| Objectives:1. To comprehend the appearance and courser of cervical sympathetic trunk, todetermine the main adjacent relationship and recognise the topography feature ofcervical sympathetic trunk.2. To observe the nutrient artery's origin of the superior thyroid ganglion, the inferiorcervical ganglion(cervicothoracic ganglion,ganglion stellare) and the dispositioncondition in the neural ganglion. To comprehend the appearance and location ofthe upper, midplate and inferior segment of cervical sympathetic ganglia, todetermine the main adjacent relationship and then to carry out the body surfaceallocation.3. To approach the morphology feature of arteria vertebralis initial segment andprocessus transversuss segment, to apply the anatomy basis for preventing fromthe servere complication of damaging arteria vertebralis in the middle and inferiorcervical ganglion blocking method. 4. To comprehend the locational relationship of cervical sympathetic trunk,midplate, inferior segment of cervical sympathetic ganglia and diaphragmaticnerve, laryngeal nerve, recurrent nerve.5. To approach the anatomy factor which can cause complication in the blockingmethod of cervical sympathetic ganglia with the method of the seventh transverseprocess anterior tubercle of cervical vertebra(C7-SGB), the sixth transverse processanterior tubercle of cervical vertebra(C6-SGB), the approaching method of thescalene muscle sulcus anterior and the lateral approaching method of myointergroove.MethodsChoose 4 fresh adult body types; 20 adult body types which had beenantisepticized, expose bilateralis collilongus and reveal bilateralis cervicalsympathetic trunk. Cut off cleidomastoidal and the other tissue of the surface. Removethe clavicle and open the apex of lung down. Dissect to expose the whole of cervicalsympathetic trunk and the upper segment midplate inferior segment(stellate)ofcervical sympathetic ganglia, arteria vertebralis diaphragmatic nerve laryngealnerve, recurrent nerve and the periph structure, expose scalene muscle blank. To dothe following observation and measure with microscopic spectacles on the head or bynaked eye:1. The location, appearance, size and distance to the median line of cervicalsympathetic trunk, and neuroganglion; the relationship and anatomy featurebetween the cervical sympathetic trunk and the upper segment midplate inferior segment(stellate )of cervical sympathetic ganglia and the periph structure; Thediameter of the cervical sympathetic trunk. The nearest distance between thecervical sympathetic trunk and the anterior median line and the collilongus innermargin.2. The position, appearance, and size of ganglion cervicale superius, with mainadjacent structure position relations and distance. The nutrient artery's origin of thesuperior thyroid ganglion and the disposition condition in the neural ganglion.3. The position, appearance and the size of ganglion stellare, the distance offorthcoming the blood vessel and nerve, the distance of cervical anterior medianline, the vertical depth to the skin., The nutrient artery's origin of the inferiorcervical ganglion(ganglion stellare) and the disposition condition in the neuralganglion.4. The origin, erupting aspect, Courser and the variation situation of arteria vertebralis.5. The lateral approaching method of myo-intergroove ganglion stellare blocks theroad of the anatomy and the body surface localization.6. The adjoining relations of the diaphragmatic nerve and the big blood vessel,cervical pleura, the apex of lung, alimentary duct, vagus nerve and so on; thelength of diaphragmatic nerve and the width of the puncturing spot; the minimumdistance is from the diaphragmatic nerve to the cervical sympathetic trunk.7. The appearance, distribution and the variation of the superior laryngeal nerve andthe laryngeal nerve branch, the adjoining relations of the superior laryngeal nerveand the laryngeal nerve branch and with the cervical sympathetic trunk and the cervical sympathetic ganglia.Results1. The dissection observation and the survey with the cervical sympathetic trunk: the5th cervical vetebrae processus transversus is the cervical sympathetic trunk whichis located between the scalene muscle tendinous crossing beginning and thetendinous balteum of the musculus longus capitis and the collilongus, thesympathetic nerve in this place is away from recent with the two.1.2. The distance from the truncus sympathicus cervicalis to the anterior median line:the 3rd～7th cervical vertebra truncus sympathicus cervicalis is involved the medianline distance gradually to reduce, left right flank mean value: the 3rd cervicalvertebra level: 25.89±2.98mm, the 4th cervical vertebra level: 25.35±2.45mm, the5th cervical vertebra level:23.56±2.01mm, the 6th cervical vertebra level:21.67±2.29 mm, the 7th cervical vertebra level: 19.78±2.67mm.1.3 The distance between the truncus sympathicus cervicalis and the posterior marginof collilongus: the distance between the truncus sympathicus cervicalis and theposterior margin of collilongus becomes smaller from the 3rd to the 7th cervicalvertebra, until the 7th cervical vertebra superior border to be smallest. When it takethe centrum superior border as the plane of survey, At the 3rd cervical vertebralevel the distance is about 20.56±2.62mm and the 7th cervical vertebra is12.35±2.97mm. The mean value of the left and right sides: the 3th cervicalvertebra level: 20.56±2.62mm, the 4th cervical vertebra level: 19.68±2.91mm, the5th cervical vertebra level: 18.55±2.21mm, the 6th cervical vertebra level: 15.49±2.58mm, the 7th cervical vertebra level: 12.35±2.97mm.1.4 The diameter of the cervical sympathetic trunk: The mean value of the left andright sides: the 3th cervical vertebra plane: 2.24±0.51mm; the 4th cervical vertebraplane: 2.12±0.41mm; the 5th cervical vertebra plane: 2.04±0.23mm; the 6thcervical vertebra plane: 2.22±0.25mm; the 7th cervical vertebra plane:1.82±0.59mm.2 Anatomy observes and surveys on the ganglion cervicale superius2.1 The appearance of the ganglion cervicale superius is always asymmetrical, buttwo sides most common appearance for the shuttle, account for 60%, the ellipsenext. the ganglion cervicale superius is located front the 1st～3th cervical vertebraprocessus transversus, behind carotis interna.2.2 The size of ganglion cervicale superius: Left side long: 24.42±7.44mm; Width:8.05±1.32mm; Thickness: 2.69±0.51mm. Right flank long: 26.41±0.65mm; Width:7.45±0.73mm; Thickness2.52±0.84mm.2.3 The distance from ganglion cervicale superius anterior border to the tongue bonebig angle: Left side: 8.3±4.4mm; Right flank: 5.4±3.2mm.2.4 The distance from ganglion cervicale superius inferior extremity to the tonguebone big angle: Left side: 7.14±4.26mm; Right flank: 2.38±1.41mm.2.5 The distance from ganglion cervicale superius inferior extremity to the arteriacarotis communis furcation place: Left side: 9.54±4.07mm; Right flank:12.81±3.67mm.2.6 The distance from ganglion cervicale superius inferior extremity to the line between the angle of jaw and the mastoid process: Left side: 7.64±2.42mm;Right flank: 8.64±1.76mm.2.7 The distance from the truncus sympathicus cervicalis in the third cervical vertebraplanes to the neck anterior median line: Left side: 25.51±4.78mm; Right flank:24.83±4.30mm.2.8 The superior thyroid ganglion's nutrient artery is mainly from the vasoganglionbetween the superior thyroid artery and the tunica adventitia of common carotidartery. The nutrient vessels and the vasoganglion mainly distribute theganglionic anteriomedialis, ganglionic upper pole.3. Anatomy observes and surveys on the ganglion stellare3.1. The position, appearance and the size of the ganglion stellareGanglion stellare is located in the collar of the neck, the 7th cervical vertebraprocessus transversus to the first collum costae level 40 examples, accounts for83.33%; the T1 level ganglion stellare 8 examples, accounts for 16.67%. Thesuperior border to T1 superior border 0.17±0.13cm, 43 examples, accounts for89.58%; the superior border to the 7th cervical vertebra superior border0.84±0.15cm, 5 examples, accounts for 10.42%; behind the arteria vertebralisoutset department 38 examples, accounts for 79.17%, the post-outside 6 examples,account for 12.5%, the post-inside 4 examples, account for 8.33%. The shape ofganglion stellare: The ganglion stellare most common shape is: Star type: Left side8 examples, account for 66.67%, right flank 7 examples, account for 58.33%; Nextis the ellipse: Left side 3 examples, account for 25.00%, right flank 4 examples, account for 33.33%; dumb bell shape: Left side 1 example, accounts for 8.33%,right flank 1 example, accounts for 8.33%. Size: Left side is long 16.85±4.57mm,width 4.94±0.33mm, thick4.17±0.68mm; Right flank long 17.13±5.19mm,width4.73±0.56mm, thick 4.78±0.27mm.3.2. The distance of the ganglion stellare to the near vessel and nerve: The minimumdistance from the ganglion stellare to the arteria carotis communis is 6.24±1.96mm;horizontal range to the diaphragmatic nerve is 16.25±4.89mm; Is apart from thethyrocervical trunk minimum distance for 15.72±3.75mm; Is apart from arteriathyreoidea inferior minimum distance for 7.86±2.13mm; Is apart from thelaryngeal nerve horizontal range for 11.92±3.42mm; Is apart from the center of thebrachiplex superior trunk horizontal range for 23.97±5.36mm. The distance frominferior cervical ganglion superior border to the cricoid cartilage inferior border:left side the mean value is 31.15±7.79mm; right flank the mean value is31.4±6.81mm. The distance from inferior cervical ganglion to the neck anteriormedian line: Left side mean value 30.92±6.67mm; Right flank mean value30.53±6.65mm; inferior cervical ganglion to skin vertical depth: Left side the meanvalue is 32.87±7.59mm; Right flank the mean value is 33.54±6.62mm. The centerpoint of the inferior cervical ganglion middle to the middle of breastbone neck veinincisure the vertical range: Left side mean value 31.95±6.82mm; Right flank meanvalue 31.74±7.79mm.3.3 The ganglion stellare's nutrient artery is mainly from the vasoganglion betweenthe inferior thyroid artery, the arteria vertebralis, the arteriae subclavia and the tunica adventitia of the arteria vertebralis, the nutrient vessels mainly distribute theganglionic upper pole, the ganglionic anus pcrineum.4 Anatomy observes and surveys on arteria vcrtebralises initial sectors and processustransversus section anatomy observes and surveys4.1 Artcria vertebralises initial sectors shape observed result: The arteria vertebralisinitial sector lumens shows the circle columnarly, not obviously collapse, after theentire upward post-inside journey gradually rises to approach scalene muscle untilentering cervical foramen. The origin of the arteria vertebralis and the evolutionposition: The left size has 18 examples (75%) from the arteria subclavia superiorwall, 3 examples (12.5%) from post- superior wall, 1 example(4.17%) from theante-superior wall, another example (4.17%) is direct on the arch of the arteriaeaorta superior wall; Right flank has 17 examples (70.8%) from the arteria subclaviasuperior wall, 4 examples (16.7%) from post- superior wall, 3 examples from thepost wall (12.5%). The initial sector the outset department direction shows thetendency on the arteria subclavia which place above concentrates to after.Artcria vertebralis processus transversus section insertion: The processustransversus section (right flank) enters from the 6th cervical vertebra cervicalforamen inferior border to the 2nd cervical vertebra cervical foramen upperopening, 1 examples from the 5th cervical vertebra cervical foramcn inters. Themajority puts on the 6th～3rd cervical vertebra cervical foramen to upward. Mostlyvertical walks when bounding to the line, only 2 examples separately slightly havethe curve in 3rd～2nd cervical vertebra and between the 4th～3rd cervical vertebra. 4.2 Arteria vertebralises beginnings are apart from the median line distance: Left sidethe arteria vertebralis beginning is apart from the median line to be away fromaverage 2.69±0.18cm; Right flank average 2.52±0.36cm.4.3 Arteria vertebralises Courser situation: The majority of Arteria vertebralis initialsector (left 25 examples, accounts for 83.3%, right 24 examples, 80.0%)craspedodrome rise. The initial sector walks in the line mainly to show the arrow,the coronal position curving, the arteria vertebralis initial sector curving changewhich is taking'S', inside and outside directions curving are 32.4% (34 examples),around the direction curving accounts for 16.2% (17 examples).4.4 The position relations of the arteria vertebralises arteries beginning segment andthe sympathicus cervicalis. Left flank: The inferior(stellare) cervical ganglion issituated in the arteria vertebralis inside, in rear area 1～2cm, the truncussympathicus cervicalis and the middle cervical ganglion are situated behind thearteria vertebralis 9 examples (37.5%); the inferior cervical ganglion is situated inarteria vertebralis inside and in rear area, but the truncus sympathicus cervicalisand middle cervical ganglion are situated in the front of arteria vertebralis 14examples (58.33%), the only 1 example is situated in the arteria vertebralis outside,another 1 example twines around the arteria vertebralis on the line. Right flank:The truncus sympathicus cervicalis and the ganglion are situated in the arteriavertebralis inside or rear area 11 examples (45.83%), 13 examples (54.17%) thetruncus sympathicus cervicalis is located in front of the arteria vertebralis, and 1example is located in arteria vertebralis outside. 5. The anatomy observation and the survey on the correlation with the anteriorscalenus muscle and the truncus sympathicus cervicalis: Anterior scalenus musclegets up to the 3rd～6th cervical vertebra processus transversus around tubercle,outside the muscle fiber course underneath, stops above the first rib anteriorscalenus muscle the tubercle, the anterior scalenus muscle anterior border neighbortruncus sympathicus cervicalis does, is apart from ganglionated cord the distancefor 25.84±2.38mm, in the 5th cervical vertebra processus transversus placeexactly is its tendinous ingredient most centralized region.6. Anatomy observation and survey on diaphragmatic nerve and truncus sympathicuscervicalis correlation: Diaphragmatic nerve the front inside pate ganglionated cordis neighboring, diaphragmatic nerve is away from the truncus sympathicuscervicalis distance in the 6th cervical vertebra plane is: Left side 1.58±0.53cm;Right flank 1.62±0.28cm. The middle and inferior cervical ganglion is located inits front inside, the horizontal range from the first thoracic ganglion to thediaphragmatic nerve is: Left side 1.59±0.46cm; Right flank 1.61±0.89cm; therelation frequency of the truncus sympathicus cervicalis which is involved indiaphragmatic nerve is 43.6%, mainly with diaphragmatic nerve, with accessoryphrenic nerve then are less. The maximum relation with them and the inferiorcervical ganglion is 60.4%, next with the middle cervical ganglion is 17.5%. Inaddition also has with the arteria vertebralis ganglion, ansa subclavia, middle andinferior cervical ganglion relates, obviously diaphragmatic nerve with ganglionatedcord has the widespread relation to it in the neck. 7. The branch, the shape, the distribution and the variation of laryngeal nerve: In 48laryngeal nerve examples, 43 examples which branch assumes arborization, callsthe tree branch; 5 examples between their branchs or between the branch and thetruncus sympathicus cervicalis mutually anastomose, forms ansiform, and we callsit laryngeal nerve loop, its front and latter directly from the loop on sends outlaryngeal nerve to branch out after the vagus nerve, along the trache-esophaguscanal on line, along the way sends out several branches to distribute in the throat,the trachea, the esophagus and the neighbor muscles.Conclusion1. The truncus sympathicus cervicalis directly is located in front of collilongus, ponethe antero-vertebra anadesma, the branch and the collilongus is connected, theinfused physic liquor diffusion of the middle and inferior cervical ganglionblocking is limited by the muscle nd the fascia musculares, the spot, the direction,the depth and the speed of needling can affect the infused physic liquor to producedifferent blocking effects. The effect of the middle and inferior cervical ganglion isnot caused by the direct blocking the nerve ganglion, for the effect of the blockingby the preganglionic fibre and postganglionic fibre of the middle cervical ganglionand the ganglion stellare out of the collilongus anadesma.2. The body surface of the ganglion cervicale superius localization whenpuncturing: First to touch the tongue bone big angle, then the puncture spotcleidomastoidal process anterior border and the tongue bone big angle segmentcenter point is the puncture spot, the mastoid process point next 1.5 cm place fixed point processus transversus is at the 2nd cervical vertebra; The 4th cervicalvertebra processus transversus cleidomastoidal posterior border and the externaljugular vein intersection 1.5cm place, is equal to the thyroid cartilage superiorborder; the 3rd cervical vertebra processus transversus in the 4th cervical vertebraprocessus transversus place above 1.5 cm place, is equal to tongue bone level. Thepatient takes dorsal decubitus and make the head deviate to the opposite side,processus transversus place makes the mark in the 2nd～4 cervical vertebra, with22G or 24G, long 3.5 cm transfixion pin connects the injector to do to in, under andrear area to prick approximately 2～3cm, when touches the bone sense and maydetermine the 2nd or the 3rd cervical vertebra processus transversus, withdrawal ofneedles 2 mm.The ganglion cervicale superius surgery approuching: First to touch thetongue bone big angle, then cleidomastoidal process anterior border and in thetongue bone big angle segment center point, under respectively lengthens 1.5centimeters margins. By the level incision, pull the carotid artery sheath to theinside, again may obviously touch the second cervical vertebra to the deep surfaceprocessus transversus, strips with the blunt instrument the antero-vertebraanadesma, obviously one shallow concave in, the ganglion cervicale superiusnamely in its shallow is concave.3. Body surface locating point of the ganglion stellare: This spot is located above theextremitas stemalis claviculae 22.38±3.97mm and the median line sid24.18±2.35mm underneath the mm point of intersection or the tuberculum caroticum chassaignaci 37.14±5.86mm opens 24.21±3.79mm points of intersectionspots with the median line nearby; perpendicular needling after this spot32.48±2.54mm namely to reach the star shape ganglion.4. The arteria vertebralis initial sector variation is the truncus sympathicus cervicalisblocking technique in the technique to damage the arteria vertebralis to have theserious illness complication main reason.5. The lateral approaching method of myo-intergroove ganglion stellare blocks theroad of the body surface localization: Take dorsal decubitus and make the headdeviate to the opposite side, expose the blocked side cervical part completely, electthe puncture spot at the intersection place which is located in the myo- intergroovethat is between anterior and medial scalenus muscle and the cricoid cartilageparallel line, which is equal to the 6th cervical vertebra processustransversus. Search the peak of the 6th cervical vertebra processus transversus to thecricoid cartilage plane, with the left hand index and middle figures slightly pressmyo- intergroove, and separate the circa muscle group, go against cleidomastoidalwith the nail side and the carotid artery sheath,and the finger pulp side is among thescalene muscle group, diaphragmatic nerve and the 6th cervical vertebra processustransversus. Then the 6th cervical vertebra processus transversus anterior aspect oranterior tubercle is pressed between the two finger pulps, and during the twofigures there is 3～5 mm seam, that is the needling gap. The distance of the skin ofpuncture spot to the 6th cervical vertebra facio- processus transversus is: Left side:1.53±0.32cm; Right flank: 1.49±0.36cm. The distance of the skin of puncture spot to inter- muscle anadesma is: Left side: 1.26±0.13cm; Right flank: 1.19±0.14cm.The lateral approaching method of myo- intergroove characteristic lies in: The 6thcervical vertebra processus transversus tubercle in myo- intergroove placecomparatively shows shallowly, is easy to touch, the obvious dissection mark ofthe puncture; also it is far away the big vessel comparatively, puncture not easyto harm; after transfixion pin reaches the 6th cervical vertebra processustransversus then retrocede the needle then prick in about 2.5cm to decoct later andthen it can reach the 7th cervical vertebra processus transversus easily, inject intothis place it can block the ganglion stellare located underneath.6. In the truncus sympathicus cervicalis blocking technique, inaccur ganglion stellareate location, deeper needling and the overdose of local anesthesia are the mainreasons to damage the diaphragmatic nerve and the complication of blockage.7. In the cervical sympathetic ganglia blocking technique, the insufficiencyunderstanding to laryngeal nerve Courser, the branch number and the nerve trunkshape, the branch variation and its relation with truncus sympathicus cervicalis isthe main reason that blocks laryngeal nerve.8. When committing the superior thyroid ganglion and the ganglion stellare blockingtechnique, we should prevent the transfixion pin from pricking into the nerveganglion, otherwise it will make the nerve ganglion and the nerve ganglion'snutrient vessel insult, the physic liquor may be absorbed through the part bloodvessel to influence the blocking effect. |
PDF Full Text Request