Kazan medical journalKazan medical journalКазанский медицинский журнал0368-48142587-9359Eco-Vector10697910.17816/KMJ106979Theoretical and clinical medicineТеоретическая и клиническая медицинаResearch ArticleVariant anatomy and codes of the human brachial plexusВариантная анатомия и коды плечевого сплетения человекаhttps://orcid.org/0000-0003-4809-4491W-4527-2017GorbunovNikolay S.ГорбуновНиколай Станиславович
Russian Federation

M.D., D. Sci. (Med.), Prof., Depart. of Operative Surgery and Topographic Anatomy; Leading Researcher

докт. мед. наук, проф., каф. оперативной хирургии и топографической анатомии; ведущий научный сотрудник

gorbunov_ns@mail.ruhttps://orcid.org/0000-0001-5209-182XD-9666-2019KoberKristina V.КоберКристина Владимировна
Russian Federation

M.D.

хирург-онколог

kober@mail.ruhttps://orcid.org/0000-0002-5988-1688KasparovEduard V.КаспаровЭдуард Вильямович
Russian Federation

M.D., D. Sci. (Med.), Prof., Director

докт. мед. наук, проф., глав. врач

rsimpn@scn.ruhttps://orcid.org/0000-0002-1462-7379RostovtsevSergey I.РостовцевСергей Иванович
Russian Federation

M.D., D. Sci. (Med.), Assoc. Prof., Depart. of Anesthesiology and Resuscitation

докт. мед. наук, доц., каф. анестезиологии и реаниматологии

rostovcev.1960@mail.ruKrasnoyarsk State Medical University named after V.F. Voino-YasenetskyКрасноярский государственный медицинский университет им. В.Ф. Войно-ЯсенецкогоScientific Research Institute of Medical Issues of the NorthНаучно-исследовательский институт медицинских проблем СевераKrasnoyarsk Regional Clinical Oncological Dispensary named after A.I. KryzhanovskyКрасноярский краевой клинический онкологический диспансер им. А.И. Крыжановского0812202201022023104162713004202203112022Copyright ©; 2023, Eco-VectorCopyright ©; 2023, Эко-Вектор2023Eco-VectorЭко-Векторhttps://kazanmedjournal.ru/kazanmedj/article/view/106979

Background. Understanding the complexities of formation and structural features of the brachial plexus remains important for diagnosis, effective surgical treatment and regional anesthesia.

Aim. To identify variants of the brachial plexus structure and develop a system for their coding.

Material and methods. Macroscopic anatomical layer-by-layer and macro-microscopic intratubular dissection of 121 brachial plexus preparations were performed in 105 cadavers of men and women aged 40–100 years. A database was formed from the obtained indicators in the MS Excel 2012 program, and their processing was carried out using Statistica for Windows 12. All indicators were tested for the normal distribution using the Shapiro–Wilco criterion. When describing the studied indicators, the median (Me) and interquartile intervals [Q1, Q3] were determined, as well as the significance of intergroup differences according to the Mann–Whitney test.

Results. It was established that the farther from the spinal cord, the more variants of the macroscopic and macro-microscopic structure of the brachial plexus elements exist: roots — 3, trunks — 7, divisions — 3, bundles — 12–16, and a total of 20 variants of the general structure were identified. The roots of spinal nerves C6 (66.1%), C7 (66.4%) and C8 (64.2%) take the greatest part in the formation of brachial plexus bundles, 2 times less often — C5 (34.8%) and Th1 (33.3%), very rarely — C4 (2.5%) and Th2 (0.8%). Reverse coding of variants of the brachial plexus structure in the direction: bundle ← division ← trunk (root) allows to briefly and clearly display the entire morphological diversity of the nervous system of the human upper limb. The results obtained should be taken into account when diagnosing injuries, performing regional anesthesia, reconstructive operations, rehabilitation measures, creating neurosimulators, neurochips, and nerve conductors.

Conclusion. 20 different variants of the general structure of the human brachial plexus have been identified and a reverse coding system has been developed.

Актуальность. Понимание сложностей формирования и особенностей строения плечевого сплетения остаётся значимым для диагностики, эффективного хирургического лечения и регионарной анестезии.

Цель. Выявить варианты строения плечевого сплетения и разработать систему их кодирования.

Материал и методы исследования. Выполнено макроскопическое анатомическое послойное и макро-микроскопическое внутриствольное препарирование 121 препарата плечевого сплетения у 105 трупов мужчин и женщин в возрасте 40–100 лет. Из полученных показателей в программе MS Excel 2012 сформирована база данных, проведена их обработка с использованием Statistica for Windows 12. Все показатели проверены на нормальность распределения по критерию Шапиро–Уилка. При описании изучаемых показателей определяли медиану (Mе) и межквартильные интервалы [Q1, Q3], а значимость межгрупповых различий — по U-тесту Манна–Уитни.

Результаты. Установлено, что чем дальше от спинного мозга, тем больше вариантов макроскопического и макро-микроскопического строения элементов плечевого сплетения: корешков — 3, стволов — 7, разделений — 3, пучков — 12–16, а всего выявлено 20 вариантов общего строения. Наибольшее участие в формировании пучков плечевого сплетения принимают корешки спинномозговых нервов С6 (66,1%), С7 (66,4%) и С8 (64,2%), в 2 раза реже — С5 (34,8%) и Th1 (33,3%), очень редко — С4 (2,5%) и Th2 (0,8%). Обратное кодирование вариантов строения плечевого сплетения в направлении пучок ← разделение ← ствол (корешок) позволяет кратко и наглядно отобразить всё морфологическое разнообразие нервной системы верхней конечности человека. Полученные результаты целесообразно учитывать при диагностике повреждений, выполнении регионарной анестезии, реконструктивных операций, реабилитационных мероприятий, создании нейротренажёров, нейрочипов, нервных проводников.

Вывод. Выявлено 20 различных вариантов общего строения плечевого сплетения человека и разработана обратная система их кодирования.

variantsbrachial plexusrootstrunksdivisionsbundlescodesвариантыплечевое сплетениекорешкистволыразделенияпучкикодыИсследование поддержано Красноярским краевым фондом наукиNatsis K, Piagkou M, Totlis T, Kapetanakis S. A prefix brachial plexus with two trunks and one anterior cord. Folia Morphol. 2020;79(2):402–406. DOI: 10.5603/FM.a2019.0081.Llusá M, Morro MR, Casañas J, Moore AM. Surgical anatomy of the brachial plexus. In: Shin AY, Pulos N, editors. Operative Brachial Plexus Surgery. Cham: Springer; 2021. p. 19–39. DOI: 10.1007/978-3-030-69517-0_2.Schnick U, Dähne F, Tittel A, Vogel K, Eisenschenk A, Ekkernkamp A, Böttcher R. Traumatic lesions of the brachial plexus: Clinical symptoms, diagnostics and treatment. Der Unfallchirurg. 2018;121:483–496. DOI: 10.1007/s00113-018-0506-7.Noland SS, Bishop AT, Spinner RJ, Shin AY. Adult traumatic brachial plexus injuries. J Am Acad Orthop Surg. 2019;27(19):705–716. DOI: 10.5435/jaaos-d-18-00433.El Beheiry H. Management of patient with brachial plexus injury. In: Prabhakar H, Rajan S, Kapoor I, Mahajan C. Problem Based Learning Discussions in Neuroanesthesia and Neurocritical Care. Singapore: Springer; 2020. p. 15–24. DOI: 10.1007/978-981-15-0458-7_2.Soleymanha M, Mobayen M, Asadi K, Adeli A, Haghparast-Ghadim-Limudahi Z. Survey of 2582 cases of acute orthopedic trauma. Trauma Mon. 2014;19(4):e16215. DOI: 10.5812/traumamon.16215.Williams AA, Smith HF. Anatomical entrapment of the dorsal scapular and long thoracic nerves, secondary to brachial plexus piercing variation. Anatomical Science International. 2019;95(1):67–75. DOI: 10.1007/s12565-019-00495-1.Chaudhary P, Singla R, Arora K, Kalsey G. Formation and branching pattern of cords of brachial plexus — A cadaveric study in north Indian population. Int J Ana Res. 2014;2(1):225–233.Gilcrease-Garcia BM, Deshmukh SD, Parsons MS. Anatomy, imaging, and pathologic conditions of the brachial plexus. Radiographics. 2020;40(6):1686–1714. DOI: 10.1148/rg.2020200012.Feigl GC, Litz RJ, Marhofer P. Anatomy of the brachial plexus and its implications for daily clinical practice: regional anesthesia is applied anatomy. Regional Anesthesia and Pain Medicine. 2020;45(8):620–627. DOI: 10.1136/rapm-2020-101435.Uysal II, Seker M, Karabulut AK, Büyükmumcu M, Ziylan T. Brachial plexus variations in human fetuses. Neurosurgery. 2003;53(3):676–684. DOI: 10.1227/01.NEU.0000079485.24016.70.Matejcik V. Variations of nerve roots of the brachial plexus. Bratisl Lek Listy. 2005;106(1):34–36. PMID: 15869012.Akboru IM, Solmaz I, Secer HI, Izci Yu, Daneyemez M. The surgical anatomy of the brachial plexus. Turk Neurosurg. 2010;20(2):142–150. DOI: 10.5137/1019-5149.TN.2368-09.2.Emamhadi M, Chabok SY, Samini F, Alijani B, Behzadnia H, Firozabad FA, Reihanian Z. Anatomical variations of brachial plexus in adult cadavers; A descriptive study. Arch Bone Jt Surg. 2016;4(3):253–258. PMID: 27517072.Sharma R, Sharma DK, Rani S. To study the variations in the formation and branching pattern of brachial plexus in Rajasthan population. International Journal of Scientific Research. 2020;8(12):5853–5860.Aggarwal A, Puri N, Aggarwal AK, Harjeet K, Sahni D. Anatomical variation in formation of brachial plexus and its branching. Surg Radiol Anat. 2010;32(9):891–894. DOI: 10.1007/s00276-010-0683-8.Kimura S, Amatani H, Nakai H, Miyauchi R, Nagaoka T, Abe M, Kai M, Yamagishi T, Nakajima Y. A novel case of multiple variations in the brachial plexus with the middle trunk originating from the C7 and C8. Anat Sci Int. 2020;95:559–563. DOI: 10.1007/s12565-020-00541-3.Fazan VP, Amadeu AD, Caleffi AL, Rodrigues Filho OA. Brachial plexus variations in its formation and main branches. Acta Cir Bras. 2003;18(5):14–18. DOI: 10.1590/S0102-86502003001200006.Kirik A, Mut SE, Daneyemez MK, Secer HI. Anatomical variations of brachial plexus in fetal cadavers. Turk Neurosurg. 2018;28(5):783–791. DOI: 10.5137/1019-5149.JTN.21339-17.2.Budhiraja V, Rastogi R, Asthana AK. Variations in the formation of the median nerve and its clinical correlation. Folia Morphol (Warsz). 2012;71(1):28–30. PMID: 22532182.Mistry PN, Rajguru J, Dave MR. Unique variation of the radial nerve involving the subscapular artery — A case report. International Journal of Anatomy, Radiology and Surgery. 2020;9(3):AC01–02.Hassan A, Jan N. Anatomical variations in brachial plexus formation and branching pattern in adult cadavers. Annals of the Romanian Society for Cell Biology. 2021;25(4):4869–4876.Guday E, Bekele A, Muche A. Anatomical study of prefixed versus postfixed brachial plexuses in adult human cadaver. ANZ Journal of Surgery. 2016;87(5):399–403. DOI: 10.1111/ans.13534.Khan GA, Yadav ShK, Gautam A, Shakya S, Chetri R. Anatomical variation in branching pattern of brachial plexus and its clinical significance. Int J Anat Res. 2017;5(1):3324–3328. DOI: 10.16965/ijar.2016.459.Huynh M, Spence S, Huang JW. Anatomical variation of the brachial plexus: An ancillary nerve of the middle trunk communicating with the radix of the median nerve. UOJM. 2018;1(8):68–71. DOI: 10.18192/uojm.v0i0.2170.Benes M, Kachlik D, Belbl M, Kunc V, Havlikova S, Whitley A, Kunc V. A meta-analysis on the anatomical variability of the brachial plexus. Part I — Roots, trunks, divisions and cords. Ann Anat. 2021;238:151751. DOI: 10.1016/j.aanat.2021.151751.Orebaugh SL, Williams BA. Brachial plexus anatomy: Normal and variant. Scientific World Journal. 2009;9:300–312. DOI: 10.1100/tsw.2009.39.Lasch EF, Nazer MB, Bartholdy LM. Bilateral anatomical variation in the formation of trunks of the brachial plexus — A case report. Journal of Morphological Sciences. 2018;35(1):9–13. DOI: 10.1055/s-0038-1660485.Andrade LS, Singh I. Variations of the brachial plexus: A study in human fetuses. Online Journal of Health Allied Sciences. 2019;18(1):13.Claassen H, Schmitt O, Wree A, Schulze M. Variations in brachial plexus with respect to concomitant accompanying aberrant arm arteries. Ann Anat. 2016;208:40–48. DOI: 10.1016/j.aanat.2016.07.007.Pandey V, Yadav Y, Bharihoke V, Singh V. Bilateral variant branching pattern of posterior cord of brachial plexus. Journal of the Anatomical Society of India. 2016;65(1):S76–S78. DOI: 10.1016/j.jasi.2016.05.002.Singh R. Variations of cords of brachial plexus and branching pattern of nerves emanating from them. J Craniofac Surg. 2017;28(2):543–547. DOI: 10.1097/scs.00000000000033.Adebisi SS, Singh SP. Anomalous patterns of formation and distribution of the brachial plexus in Nigerians and the implication for brachial plexus block. Nigerian Journal of Surgical Research. 2002;4(3–4):103–106. DOI: 10.4314/njsr.v4i3.12158.Golarz SR, White JM. Anatomic variation of the phrenic nerve and brachial plexus encountered during 100 supraclavicular decompressions for neurogenic thoracic outlet syndrome with associated postoperative neurologic complications. Ann Vasc Surg. 2020;62:70–75. DOI: 10.1016/j.avsg.2019.04.010.Leijnse JN, Bakker BS, D’Herde K. The brachial plexus — explaining its morphology and variability by a generic developmental model. J Anat. 2020;236:862–882. DOI: 10.1111/joa.13123.