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臂丛神经综合征

Author
Mark B Bromberg, MD, PhD
Section Editor
Jeremy M Shefner, MD, PhD
Deputy Editor
John F Dashe, MD, PhD

引言与背景

臂丛神经是一个神经汇集和分支的网络，起自颈神经根和上胸部神经根，终止于支配肩、臂部肌肉和皮肤的已命名神经。虽然详细了解此神经网络组成部分对于鉴别神经根病与单神经病是重要的，但是以综合征方式进行处理更有利于诊断累及神经丛本身的病变。

本专题将简要总结臂丛神经病的基础解剖、发病机制以及一般临床特征，然后将讨论若干特异性臂丛神经病，为了方便根据临床情况将其分为创伤性、非创伤性、医源性和新生儿型4种类型。

解剖学 — 臂丛由从C5至T1的神经根构成(图 1)。臂丛(由近端至远端)可被分为干、股、束、支和神经5区。根据基于臂丛与其他上肢解剖结构整体关系的命名规则，干和股可被进一步细分为上干、下干和中干以及后束、外侧束和内侧束。

  • C5和C6神经根合并形成了臂丛上干。C7神经根形成臂丛中干。C8和T1神经根合并形成臂丛下干。
  • 上干分开并且发出分支至外侧束和后束。中干分开并且发出分支至外侧束和后束。下干分开并且发出分支至后束和内侧束。
  • 外侧束发出分支，形成肌皮神经，并参与形成正中神经。后束发出分支，形成腋神经，继而成为桡神经。内侧束发出分支，参与组成正中神经，继而形成尺神经。
  • 其他神经由臂丛神经的不同组分发出。肩胛背神经起自C5神经根。胸长神经起自C5、C6和C7神经根。肩胛上神经起自臂丛上干。
  • 臂丛神经内各组分对运动和感觉功能的促成作用不同。占比例最大的运动神经纤维起自C5和C6神经根，而占比例最小的运动神经纤维起自C7和T1神经根。数量最大的感觉神经纤维起自C7神经根，而数量较少的感觉神经纤维起自C5、C6、C8和T1神经根[1]。来自脊椎神经节的节后交感神经纤维穿过臂丛。

发病机制 — 臂丛神经病变的病理基础与组织学改变随着基础病因的不同而变化，具体病因包括压迫、横断、缺血、炎症、代谢异常、肿瘤形成以及放射治疗。由于直接检查臂丛神经相对困难，所以臂丛神经病变的多数病理过程均由推理得出。

                                

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Literature review current through: 2017-06 . | This topic last updated: 2017-05-31.
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