大圆肌的神经入肌点定位及其临床意义
Localization and clinical significance of the nerve entry point of the teres major muscle
目的 准确定位大圆肌神经入肌点（NEP）的体表位置和穿刺深度。 方法 12具中国成年人尸体。设计紧贴皮肤连接颈静脉切迹最低点至肩峰尖为横向参考线（H线）、颈静脉切迹最低点至剑胸结合处为纵向参考线（L线）。解剖暴露大圆肌NEP，涂抹硫酸钡，逐层复位缝合，CT扫描与三维重建。Syngo系统下确定大圆肌NEP的体表投影点（P）；P通过NEP投影至背部皮肤上的点为P'点；经P的垂线与H线的交点记为PH，经P的水平线与L线的交点记为PL；分别测量PH和PL在H和L线上的百分位置及NEP的百分深度。 结果 大圆肌NEP的PH位于H线的（9.59±1.24）%处，PL位于L线的（39.37±2.45）%处；NEP深度位于PP'线的（41.83±2.98）%处。 结论 这些参数可为提高大圆肌痉挛的神经阻滞效率和疗效提供指导。
Objective This study aimed to localize the body location of nerve entry point (NEP) of the teres major muscle accurately. Methods Twelve Chinese adult cadavers in the supine position were used. The lineclose to the skin that connecting the most inferior point of the jugular notch to the apex of the acromion was the horizontal reference H line and the line from the most inferior point of the jugular notch to the junction of sterna body and xiphoid process were designated as the L line longitudinal reference line L. Those cadavers were dissected to expose the NEPs of teres major muscle for marking the NEPs by barium sulfate. CT scanning and three-dimensional reconstruction were performed. The body surface projection points (P) of the NEPs were determined under Syngo system, P projected to the back skin was designated as P' point by NEP. The intersections between the vertical P and the H line, and between the horizontal P and L line were designated as PH and PL, respectively. The percentage location of PH and PL points on H line and L line and the percentage depth of NEPs were measured respectively. Results The points PH and PL of the NEP of teres major muscle were located at (9.59±1.24)% of the H line and (39.37±2.45)% of the L line, respectively. The percentage depth of NEP was located at (41.83±2.98)%. Conclusion These parameters can provide guidance for improving the efficiency and efficacy of the treatment of teres major muscle spasticity with shoulder pain after hemiplegia.
Teres major muscle / Spasticity / Nerve entry point / Localization / Spiral computed tomography
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国家自然科学基金（31540031）；贵州省科技厅联合基金(LH-2015-7528)
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