目的 准确地定位小腿前群肌神经入肌点（NEP）的体表位置和深度。 方法 20具中国成年人尸体。设计紧贴皮肤连接股骨外上髁与腓骨外踝的曲线为纵向参考线（L），连接股骨外上髁与内上髁的曲线为横向参考线（H）。解剖暴露NEP，硫酸钡标记，螺旋CT扫描，三维重建，Syngo系统下确定NEP在体表前后的投影点（P和P'点），P点投射到L和H线上的位置（PL和PH点）及NEP的深度。 结果 胫骨前肌、长伸肌、趾长伸肌均有一个较为恒定的NEP，其中PL点分别位于L线的（23.63±2.43）%、（52.46±2.94）%和（36.07±2.99）%处；PH点分别位于体表H线上的（27.27±2.58）%、（34.41±2.38）%和（32.11±2.52）%处；深度分别位于PP'线的（45.32±3.06）%、（36.20±2.84）%和（33.72±3.18）%处。 结论 这些NEP的体表位置和深度的界定将为提高小腿前群肌痉挛肌外神经溶解术靶点定位的效率与疗效提供形态学指导。
Objective To accurately localize the body surface location and depth of nerve entry points (NEPs) of the anterior leg muscles. Methods Twenty chinese adult cadavers were used. The curved line close to skin connecting the lateral femoral epicondyle and the lateral malleolus of fibula was designed as the longitudinal reference line (L line). A curved line connecting the lateral femoral epicondyle and medial femoral epicondyle was designed as the horizontal reference line (H line). Following dissection, the NEPs were labeled with barium sulfate and then subjected to spiral computed tomography scanning and three-dimensional reconstruction. Syngo system was used to identify the projection points (points P and P') of the NEPs on anterior and posterior skin surface of the leg, the location (points PL and PH) of point P projected on the L and H lines and the depth of NEPs. Results There was a constant NEP in tibialis anterior, extensor hallucis longus and extensor digitorum longus muscles, and the points PL were located at (23.63±2.43) %, (52.46±2.94) % and (36.07±2.99) % of the L line, respectively; the points PH were at (27.27±2.58) %, (34.41±2.38) % and (32.11±2.52) % of the H line, respectively; the depth of NEPs were at (45.32±3.06)%, (36.20±2.84)% and (33.72±3.18)% of the PP' line, respectively. Conclusions The identification of the surface position and depth of these NEPs will provide morphological guidance for improving the localizing efficiency of extramuscular neurolysis and the efficacy during anterior leg muscle spasticity.
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