Yelka chigali: Versiyalar orasidagi farq
„Brachial plexus“ sahifasi tarjima qilib yaratildi Teglar: [tarjimon] [tarjimon 2] |
(Farq yoʻq)
|
12-Dekabr 2022, 15:02 dagi koʻrinishi
Yelka chigali - pastki to'rtta bo'yin nervlarning oldingi shoxi va birinchi ko'krak nervi ( C5, C6, C7, C8 va T1 ) tomonidan hosil qilingan nervlar tarmog'idir. Ushbu chigal orqa miyadan, bo'yindagi c.cervicoaxillary orqali, birinchi qovurg'a orqali qo'ltiq ostiga o'tadi. U ko'krak, yelka,bilak va qo'lni afferent va efferent nerv tolalari bilan ta'minlaydi.
Tuzilishi
Yelka chigali beshta ildizga, uchta magistralga, oltita bo'limga (uchta old va uchta orqa) va beshta shoxga bo'linadi. Beshta "terminal" shoxchalar va boshqa ko'plab "terminaldan oldingi" yoki "lateral" shoxchalar, masalan, kurak nervi, ko'krak qafasi nervi va uzun ko'krak nervi [1] bo'lib, ular chigalni uzunligi bo'ylab turli nuqtalarda qoldiradi[2].
Ildizlari
Beshta ildiz umurtqa nervlarning oldingi asosiy tarmoqlaridir, ular bo'yin muskullariga segmental tarmoqlar beradi. Yelka chigali besh xil darajada paydo bo'ladi: C5, C6, C7, C8 va T1. C5 va C6 yuqori magistralni o'rnatish uchun birlashadi, C7 doimiy ravishda o'rta magistralni hosil qiladi va C8 va T1 pastki magistralni hosil qilish uchun birlashadi.Oldingi va orqa tarmoqlar esa mos ravishda C4 yoki T2 ni o'z ichiga oladi. Dorsal kurak nervi yuqori magistraldan [2] chiqadi va yelka suyagini orqaga tortuvchi va pastga aylantiruvchi rombsimon mushaklarni innervatsiya qiladi.Kurak osti nervi ham C5, ham C6 dan hosil bo'ladi va innervatsiya qiladi, bu nafas olish paytida birinchi qovurg'alarni ko'tarishni ham o'z ichiga oladi. Uzun ko'krak nervi C5, C6 va C7 dan hosil bo'ladi. Bu nerv tishsimon oldingi mushakni innervatsiya qiladi, u yelka suyagini yon tomonga tortadi va barcha oldinga surish harakatlarida asosiy harakatlantiruvchi hisoblanadi.
Poyalari
Ushbu ildizlar birlashib, poyalarni hosil qiladi:
- "superior" yoki "upper" (C5-C6)
- "middle" (C7)
- "inferior" yoki "lower" (C8, T1)
Bo'limlari
Keyin har bir magistral oltita bo'linish hosil qilish uchun ikkiga bo'linadi:
- yuqori, o'rta va pastki magistrallarning oldingi bo'linmalari
- yuqori, o'rta va pastki magistrallarning orqa bo'linmalari
- tanani anatomik holatda kuzatganda, oldingi bo'linmalar orqa bo'linmalarga yuzaki bo'ladi.
Andoza:Brachial plexus diagramAndoza:Brachial plexus diagram
Tarmoqlari
Ko'pgina tarmoqlar shnurlardan paydo bo'ladi, lekin bir nechta tarmoqlar to'g'ridan-to'g'ri oldingi tuzilmalardan paydo bo'ladi. Chapdagi beshtasi "terminal shoxlari" deb hisoblanadi. Ushbu terminal shoxlari mushak-teri nervi, axilary nerv, radial nerv, medial nerv va bilak nervlaridir . Yon shnurdan chiqib ketishi tufayli mushak-teri nervi va medial nerv yaxshi bog'langan. Mushak-teri nervi hatto ularni yanada bog'laydigan medial nervga shoxcha yuborishi ko'rsatilgan[1][3].
From | Nerve | Roots[4] | Muscles | Cutaneous |
roots | dorsal scapular nerve | C4, C5 | rhomboid muscles and levator scapulae | - |
roots | long thoracic nerve | C5, C6, C7 | serratus anterior | - |
roots | branch to phrenic nerve | C3, C4,C5 | Diaphragm | - |
upper trunk | nerve to the subclavius | C5, C6 | subclavius muscle | - |
upper trunk | suprascapular nerve | C5, C6 | supraspinatus and infraspinatus | - |
lateral cord | lateral pectoral nerve | C5, C6, C7 | pectoralis major and pectoralis minor (by communicating with the medial pectoral nerve) | - |
lateral cord | musculocutaneous nerve | C5, C6, C7 | coracobrachialis, brachialis and biceps brachii | Becomes the lateral cutaneous nerve of the forearm Innervates the skin of the anterolateral forearm; elbow joint.[2] |
lateral cord | lateral root of the median nerve | C5,C6,C7 | fibres to the median nerve
(see below) |
- |
posterior cord | upper subscapular nerve | C5, C6 | subscapularis (upper part) | - |
posterior cord | thoracodorsal nerve (middle subscapular nerve) | C6, C7, C8 | latissimus dorsi | - |
posterior cord | lower subscapular nerve | C5, C6 | subscapularis (lower part ) and teres major | - |
posterior cord | axillary nerve | C5, C6 | anterior branch: deltoid and a small area of overlying skin posterior branch: teres minor and deltoid muscles |
posterior branch becomes superior lateral cutaneous nerve of arm Innervates the skin of the lateral shoulder and arm: shoulder joint.[2] |
posterior cord | radial nerve | C5, C6, C7, C8, T1 | triceps brachii, supinator, anconeus, the extensor muscles of the forearm, and brachioradialis | skin of the posterior arm as the posterior cutaneous nerve of the arm. Also superficial branch of radial nerve supplies back of the hand, including the web of skin between the thumb and index finger. |
medial cord | medial pectoral nerve | C8, T1 | pectoralis major and pectoralis minor | - |
medial cord | medial root of the median nerve | C8, T1 | all of the flexors in the forearm except flexor carpi ulnaris and that part of flexor digitorum profundus that supplies the 2nd and 3rd digits
1st and 2nd lumbrical muscles. muscles of the thenar eminence by a recurrent thenar branch |
portions of hand not served by ulnar or radial, i.e skin of the palmar side of the thumb, the index and middle finger, half the ring finger, and the nail bed of these fingers |
medial cord | medial cutaneous nerve of the arm | C8, T1 | - | front and medial skin of the arm |
medial cord | medial cutaneous nerve of the forearm | C8, T1 | - | medial skin of the forearm |
medial cord | ulnar nerve | C7, C8, T1(C7 because it supplies to the Flexor carpi ulnaris) | flexor carpi ulnaris, the medial two bellies of flexor digitorum profundus, the intrinsic hand muscles, except the thenar muscles and the two lateral lumbricals of the hand which are served by the median nerve | the skin of the medial side of the hand and medial one and a half fingers on the palmar side and medial two and a half fingers on the dorsal side |
Yelka chigaliniFunksiyasi
Yelka chigali qo'llarning terisi va mushaklarini nerv bilan ta'minlaydi, ikkita istisno bundan mustasno: trapezius mushaklari ( orqa miya yordamchi nervi tomonidan ta'minlanadi) va qo'ltiq ostiga yaqin joylashgan teri maydoni ( intercostobraxial nerv bilan ta'minlanadi). Yelka chigali simpatik magistral orqali chigal ildizlariga qo'shiladigan kulrang tarmoq kommunikantlar orqali bog'lanadi.
Yelka chigalining terminal shoxlari (mushak-teri n., qoʻltiq osti n., radial n., mediana n. va ulnar n.) barchasi oʻziga xos sezgi, harakatlantiruvchi va proprioseptiv funksiyalarga ega[5] [6].
Terminal Branch | Sensory Innervation | Muscular Innervation |
---|---|---|
musculocutaneous nerve | Skin of the anterolateral forearm | Brachialis, biceps brachii, coracobrachialis |
axillary nerve | Skin of lateral portion of the shoulder and upper arm | Deltoid and teres minor |
radial nerve | Posterior aspect of the lateral forearm and wrist; posterior arm | Triceps brachii, brachioradialis, anconeus, extensor muscles of the posterior arm and forearm |
median nerve | Skin of lateral 2/3rd of hand and the tips of digits 1-4 | Forearm flexors, thenar eminence, lumbricals of the hand 1-2 |
ulnar nerve | Skin of palm and medial side of hand and digits 3-5 | Hypothenar eminence, some forearm flexors, thumb adductor, lumbricals 3-4, interosseous muscles |
Klinik ahamiyati
Jarohat
Yelka chigalining shikastlanishlari qo'lning turli qismlarining hissiyotiga yoki harakatiga ta'sir qilishi mumkin. Shikastlanish yelkaning pastga surilishi va boshning yuqoriga tortilishi natijasida yuzaga kelishi mumkin, bu esa nervlarni cho'zadi yoki yirtadi. Noto'g'ri joylashish bilan bog'liq jarohatlar odatda boshqa periferik nerv guruhlariga emas, balki yelka chigali nervlariga ta'sir qiladi[7] [8]. Yelka chigalini nervlari pozitsiyaga juda sezgir bo'lganligi sababli, bunday jarohatlarning oldini olishning juda cheklangan usullari mavjud.Yelka chigalini jarohatlarining eng ko'p qurbonlari avtohalokat qurbonlari va yangi tug'ilgan chaqaloqlardan iborat[9].
Shikastlanishlar bo'yin yoki axillarning lateral bo'yin mintaqasiga (orqa uchburchakka) cho'zish, kasalliklar va yaralar sabab bo'lishi mumkin. Shikastlanish joyiga qarab, belgilar va alomatlar to'liq falajdan behushlikgacha bo'lishi mumkin. Bemorning harakatlarni amalga oshirish qobiliyatini sinab ko'rish va uni normal tomoni bilan taqqoslash falaj darajasini baholash usuli hisoblanadi. Yelka chigalining keng tarqalgan shikastlanishi qattiq qo'nish natijasida yuzaga keladi, bu yerda yelka bo'ynidan keng ajraladi (masalan, mototsikl halokati yoki daraxtdan yiqilish). Ushbu cho'zilishlar chigalning yuqori qismlarining yorilishi yoki umurtqa shnurning ildizlarini olib tashlashi mumkin. Yangi tug'ilgan chaqaloqlarda tug'ruq vaqtida bo'yinning haddan tashqari cho'zilishi natijasida sodir bo'lganda, yuqori bo'yin chigali shikastlanishi tez-tez uchraydi. Tadqiqotlar yangi tug'ilgan chaqaloqning vazni va jarohatlari o'rtasidagi munosabatni ko'rsatdi, biroq jarohatni oldini olish uchun zarur bo'lgan tug'ish soni ko'pchilik tug'ilish vaznidan yuqori[10].
Yuqori yelka chigalining shikastlanishi uchun deltasimon, ikki boshli, yelka va yelka-bilak kabi C5 va C6 tomonidan ta'minlangan mushaklarda falaj paydo bo'ladi. Yuqori oyoq-qo'lning lateral tomonida sezuvchanlik yo'qolishi ham bunday jarohatlar bilan tez-tez uchraydi. Pastki yelka chigalining shikastlanishi juda kam uchraydi, ammo tug'ruq paytida odam yiqilib sindirish uchun biror narsani ushlaganida yoki bolaning yuqori oyoq-qo'lini haddan tashqari tortganda paydo bo'lishi mumkin. Bunday holda, qo'lning qisqa mushaklari ta'sirlanadi va to'liq musht holatini shakllantirishga qodir emas[11].
Preganglionik va postganglionik shikastlanishni farqlash uchun klinik tekshiruv shifokordan quyidagi fikrlarni yodda tutishni talab qiladi. Preganglionik shikastlanishlar o'mrov darajasidan yuqori sezuvchanlikni yo'qotish, aks holda sezilmaydigan qo'lda og'riq, ipsilateral Horner sindromi va to'g'ridan-to'g'ri ildizlardan kelib chiqadigan shoxlar tomonidan ta'minlangan mushaklarning funksiyasini yo'qotish, ya'ni kurak qanotiga olib keladigan uzun ko'krak nervi falajiga olib keladi.
O'tkir plexsus branchialis nevriti - yelka sohasida kuchli og'riq paydo bo'lishi bilan tavsiflangan nevrologik kasallik. Bundan tashqari, shnurlarning siqilishi qo'lda tarqaladigan og'riq, uyqusizlik, paresteziya, eritema va qo'llarning zaifligiga olib kelishi mumkin.
Sport jarohatlari
Kontaktli sport turlarida, xususan, Amerika futboli sportida keng tarqalgan sport jarohati "stinger" deb ataladi. Sportchi bu jarohatni yelka eksenel siqilish, fleksiyon yoki nerv ildizlari yoki yelka chigalining terminal shoxlarini kengaytirishga olib kelishi mumkin bo'lgan to'qnashuvda olishi mumkin[12]. Amerika Qo'shma Shtatlari Harbiy Akademiyasida futbolchilar o'rtasida o'tkazilgan tadqiqotda, tadqiqotchilar jarohatlanishning eng keng tarqalgan mexanizmi "yostiqni yelka suyagi bilan yuqori medial kurak o'rtasida qo'zg'almas yelka chigalining siqilishi" ekanligini aniqladilar[13]. Buning natijasi bo'yin sohasidan barmoq uchlarigacha tarqaladigan "yonish" yoki "qichituvchi" og'riqdir. Garchi bu jarohat faqat vaqtinchalik his-tuyg'ularga sabab bo'lsa-da, ba'zi hollarda surunkali belgilarga olib kelishi mumkin.
Penetran yaralar
Ko'pgina penetratsion yaralar darhol davolanishni talab qiladi va ularni tuzatish oson emas. Misol uchun, yelka chigaliga chuqur pichoq jarohati nervni shikastlashi yoki kesishi mumkin.
Tug'ilish paytida shikastlanishlar
Yelka chigalining shikastlanishi yangi tug'ilgan chaqaloqlarni tug'ish paytida paydo bo'lishi mumkin, agar bosh tug'ilgandan keyin chaqaloqning oldingi yelkasi manipulyatsiyasiz yonbosh simfizdan pastga o'tolmaydi. Ushbu manipulyatsiya chaqaloqning elkasining cho'zilishiga olib kelishi mumkin, bu esa unga darajada zarar etkazishi mumkin[14]. Ushbu turdagi jarohatlar yelkama distosi deb ataladi. Yelka distosiyasi akusherlik yelka chigali falajiga (OBPP) olib kelishi mumkin, bu uning haqiqiy shikastlanishi. Qo'shma Shtatlarda OBPP bilan kasallanish 1000 tug'ilgan chaqaloqqa 1,5%ni tashkil qiladi, Buyuk Britaniya va Irlandiya Respublikasida esa pastroq (1000 tug'ilgan chaqaloqqa 0,42)[15]. OBPP uchun ma'lum xavf omillari mavjud bo'lmasa-da, agar yangi tug'ilgan chaqaloqda Yelka distosiyasi bo'lsa, bu ularning OBPP xavfini 100 baravar oshiradi. Nervlarning shikastlanishi tug'ilish vazniga bog'liq bo'lib, kattaroq yangi tug'ilgan chaqaloqlar shikastlanishga ko'proq moyil bo'ladi, ammo bu tug'ish usullari bilan ham bog'liq. Tirik tug'ilish paytida oldini olish juda qiyin bo'lsa-da, shifokorlar bolaning shikastlanish ehtimolini kamaytirish uchun aniq va yumshoq harakatlar bilan yangi tug'ilgan chaqaloqni tug'ishlari kerak.
Shishlar
Yelka chigalida paydo bo'lishi mumkin bo'lgan o'smalar schwannomalar, neyrofibromalar va malign periferik nerv qobig'ining o'smalaridir .
Tasvirlash
Yelka chigalini tasvirlash 1,5 T yoki undan yuqori magnit quvvatli MRI skaneri yordamida samarali amalga oshirilishi mumkin. Yelka chigalini oddiy rentgenografiya bilan baholash mumkin emas, KT va ultratovush skanerlash chigallarni ma'lum darajada ko'rinishini boshqarishi mumkin; shuning uchun MRI ko'p tekislik qobiliyati va qo'shni tomirlar o'rtasidagi to'qimalari farqi tufayli boshqa ko'rish usullaridan ko'ra yelka chigalini tasvirlashda afzallik beriladi. Odatda, T1 WI va T2 WI tasvirlari tasvirlash uchun turli tekisliklarda qo'llaniladi; ammo anatomiyani ko'proq baholash uchun qo'shimcha ma'lumot to'plash uchun asosiy ketma-ketliklarga qo'shimcha ravishda MR Myelolography, Fiesta 3D va T2 kubi kabi yangi ketma-ketliklar ham qo'llaniladi.
Anesteziyada
Qo'shimcha rasmlar
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Yelka chigali yelka arteriyani o'rab oladi.
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Qo'ltiq osti chuqurchasidagi o'ng yelka chigalining kurak nervlari.
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Yelka chigalining tashqi (distal) qismi.
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Yelka chigali
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Yelka chigalining shoxlarini ko'rsatadigan aql xaritasi
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Orqa miya.Yelka chigali. Bosh miya. Pastki ko'rinish va tarmoqlanishi.
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Har bir nerv ildizining shoxlarga qo'shgan hissasini tasvirlash uchun ranglar yordamida yelka chigali diagrammasi.
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Yelka chigali, shu jumladan C5-T1 ventral asosiy shoxining barcha tarmoqlari.
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Orqa miya nervining aralash tolalari
Manbalar
- ↑ 1,0 1,1 Kawai, H. Brachial Plexus Palsy. Singapore: World Scientific, 2000 — 6, 20 bet. ISBN 9810231393.
- ↑ 2,0 2,1 2,2 2,3 Saladin, Kenneth. Anatomy and Physiology, 7, New York: McGraw Hill, 2015 — 489–491 bet. ISBN 9789814646437.
- ↑ Goel, Shivi; Rustagi, SM; Kumar, A; Mehta, V; Suri, RK (Mar 13, 2014). "Multiple unilateral variations in medial and lateral cords of brachial plexus and their branches". Anatomy & Cell Biology 47 (1): 77–80. doi:10.5115/acb.2014.47.1.77. PMID 24693486. PMC 3968270. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3968270.
- ↑ Moore, K.L.. Essential Clinical Anatomy, 3rd, Baltimore: Lippincott Williams & Wilkins, 2007 — 430–1 bet. ISBN 978-0-7817-6274-8.
- ↑ Saladin, Kenneth. Anatomy and Physiology: The Unity of Form and Function. New York, NY: McGraw-Hill, 2007 — 491 bet. ISBN 9789814646437.
- ↑ „Axillary Brachial Plexus Block“. www.nysora.com. New York School of Regional Anesthesia (2013-yil 20-sentyabr). 2017-yil 12-iyulda asl nusxadan arxivlangan.
- ↑ Cooper, DE; Jenkins, RS; Bready, L; Rockwood Jr, CA (1988). "The prevention of injuries of the brachial plexus secondary to malposition of the patient during surgery". Clinical Orthopaedics and Related Research (228): 33–41. doi:10.1097/00003086-198803000-00005. PMID 3342585.
- ↑ Jeyaseelan, L.; Singh, V. K.; Ghosh, S.; Sinisi, M.; Fox, M. (2013). "Iatropathic brachial plexus injury: A complication of delayed fixation of clavicle fractures". The Bone & Joint Journal 95-B (1): 106–10. doi:10.1302/0301-620X.95B1.29625. PMID 23307682.
- ↑ Midha, Rajiv (1997). "Epidemiology of Brachial Plexus Injuries in a Multitrauma Population". Neurosurgery 40 (6): 1182–8; discussion 1188–9. doi:10.1097/00006123-199706000-00014. PMID 9179891.
- ↑ Ecker, Jeffrey L.; Greenberg, James A.; Norwitz, Errol R.; Nadel, Allan S.; Repke, John T. (1997). "Birth Weight as a Predictor of Brachial Plexus Injury". Obstetrics & Gynecology 89 (5): 643–47. doi:10.1016/S0029-7844(97)00007-0. PMID 9166293.
- ↑ Moore, Keith. Clinically Oriented Anatomy. Philadelphia: Lippincott Williams & Wilkins, 2006 — 778–81 bet. ISBN 0-7817-3639-0.
- ↑ Elias, Ilan. Recurrent burner syndrome due to presumed cervical spine osteoblastoma in a collision sport athlete - a case report. PMID 17553154. http://www.biomedcentral.com/1749-7221/2/13. Qaraldi: 2015-02-06.Yelka chigali]]
- ↑ Cunnane, M (2011). "A retrospective study looking at the incidence of 'stinger' injuries in professional rugby union players". British Journal of Sports Medicine 45 (15): A19. doi:10.1136/bjsports-2011-090606.60. http://bjsm.bmj.com/content/45/15/A19.1.abstract. Qaraldi: 2015-02-12.Yelka chigali]]
- ↑ „Brachial Plexus Injuries Information Page: National Institute of Neurological Disorders and Stroke (NINDS)“. www.ninds.nih.gov. Qaraldi: 2016-yil 28-noyabr.
- ↑ Doumouchtsis, Stergios K.; Arulkumaran, Sabaratnam (2009-09-01). "Are all brachial plexus injuries caused by shoulder dystocia?". Obstetrical & Gynecological Survey 64 (9): 615–623. doi:10.1097/OGX.0b013e3181b27a3a. ISSN 1533-9866. PMID 19691859.
Bibliografiya
- Saladin, Kenneth. Anatomy and Physiology, 7th, McGraw-Hill Education, 2014 — 491 bet.
- Kishner. „Brachial Plexus Anatomy“. Medscape. WebMD. Qaraldi: 2015-yil 29-noyabr.
Tashqi havolalar
- Brachial Plexus Injury/Illustration, Cincinnati Children's Hospital Medical Center
- Learn the Brachial Plexus in Five Minutes or Less by Daniel S. Romm, M.D. and Dennis A. Chu Chu, M.D. [1]
- Video of the dissected axilla and brachial plexus