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

doi:10.13418/j.issn.1001-165x.2018.02.001

中国临床解剖学杂志 ›› 2018, Vol. 36 ›› Issue (2): 121-126.doi: 10.13418/j.issn.1001-165x.2018.02.001

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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

卓立凡¹，　胡帅宇²，　潘艳梅¹，　柯志腾¹，　杨胜波²

1. 遵义医学院2013级临床医学系；　2. 遵义医学院人体解剖学教研室，贵州遵义 563099

收稿日期:2018-02-11 出版日期:2018-03-25 发布日期:2018-05-04
通讯作者: 杨胜波，教授，硕士生导师，E-mail: yangshengbo8205 486@163.com
作者简介:卓立凡（1994-），Tel：15285986192，E-mail: zhuolifany @163.com
基金资助:
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）

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

ZHUO Li-fan¹， HU Shuai-yu²，PAN Yan-mei¹，KE Zhi-teng¹，YANG Sheng-bo²

1.Department of Clinical Medicine，Grade 2013, Zunyi Medical College; 2. Department of Anatomy，Zunyi Medical College，Zunyi 563099，Guizhou, China

Received:2018-02-11 Online:2018-03-25 Published:2018-05-04

摘要/Abstract

摘要：

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。

关键词: , 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

Abstract:

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.

Key words: Lateral leg muscle, Spasticity;　Nerve entry point;　Intramuscular nerve dense regions, Muscle spindle abundance

卓立凡,胡帅宇,潘艳梅,柯志腾,杨胜波. 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[J]. 中国临床解剖学杂志, 2018, 36(2): 121-126.

ZHUO Li-fan,HU Shuai-yu, PAN Yan-mei, KE Zhi-teng, YANG Sheng-bo. 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[J]. Chinese Journal Of Clinical Anatomy, 2018, 36(2): 121-126.

参考文献

[1] Ding X, Huang L, Wang Q, et al. Clinical study of botulinum toxin A injection combined with spasmodic muscle therapeutic instrument on lower limbspasticity in patients with stroke[J]. Exp Ther Med, 2017, 13(6):3319-3326.
[2] Hu S, Zhuo L, Zhang X, et al. Localization of nerve entry points as targets to block spasticity of the deep posterior compartment muscles of the leg[J]. Clin Anat, 2017, 30(7): 855-860.
[3] Santamato A, Micello MF, Panza F, et al. Safety and efficacy of incobotulinum toxin type A (NT 201-Xeomin) for the treatment of post-stroke lower limb spasticity:a prospective open-label study[J]. Eur J Phys Rehabil Med, 2013, 49(4):483-489.
[4] Yang S, Hu S, Tian X, et al. A novel method for localizing nerve entry points during spasticity treatment[J]. Int J Morphol, 2017, 35(3):805-809.
[5] Yang S, Hu S, Li B, et al. Localization of nerve entry point and intramuscular nerve-dense regions as targets to block brachioradialis muscle spasticity[J]. Int J Clin Exp Med, 2017, 10(8):11912-11920.
[6] 王猛，王国亚，杨胜波. 大圆肌的神经入肌点定位及其临床意义[J]. 中国临床解剖学杂志，2017，35(5): 486-489.
[7] 胡帅宇，卓立凡，杨胜波. 利用神经入肌点定位小腿三头肌痉挛的神经阻滞靶点[J]. 中国临床解剖学杂志，2017，35(1):15-18.
[8] 唐少华，胡勇，杨胜波. 臂前群肌神经入肌点的定位[J]. 解剖学杂志，2017，40(2): 181-185.
[9] 袁欣欣，杨胜波. 肱三头肌神经入肌点的定位[J]. 遵义医学院学报，2017，40(5): 522-525.
[10] 刘立梅，胡帅宇，杨胜波. 为成人鱼际肌痉挛化学神经溶解术作神经入肌点定位研究[J]. 遵义医学院学报，2017，40(5):482-485.
[11] Amirali A, Mu L, Gracies J M, et al. Anatomical localization of motor endplate bands in the human biceps brachii[J]. J Clin Neuromuscul Dis, 2007, 9(2): 306-312.
[12] 杨胜波，李季蓉，薛黔. 家兔跖肌肌内神经、运动终板及肌梭的分布[J]. 解剖学杂志，2005，28(1):79-81.
[13] Xie P, Jiang Y, Zhang X, et al. The study of intramuscular nerve distribution patterns and relative spindle abundance of the thenar and hypothenar muscles in human hand[J]. PLoS One, 2012, 7(12):e51538.
[14] Phadke C P, On A Y, Kirazli Y, et al. Intrafusal effects of botulinum toxin injections for spasticity: revisiting a previous paper[J]. Neurosci Lett, 2013, 541: 20-23.
[15] Lee J H, Lee B N, An X, et al. Anatomic localization of motor entry point of superficial peroneal nerve to peroneus longus and brevis muscles[J]. Clin Anat, 2011, 24(2): 232-6.
[16]王伟. 肌梭的形态学研究进展[J]. 中国临床解剖学杂志，1997，15(1):73-75.
[17] Banks R W. An allometric analysis of the number of muscle spindles in mammalian skeletal muscles[J]. Journal of anatomy, 2006, 208(6):753-768.
[18]Simpson D W, Gracies J M, Yablon S A, et al. Botulinum neurotoxin versus tizanidine in upper limb spasticity: a placebo-controlled study[J]. J Neurol Neurosurg psychiatry, 2009, 80(4): 380-385.
[19] Yang E J, Rha D, Yoo Y J, et al. Accuracy of manual needle placement for gastrocnemius muscle in children with cerebral palsy checked against ultrasonography[J]. Arch Phys Med Rehabil, 2009, 90(5): 741-744.
[20]Kawashima N, Popovic M R, Zivanovic V. Effect of intensive functional electrical stimulation therapy on upper-limb motor recovery after stroke: case study of a patient with chronic stroke[J]. Physiother Can, 2013, 65(1): 20-28.
[21] 段显亮，赵世伟，李炳万，等. 腓浅神经运动支的应用解剖学研究[J].中国民康医学，2014，26(24): 1-3.
[22] 杨文，邓鹏燕，李远兵，等. 腓骨长肌、腓骨短肌的肌腹与神经入肌点定位[J]. 四川解剖学杂志，2013，21(4): 9-11.

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

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