허리엉치신경얼기의 말단가지를 이루는 척수신경구성
Spinal Nerve Compositions of the Terminal Branches of the Lumbosacral Plexus
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초록
이 연구는 허리엉치신경얼기에서 분지하는 각 말단신경의 척수신경 구성과 참여량을 밝히는 데 목적이있다. 한국성인 시신의 25쪽(남: 17, 여자: 8, 왼쪽: 13, 오른쪽: 12, 평균나이: 73.6세)에서 허리엉치신경얼기와 그 말단신경을 떼어내 Guanidine-HCl (0.2 M)에 약 2주 동안 담가 신경주위결합조직을 부드럽게 한 후 수술현미경(OPMI-Pico, Carl Zeiss) 아래에서 신경다발을 분리하였다. 허리엉치신경얼기에서 분지되는 말단신경의 주요 구성성분으로 엉덩아랫배신경은 88.2%에서 L1로만 구성되었고 엉덩샅굴신경은 100% 모두 L1로, 음부넙다리신경은 62.5%에서 L1과 L2로, 가쪽넙다리피부신경 56.0%에서 L2와 L3으로, 넙다리신경은 88.0%에서 L2, L3 그리고 L4로 구성되었다. 또 폐쇄신경은 100%에서 L2, L3 그리고 L4로 구성되었고, 궁둥신경의 온종아리부분은 84.0%에서 L4, L5, S1 그리고 S2로, 정강부분은 96.0%에서L4, L5, S1 그리고 S2로, 위볼기신경은 56.0%에서 L4, L5 그리고 S1로 구성되었다. 아래볼기신경은 54.2%에서L5와 S1 그리고 S2로, 뒤넙다리피부신경은 40.0%에서 S1과 S2로, 관통피부신경은 56.0%에서 S2와 S3으로, 음부신경은 52.9%에서 S3으로만 구성되었다. 한편, 참여하는 척수신경의 굵기를 살핀 결과, 엉덩아랫배신경의 경우 L1 (0.72 mm)이 가장 많이 참여하였고 엉덩샅굴신경도 L1 (0.63 mm)에서, 음부넙다리신경은 L2 (0.72 mm)에서, 가쪽넙다리피부신경도 L2 (0.80 mm)에서, 넙다리신경은 L3 (2.68 mm)에서, 폐쇄신경도 L3 (1.27 mm)에서, 궁둥신경의 온종아리부분은 S1 (2.12 mm)에서, 궁둥신경의 정강부분도 S1 (2.22 mm)에서, 위볼기신경은 L5 (1.09mm)에서, 아래볼기신경은 S1 (1.27 mm)에서, 뒤넙다리피부신경은 S2 (1.04 mm)에서, 관통피부신경은 S3 (1.09mm)에서, 음부신경은 S4 (1.46 mm)에서 가장 많은 신경섬유가 참여하였다. 이 연구의 결과는 척수신경뿌리 병변시 임상적 증상을 예측하는 데 도움이 될 것으로 생각된다.
Abstract
The purpose of this study was to classify the spinal nerve compositions of the terminal branches of the lumbosacral plexus, providing data of their participating quantities. Twenty-five sides of the lumbosacral plexus extracted from Korean adult cadavers were used in this study. The iliohypogastric nerve was mostly arisen from L1 (88.2%, thickness L1 0.7 mm). The ilioinguinal nerve was arisen from only L1 (100%, thickness L1 0.6 mm). The genitofemoral nerve was commonly arisen from L1 and L2 (62.5%, thickness L1 0.6 mm, L2 0.7 mm). The lateral femoral cutaneous nerve was classified into 4 types, and the most common type was that L2 and L3 composed this nerve (56.0%, thickness L2 0.8 mm, L3 0.4 mm). The femoral nerve was classified into 2 types, and it was usually composed of L2, L3 and L4 (88.0%, thickness L2 1.4mm, L3 2.7 mm, L4 2.3 mm). The obturator nerve was arisen from L2, L3 and L4 in all cases (100%, thickness L2 0.5 mm, L3 1.3 mm, L4 1.1 mm). The common fibular component of sciatic nerve was mostly arisen from L4,L5, S1 and S2 (84.0%, thickness L4 0.9 mm, L5 2.0 mm, S1 2.1 mm, S2 1.2 mm). The tibial component of sciatic nerve was mainly arisen from L4, L5, S1 and S2 (96.0%, thickness L4 0.9 mm, L5 1.9 mm, S1 2.2 mm, S2 1.9 mm). The superior gluteal nerve was commonly derived from L4, L5 and S1 (56.0%, thickness L4 0.7 mm, L5 1.1 mm,S1 0.9 mm). The inferior gluteal nerve was comprised of L5, S1 and S2 in several cases (54.2%, thickness L5 0.9mm, S1 1.3 mm, S2 0.8 mm). The posterior femoral cutaneous nerve was composed of S1 and S2 in higher freqeuncy (40.0%, thickness S1 0.9 mm, S2 1.0 mm, S3 0.8 mm). The perforating cutaneous nerve was arisen from S2and S3 in higher frequency (56.0%, thickness S1 0.7 mm, S2 0.9 mm, S3 1.1 mm). The pudendal nerve was derived from S3 in many cases (52.9%, thickness S3 1.5 mm). These anatomical results may be helpful to predict the spinal nerve root lesions of the lumbosacral plexus.
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