利用神经入肌点和肌内神经密集区中心定位成人背阔肌痉挛的阻滞靶点
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摘要
目的准确定位背阔肌神经入肌点(NEP)和肌内神经密集区中心(CINDR)的位置。方法将12具成人尸体颈静脉切迹至剑胸接合处,腋前线至腋后线之间的体表曲线分别设为NEP的纵向参考线(L1)和横向参考线(H1);肩胛冈内、外侧端间的体表曲线为CINDR的横向参考线(H2),通过CINDR体表投影点连接H2与髂嵴之间的曲线为CINDR的纵向参考线(L2)。Sihler′s染色显示CINDR。硫酸钡标记NEP和CINDR,CT扫描。结果经过NEP的体表投影点的垂线和水平线分别相交于H1和L1的(74.01±3.43)%和(30.41±3.19)%处,NEP深度为(1.28±0.35)cm;背阔肌有2个CINDR,分别投影于H2的(57.50±3.16)%和(15.03±2.76)%、L2的(36.68±3.14)%和(47.89±2.88)%处,深度分别为(1.91±0.38)和(1.85±0.41)cm。结论界定的这些位置应为背阔肌痉挛肌内和肌外神经阻滞术的最佳靶点部位。
Objective To accurately position the location of the nerve entry point(NEP)and intramuscular nerve dense region(CINDR)center of latissimus dorsi muscle.Methods In 12 adult cadavers,the body surface curved lines between the jugular notch and the junction of sternal body and xiphoid process,and the anterior axillary line and the posterior axillary line were designated as the longitudinal reference line(L1)and the horizontal reference line(H1)of NEP,respectively.The body surface curved line between the medial and the lateral end of the mesoscapula was designated as the horizontal reference line(H2)of CINDR,and the curved line joining H2 line and crista iliaca was designated as the longitudinal reference line(L2)through the body surface projection point of the CINDR.CINDR was showed by the Sihler′s staining,NEP and CINDR were labeled with barium sulfate and scanned with spiral computed tomography(CT).Results The vertical and horizontal lines through the body surface projection point of NEP were intersected at(74.01±3.43)%of H1 line and(30.41±0.38)% of L1 line,respectively,the NEP depth was(1.28±0.35)cm;there were 2 CINDRs in the latissimus dorsi,which had projections at(57.50±3.16)%and(15.03±2.76)%of H2 line,and at(36.68±3.14)%and(47.89±2.88)%of L2 line,the depths were(1.91±3.19)cm and(1.85±0.41)cm,respectively.Conclusion These defined locations should be the optimal target spot sites for intramuscular and extramuscular nerve block of latissimus dorsi muscle spasticity.
Objective To accurately position the location of the nerve entry point(NEP)and intramuscular nerve dense region(CINDR)center of latissimus dorsi muscle.Methods In 12 adult cadavers,the body surface curved lines between the jugular notch and the junction of sternal body and xiphoid process,and the anterior axillary line and the posterior axillary line were designated as the longitudinal reference line(L1)and the horizontal reference line(H1)of NEP,respectively.The body surface curved line between the medial and the lateral end of the mesoscapula was designated as the horizontal reference line(H2)of CINDR,and the curved line joining H2 line and crista iliaca was designated as the longitudinal reference line(L2)through the body surface projection point of the CINDR.CINDR was showed by the Sihler′s staining,NEP and CINDR were labeled with barium sulfate and scanned with spiral computed tomography(CT).Results The vertical and horizontal lines through the body surface projection point of NEP were intersected at(74.01±3.43)%of H1 line and(30.41±0.38)% of L1 line,respectively,the NEP depth was(1.28±0.35)cm;there were 2 CINDRs in the latissimus dorsi,which had projections at(57.50±3.16)%and(15.03±2.76)%of H2 line,and at(36.68±3.14)%and(47.89±2.88)%of L2 line,the depths were(1.91±3.19)cm and(1.85±0.41)cm,respectively.Conclusion These defined locations should be the optimal target spot sites for intramuscular and extramuscular nerve block of latissimus dorsi muscle spasticity.
引文
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[4]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.
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[7]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.
[8]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):482-485,490.
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[11]WONG M T,LIM A Y,CONINCK C D,et al.Functional units within the latissimus dorsi muscle based on Sihler technique[J].Ann Plast Surg,2007,59(2):152-155.
[12]杨方玖,薛黔.人背阔肌肌内神经分布和肌构筑特征及其临床意义[J].中国临床解剖学杂志,2005,23(5):501-503,506.
[13]YANG S B,HU S J,TIAN X F,et al.A novel method for localizing nerve entry points during spasticity treatment[J].Int J Morphol,2017,35(3):799-803.
[14]SERUYA M,JOHNSON J D.Surgical treatment of pediatric upper limb spasticity:the shoulder[J].Semin Plast Surg,2016,30(1):45-50.
[15]NAMDARI S,ALOSH H,BALDWIN K,et al.Outcomes of tendon fractional lengthenings to improve shoulder function in patients with spastic hemiparesis[J].J Shoulder Elbow Surg,2012,21(5):691-698.
[16]毛雅君,励建安.神经阻滞定位方法和临床应用[J].中华物理医学与康复杂志,2011,33(10):795-798.
[17]FRANZ A,KLAAS J,SCHUMANN M,et al.Anatomical versus functional motor points of selected upper body muscles[J].Muscle Nerve,2018,57(3):460-465.
[18]SNOBL D,BINAGHI L E,ZENKER W.Microarchitecture and innervation of the human latissimus dorsi muscle[J].J Reconstr Microsurg,1998,14(3):171-177.
[19]CHANG MA.Possible Adverse Effects of Repeated Botulinum Toxin A Injections to Decrease Post-Stroke Spasticity in Adults Undergoing Rehabilitation:A Review of the Literature[J].Allied Health,2015,44(3):140-144.
[20]LORENCE Z P,KENKEL J M,FAGIEN S,et al.A review of onabotulinumtoxinA(Botox)[J].Aesthet Surg,2013,33(1Suppl):9-12.
[21]BORODIC G E,FERRANTE R,PEARCE L B,et al.Histologic assessment of dose-related diffusion and muscle fiber response after therapeutic botulinum A toxin injections[J].Mov Disord,1994,9(1):31-39.
[22]中国康复医学会.肉毒毒索治疗成人肢体肌痉挛中国指南[J].中国康复医学杂志,2015,30(1):11-81.
[2]FRIGON A,THIBAUDIER Y,JOHNSON M D,et al.Cutaneous inputs from the back abolish locomotor-like activity and reduce spastic-like activity in the adult cat following complete spinal cord injury[J].Exp Neurol,2012,235(2):588-598.
[3]HU S Y,ZHUO L F,ZHANG X M,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.
[4]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.
[5]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.
[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]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.
[8]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):482-485,490.
[9]YANG S B,HU S Y,LI B G,et al.Localization of nerve entry point and intramuscular nerve-dense regions as targets to block brachioradialis muscle spasticity[J].Int JClin Exp Med,2017,10(8):11912-11920.
[10]杨方玖,薛黔,刘茂生.背阔肌的神经解剖及其临床意义[J].解剖与临床,2006,11(4):226-228.
[11]WONG M T,LIM A Y,CONINCK C D,et al.Functional units within the latissimus dorsi muscle based on Sihler technique[J].Ann Plast Surg,2007,59(2):152-155.
[12]杨方玖,薛黔.人背阔肌肌内神经分布和肌构筑特征及其临床意义[J].中国临床解剖学杂志,2005,23(5):501-503,506.
[13]YANG S B,HU S J,TIAN X F,et al.A novel method for localizing nerve entry points during spasticity treatment[J].Int J Morphol,2017,35(3):799-803.
[14]SERUYA M,JOHNSON J D.Surgical treatment of pediatric upper limb spasticity:the shoulder[J].Semin Plast Surg,2016,30(1):45-50.
[15]NAMDARI S,ALOSH H,BALDWIN K,et al.Outcomes of tendon fractional lengthenings to improve shoulder function in patients with spastic hemiparesis[J].J Shoulder Elbow Surg,2012,21(5):691-698.
[16]毛雅君,励建安.神经阻滞定位方法和临床应用[J].中华物理医学与康复杂志,2011,33(10):795-798.
[17]FRANZ A,KLAAS J,SCHUMANN M,et al.Anatomical versus functional motor points of selected upper body muscles[J].Muscle Nerve,2018,57(3):460-465.
[18]SNOBL D,BINAGHI L E,ZENKER W.Microarchitecture and innervation of the human latissimus dorsi muscle[J].J Reconstr Microsurg,1998,14(3):171-177.
[19]CHANG MA.Possible Adverse Effects of Repeated Botulinum Toxin A Injections to Decrease Post-Stroke Spasticity in Adults Undergoing Rehabilitation:A Review of the Literature[J].Allied Health,2015,44(3):140-144.
[20]LORENCE Z P,KENKEL J M,FAGIEN S,et al.A review of onabotulinumtoxinA(Botox)[J].Aesthet Surg,2013,33(1Suppl):9-12.
[21]BORODIC G E,FERRANTE R,PEARCE L B,et al.Histologic assessment of dose-related diffusion and muscle fiber response after therapeutic botulinum A toxin injections[J].Mov Disord,1994,9(1):31-39.
[22]中国康复医学会.肉毒毒索治疗成人肢体肌痉挛中国指南[J].中国康复医学杂志,2015,30(1):11-81.