小腿外侧群肌神经入肌点和肌梭丰度最高区中心的定位及其意义
Localization and significance of the nerve entry points and the center of the highest region of the muscle spindle abundance in the lateral muscle group of leg
目的 准确定位小腿外侧群肌的神经入肌点（NEP）和肌梭丰度最高区中心（CHRMSA）的位置。 方法 12具成人尸体，侧卧。经皮肤连接股骨外上髁与内上髁和股骨外上髁与外踝的连线分别为横向参考线（H）和纵向参考线（L）。解剖暴露NEP；Sihler's染色显示肌内神经分支密集区；HE染色肌梭，计算肌梭丰度；硫酸钡标记NEP和CHRMSA，CT扫描。NEP在体表的投影点为P，P通过NEP后投射至相反侧皮肤上的点为P'，经P的垂线与H线、水平线与L线的交点分别记为PH 和PL，确定PH和PL在H和L线上的百分位置及NEP的深度。 结果 腓骨长、短肌的NEP的PH分别位于H线的13.41%和10.35%处，PL分别位于L线的21.81%和52.6%处；深度分别位于PP'线的50.89%和25.7%处。腓骨长、短肌的CHRMSA的PH分别位于H线的14.45%和12.86%处，PL分别位于L线的35.11%和71.49%处；深度分别位于PP'线的18.16%和20.40%处。 结论 这些结果可为小腿外侧群肌痉挛治疗中准确定位阻滞靶点提供解剖学指导。
Objective To localize the location of the nerve entry points (NEPs) and the center of the highest region of the muscle spindle abundance (CHRMSA) in the lateral muscle group of the leg. Methods Twelve adult cadavers were placed in a side-lying position. The curved lines on skin surface joining the lateral epicondyle and the medial epicondyle of the femur and the lateral epicondyle of the femur and lateral malleolus of the fibula were respectively defined as the horizontal reference line (H) and the longitudinal reference line (L). Cadavers were dissected to expose NEPs; Sihler 's staining was adopted for showing the intramuscular nerve dense regions; HE staining was performed for demonstrate muscle spindles in order to calculate their abundance; barium sulfate was used to label the NEPs and CHRMSAs, and then CT scan. The body surface projection point of the NEP was designated as P, whereas the projection in the opposite direction across the transverse plane was designated as P'. The intersection between the vertical line and line H, and that between the horizontal line and line L through P were designated as PH and PL, respectively. The percentage location of PH and PL on the line H and line L and depth of NEP were determined. Results The PH and PL of the NEP of peroneus longus and peroneus brevis muscles were located at 13.14% and 10.35% of line H and 21.81% and 52.6% of line L, respectively. The depth of NEP was at 50.89% and 25.7% of line PP', respectively. The PH of the CHRMSA of the peroneus longus and peroneus brevis muscles were located at 14.45% and 12.86% of the line H and the PL is at 35.11% and 71.49% of the line L, respectively. The depth were at 18.16% and 20.40% of the line PP', respectively. Conclusion These results should provide an anatomical guidance for accurately localizing the block targets in treatment of spasticity in the lateral muscles.
/ 小腿外侧群肌 / 肌痉挛 / 神经入肌点 / 肌内神经密集区 / 肌梭丰度
Lateral leg muscle / Spasticity; Nerve entry point; Intramuscular nerve dense regions / Muscle spindle abundance
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国家自然科学基金（31660294，31540031）；贵州省卫计委基金(gzwjkj2015-1-044)；贵州省教育厅大学生创新项目（2016-13653001）
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