儿童旋前圆肌及指浅屈肌的肌内神经分布模式：为BTX-A的注射提供解剖定位
徐燕,杨方玖,谢夏丹,杨胜波,罗怀香,谢鹏
中国临床解剖学杂志 ›› 2017, Vol. 35 ›› Issue (5) : 481-484.
儿童旋前圆肌及指浅屈肌的肌内神经分布模式：为BTX-A的注射提供解剖定位
Intramuscular nerve distribution pattern in the pronator teres and flexor digitorum superficialis of children: provide anatomical positioning for the injection of BTX-A
目的 探索儿童旋前圆肌和指浅屈肌的肌内终末神经密集区的分布范围，为注射BTX-A治疗脑瘫患儿前臂肌痉挛提供解剖定位。 方法 使用改良的Sihler`s肌内神经染色法观察儿童旋前圆肌和指浅屈肌的肌内神经分支分布模式。 结果 旋前圆肌的神经入肌点有上、下两个，下部的神经支较粗大、分布更广，其肌内神经分支呈扫帚状，相邻各神经分支末端可见明显的“O”和“Y”型吻合，该肌的肌内终末神经密集区位于肌腹中部；指浅屈肌的神经入肌点有上、中、下3个，肌内终末神经密集区可分上、中、下3部，其中以中部最为密集，各终末神经间可见“Y”、“O”吻合。 结论 鉴于两肌的肌内终末神经密集区均位于肌腹中部，当脑瘫患儿旋前圆肌、指浅屈肌痉挛时，使用BTX-A治疗肌痉挛的最佳注射靶区应选择在肌腹中部。
Objective To examine the distribution pattern of intramuscular terminal neurons in the pronator teres and flexor digitorum superficialis muscles in children in order to provide the appropriate anatomical positioning for BTX-A injection in the treatment of forelimb myospasms in children with cerebral palsy. Methods The distribution pattern of intramuscular nerve branches within the pronator teres and flexor digitorum superficialis of children was observed by using the modified Sihler’s intramuscular nerve staining. Results Two nerve entry points (upper and lower) lead to the pronator teres. The lower nerve branch was wider and more extensively distributed. Its intramuscular branches were broom-like, and the adjacent nerve branch terminals had significant convergences of “O” and “Y” shapes. The intramuscular nerve terminal dense zones of this muscle lied in the middle of the muscle belly. The flexor digitorum superficialis had three nerve entry points, namely the upper, middle, and lower entry points. The intramuscular nerve terminal dense zones could be divided into the upper, middle, and lower parts, among which the middle part was the most concentrated. The “Y” and “O” convergences could be observed between the various terminal neurons. Conclusions The intramuscular nerve terminal dense zones of the pronator teres and flexor digitorum superficialis are both located in the middle part of the muscle belly. Thus, when children with cerebral palsy experience myospasms at these two muscles, the middle part of the muscle belly should be chosen as the best target area for BTX-A injection in the treatment of myospasms.
/ 脑瘫 / 旋前圆肌 / 指浅屈肌 / 肌内神经 / BTX-A
Cerebral palsy; / Pronation teres; / Flexor digitorum superficialis; / Intramuscular nerve; / BTX-A
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国家自然科学基金资助项目（31360256）；遵义医学院硕士启动基金（F-764）；遵义市红花岗区科学基全[遵红科合社字（2010）号]
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