目的 确定大圆肌肌内神经密集区中心（centers of intramuscular nerve dense regions，CINDR）的位置和标记方法。 方法 选取24具成人尸体。设计紧贴皮肤连接肩胛上角和肩峰及肩胛下角的曲线分别为横向（H）和纵向（L）参考线。改良的Sihler’s染色法显示一侧大圆肌肌内神经密集区，解剖暴露另一侧肌的肌内神经密集区相应位置，硫酸钡标记其CINDR，螺旋CT扫描确定CINDR在背部和胸部的体表投影点（P和P'点）。Syngo系统确定通过P点的垂线分别与H和L线的交点（PH和PL点）的位置和CINDR的深度。 结果 大圆肌内仅有1个肌内神经密集区，其CINDR的PH位于H线的（86.71±0.85）%处，PL位于L线的（72.07±1.08）%处。CINDR的深度位于P-P'线的（40.06±2.44）%处。 结论 这些结果可作为肌内注射肉毒毒素A阻滞大圆肌痉挛的指导依据。
Objective To localize the centers of intramuscular nerve dense region (CINDR) of teres major muscle accurately. Methods Twenty-four adult cadavers were collected. The curved lines close to skin surface connecting the superior angle of scapula and the acromion, and the inferior angle of scapula were designed as the horizontal (H) and longitudinal (L) reference lines, respectively. A modified Sihler's staining was used to show the intramuscular nerve dense region of one side teres major muscle. The corresponding position of the intramuscular nerve dense region of the other side muscle was anatomically exposed. And the CINDR was labeled with barium sulfate, and its body surface projection points（P and P'） of CINDR on the back and chest were determined by spiral computed tomography. The position of intersections（PH and PL） of point P vertical with H and L lines, and the depth of CINDR were determined by the Syngo system. Results There was only one intramuscular nerve dense region in teres major muscle. The PH of CINDR was located at (86.71±0.85) % of line H and the PL was at (72.07±1.08) % of line L. The depth of CINDR was at (40.06±2.44) % of line P-P'. Conclusions These results should be used as a guidance for intramuscular injection of botulinum toxin A to block the spasticity of teres major muscle.
[1] Mall V, Heinen F, Linder M, et al. Treatment of cerebral palsy with botulinum toxin A: functional benefit and reduction of disability. Three case reports[J]. Pediatr Rehabil, 1997, 1(4): 235-237. DOI: 10.3109/17518429709167364.
[2] Picelli A, Vallies G, Chemello E, et al. Is spasticity always the same? An observational study comparing the features of spastic equinus foot in patients with chronic stroke and multiple sclerosis[J]. J Neurol Sci, 2017, 380(Sep 15): 132-136. DOI: 10.1016/j.jns.2017.07.026.
[3] 张迪, 史凤之, 吴健, 等. 大圆肌挛缩症一例报告[J]. 中华骨科杂志, 2012, 32(4): 385. DOI: 10.3760/cma.j.issn.0253-2352.2012.04.018.
[4] Coskun Benlidayi I, Basaran S. Hemiplegic shoulder pain: a common clinical consequence of stroke[J]. Practical Neurology, 2014, 14(2): 88-91. DOI: 10.1136/practneurol-2013-000606.
[5] Decq P, Filipetti P, Feve A, et al. Peripheral selective neurotomy of the brachial plexus collateral branches for treatment of the spastic shoulder: anatomical study and clinical results in five patients[J]. J Neurosurg, 1997, 86(4): 648-653. DOI: 10.3171/jns.1997.86.4.0648.
[6] Sindou MP, Simon F, Mertens P, et al. Selective peripheral neurotomy (SPN) for spasticity in childhood[J]. Child's Nervous System, 2007, 23(9): 957-970. DOI: 10.1007/s00381-007-0399-1.
[7] García-Sánchez SF, Gómez-Galindo MT, Guzmán-Pantoja JE. Botulinum toxin A and physical therapy in gait in cerebral palsy[J]. Revista Medica Del Instituto Mexicano Del Seguro Social, 2017, 55(1): 18-24. PMID: 28092243.
[8] Michaud LJ, Louden EJ, Lippert WC, et al. Use of Botulinum toxin type A in the management of neonatal brachial plexus palsy[J]. PM&R, 2014, 6(12): 1107-1119. DOI: 10.1016/j.pmrj.2014.05.002.
[9] Ertzgaard P, Anhammer M, Forsmark A. Regional disparities in botulinum toxin A(BoNT-A) therapy for spasticity in Sweden: budgetary consequences of closing the estimated treatment gap[J]. Acta Neurol Scand, 2017, 135(3): 366-372. DOI: 10.1111/ane.12610.
[10]Tang S, Zhang MX, Yang S. Localization of center of intramuscular nerve dense regions in adult anterior brachial muscles a guide for botulinum toxin A injection to treat muscle spasticity[J]. Am J Transl Res, 2018, 10(4): 1220-1228. PMID: 29736215.
[11]Wang J, Wang Q, Zhu D, et al. Localization of the center of the intramuscular nerve dense region of the medial femoral muscles and the significance for blocking spasticity[J]. Ann Anat, 2020, 231: 151529. DOI: 10.1016/j.aanat.2020.151529.
[12]Friedman A, Diamond M, Johnston MV, et al. Effects of botulinum toxin A on upper limb spasticity in children with cerebral palsy[J]. Am J Phys Med Rehabil, 2000, 79(1): 53-59. DOI: 10.1097/00002060-200001000-00012.
[13]Jihye P, Myung C. Botulinum toxin for central neuropathic pain[J]. Toxins, 2018, 10(6): 224. DOI: 10.3390/toxins10060224.
[14] Amirali A, Mu L, Gracies JM, et al. Anatomical localization of motor endplate bands in the human biceps brachii[J]. J Clin Neuromuscul Dis, 2007, 9(2): 306-312. DOI: 10.1097/CND.0b013e31815c13a7.
[15] 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. DOI:?10.13418/j.issn.1001-165x.2017.05.002.
[16]中国康复医学会. 肉毒毒素治疗成人肢体痉挛状态中国指南(2015)[J]. 中国康复医学杂志, 2015, 30(1):81-110. DOI: 10.3969/j.issn. 1001-1242.2015.01.023.
[17]Kasapoğlu-Aksoy M, Aykurt-Karlıbel İ, Altan L. Comparison of the efficacy of intramuscular botulinum toxin type-A injection into the pectoralis major and the teres major muscles and suprascapular nerve block for hemiplegic shoulder pain: a prospective, double-blind, randomized, controlled trial[J]. Neurol Sci, 2020,41(8): 2225-2230. DOI: 10.1007/s10072-020-04334-4.
[18]Borodic GE, Ferrante R, Pearce LB, et al. Histologic assessment of dose-related dffusion and muscle fiber response after therapeutic botulinum A toxin injections[J]. Mov Disord, 1994, 9(1): 31-39. DOI:?10.1002/mds.870090106.
[19]Ghasemi M, Salari M, Khorvash F, Shaygannejad V. A literature review on the efficacy and safety of botulinum toxin: an injection in post-stroke spasticity[J]. Int J Prev Med, 2013, 4 (Suppl 2): S147-158. PMID:23776717.
京ICP备08002354号-3
