利用神经入肌点定位小腿三头肌痉挛的神经阻滞靶点
Using the nerve entry points to localize the nerve block targets of the triceps surae muscle spasticity
目的 准确定位小腿三头肌的神经入肌点（N点）位置，为临床该肌痉挛神经阻滞提供解剖学基础。 方法 10具20侧成年人尸体下肢，俯卧。紧贴皮肤连接股骨外上髁与内上髁和股骨外上髁与外踝的线分别为N点的横向参考线（H线）和纵向参考线（L线）。解剖暴露小腿三头肌各神经肌支的N点，涂抹硫酸钡，CT扫描。Syngo系统下确定N点在体表的投影点（P点）；P点通过N点后投射至对侧皮肤上的P'点；经P点的垂线与H线、水平线与L线的交点分别记为PH和PL。分别测量PH和PL在H和L线上的百分位置及N点的深度。 结果 腓肠肌内侧头、外侧头和比目鱼肌的PH分别位于H线的（46.89±2.73）%、（40.90±3.05）%和（42.56±2.59）%处，PL分别位于L线的（7.58±2.88）%、（8.15±2.52）%和（17.42±3.31）%处；N点深度分别位于PP'线的（16.32±2.52）%、（13.83±1.77）%和（29.93±2.89）%处。 结论 这些参数可提高小腿三头肌痉挛神经溶解术的疗效和效率。
Objective To investigate the location of nerve entry point (N point) of the triceps surae accurately in order to provide the anatomical basis for the clinical nerve block of this muscle spasticity. Methods Twenty sides of lower limbs of 10 adult cadavers were dissected and exposed in the prone position. The lines on the skin between the lateral epicondyle to the medial epicondyle of the femur and fro the lateral epicondyle of the femur to the lateral malleolus were designated as the horizontal reference line (H line) and the longitudinal reference line (L line) of the N point, respectively. Those cadavers were dissected to expose the point N of each nerve muscle branch of triceps surae for staining the N points by barium sulfate. CT scanning was performed. Syngo system was used to determine the body surface projection point (P point) of point N; P by N projecting to the contralateral limb skin was designated as P'; The intersections the vertical line through P and the H line, the horizontal line through P and line L were designated as PH and PL, respectively. The percentage location of PH and PL points on H line and L line and depth of point N were measured, respectively. Results The point PH of the medial head of gastrocnemius, lateral head of gastrocnemius and soleus were located at（46.89±2.73）%, （40.90±3.05）% and（42.56±2.59）% of the H line, respectively, and at （7.58±2.88）%, （8.15±2.52）% and （17.42±3.31）% of the L line, respectively; The depth of N points after P points were located at（16.32±2.52）%, （13.83±1.77）% and（29.93±2.89）%, respectively. Conclusion These parameters can improve the efficacy and efficiency of the neurolysis for the treatment of triceps muscle spasticity.
小腿三头肌 / 肌痉挛 / 神经入肌点 / 定位 / 神经阻滞
Triceps surae muscle / Muscle spasticity / Nerve entry points / Localization / Nerve block
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国家自然科学基金（31540031）；贵州省卫计委科学技术基金(gzwjkj2015-1-044)，贵州省科技厅联合基金（黔科合LH字[2015]7528）
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