�at adduction of the arm. The musculocutaneous nerve did not pierce the coracobrachialis muscle in 2.8%. One case (1.4%) showed partial fusion of the trunks of the musculocutaneous and median nerves. The musculocutaneous nerve ran next to the median nerve after the coracobrachialis muscle and coursed laterally in 5.6% with or without a communicating branch. In these cases, the angle of the musculocutaneous nerve was more acute. The musculocutaneous nerve entrapment is discussed with this angle.

동양인에 있어서 광배근피판을 이용한 유방재건술

신극선,임중혁 大韓成形外科學會 1997 Archives of Plastic Surgery Vol.24 No.5

Due to the improvement of diagnostic methods, early diagnosis of the breast cancer has increased. And as the standard of living increases, more patients who underwent radical mastectomy, want to have their breast reconstructed for aesthetic and psychological reasons. There have been various kinds of methods for breast reconstruction: latissirnus dorsi musculocutaneous flap, transverse rectus abdominis musculocutaneous flap, superior gluteal free flap, or alloplastic material such as silicone gel. In thin Oriental women with contralateral small breast volume, the authors utilized latissimus dorsi musculocutaneous flaps and muscle flap for postmastectomy state and Poland syndrome with or without breast implant. Satisfactory aesthetic results were obtained except for one case of grade II capsular contacture.

눈썹주름근과 활차상신경 및 안와상신경의 국소해부

임중혁,신극선,정인혁 大韓成形外科學會 1997 Archives of Plastic Surgery Vol.24 No.5

To clarify the exact regional anatomy of corrugator supercilii muscle and relationship between corrugator supercilii muscle, supratrochlear nerve and supraorbital nerve, we dissected 17 Korean adult cadavers(33 sides). The results were as follows. 1. The distance between nasion and the origin of corrugator supercilii was 7.6mm in average. 2. In average the width of corrugator supercilii at the origin was 7.1mm at the insertion was 18.3 mm, the length of the corrugator supercilii was 26.2mm and the angle between corrugator supercilii and horizontal line was 38.3˚. 3. We classified the variations in branching patterns of supratrochlear nerve into 4 types. Type I was classified as a single non-branching supratrochlear nerve, type II as a dividing supratrochlear nerve, type III as a converging supratrochlear nerve and type IV as a complex type. Each of these 4 types comprised 57.6%, 33.3%, 3.0% and 6.1%, respectively. 4. The variations in the location of supratrochlear nerve as it passes through the corrugator supercilii muscle was classified into 4 types. Type I was classified as a single supratrochlear trunk ascending over the muscle, type II as a single supratrochlear piercing through the muscle, type III as a branched supratrochlear nerve where one branch ascends over the muscle and the other pierces through, and type IV as a branched supratrochlear nerve where both branches pierce the muscle. Each types made up 33.3%, 27.2%, 21.2% and 18.2% respectively. 5. The average distance between the origins of corrugator supercilii muscle and supratrochlear nerve was 8.1 mm and there was much variations in this distance among the cases. In 32.6%, this distance was found to he more than 10 mm. However, the distance between the midline and the site supratrochlear nerve penetrating the corrugator supercilii muscle was found to he relatively uniform, 13.8 mm. 6. We observed that the supraorbital nerve passed underneath the corrugator supercilii muscle in our cases. This nerve was either a non-branching type or a branching type with 2 main branches. The former made up 37.7% of the cases where the latter made up the rest 62.3%. The distantly from the midline to the most medially located branch was relatively uniform, distance of 24.0 mm. From the resuits we obtained, it would be safe to resect or incise the corrugator supercilii muscle within 1 cm medial to the supraorbital nerve which can be easily identified by surface anatorny or by inspection through endoscopy.

근육피부신경과 정중신경의 연결 및 임상적 의의

정인혁,윤관현,라종주,김동환,임중혁,시게노리 다나까 대한해부학회 1998 Anatomy & Cell Biology Vol.31 No.5

반설 절제술 후 원활한 혀의 활동을 위한 요측 전완 감각 유리피판의 이엽도안

이충재,길민석,임중혁,유대현,이세일 大韓成形外科學會 2000 Archives of Plastic Surgery Vol.27 No.2

After hemiglossectomy due to tongue concer, such factors as mobility, sensation, volume and the shape of the tongue are critical elements for successful rehabilitation. As long as there is a residual segment of mobile tongue with an intact motor nerve supply, the mobility of native tongue can be preserved by using tissue with thin, pliable and sensory potential. The residual tongue motion can be maximized by separating the reconstruction of mobile tongue from the reconstruction of the floor of mouth. Six patients who underwent significant glossectomy for squamous cell cancer were reconstructed with a bilobed design of senate radial forearm flap. One lobe of the flap is used to restore the shape and volume of the tongue, while the other lobe is used to resurface the floor or the mouth. There were no flap failure and fistula formation. In all patients, the tongue mobility was preserved and the earliest recovery of sensation was noted 5 weeks following the surgery. The articulation was good enough for them to perform daily activities. With the bilobed design, we can maximize the mobility of the residual tongue by preventing tethering of the root of tongue to the inner table of the mandible. In this article we present our successful experiences with this method, especially in view of mobility and sensation.