腹前外侧群肌的肌内神经分布模式
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摘要
目的揭示腹前外侧群肌的肌内神经分布模式,探讨其临床意义。方法取经甲醛固定的12具24侧中国成年尸体的腹前外侧群肌,行改良的Sihler染色。结果腹前外侧群肌的神经绝大多数源于节段性分布的胸神经。腹外斜肌各肌齿有独立的神经支配,在髂前上棘和髂结节之间的髂嵴上方有一纵向神经密集带。腹内斜肌腹股沟韧带中点上方有一纵向神经密集带,髂嵴上方有一横向神经密集带。腹横肌髂前上棘与第8、9肋软骨连结处之间有一弧形的神经密集带。腹直肌各肌腹中部有一横向神经密集带,上3个肌腹有独立神经支配。结论腹外斜肌和腹直肌可分出神经肌肉亚部;各肌内的神经密集带应被考虑为肉毒毒素A注射和局部麻醉的最佳靶点部位,不宜设为腹壁手术的切口部位。
Objective To investigate the intramuscular nerve distribution pattern of anterolateral abdominal wall muscles and to explore its clinical significance.Methods Twenty-four anterolateral abdominal wall muscles from twelve Chinese adult cadavers that were fixed with formaldehyde were removed for modified Sihler's staining.Results Most of the innervation of the anterolateral abdominal wall muscles originated from the segmental distribution of the intercostal nerve.Each muscular serration of the obliquus externus abdominis muscle had an independent innervation and there was a single longitudinal nerve dense band above the iliac crest between the anterior superior iliac spine and iliac tubercle.In the obliquus internus abdominis muscle,there was a longitudinal nerve dense band above the midpoint of the inguinal ligament and a transverse nerve dense band above the iliac crest.In the transversus abdominis muscle,there was an arched nerve dense band between the anterior superior iliac spine and the junction of the ninth and eighth costal cartilage.The rectus abdominis muscle had one transverse nerve dense band in the middle of each muscle belly and the upper 3 muscle bellies had independent innervation.Conclusion The obliquus externus abdominis and rectus abdominis muscle can be divided into neuromuscular subdivisions.The nerve dense zone in each muscle should be considered as the optimal target site for botulinum toxin A injections and local anesthesia,and it should not be designed as the incision site for abdominal wall surgery.
Objective To investigate the intramuscular nerve distribution pattern of anterolateral abdominal wall muscles and to explore its clinical significance.Methods Twenty-four anterolateral abdominal wall muscles from twelve Chinese adult cadavers that were fixed with formaldehyde were removed for modified Sihler's staining.Results Most of the innervation of the anterolateral abdominal wall muscles originated from the segmental distribution of the intercostal nerve.Each muscular serration of the obliquus externus abdominis muscle had an independent innervation and there was a single longitudinal nerve dense band above the iliac crest between the anterior superior iliac spine and iliac tubercle.In the obliquus internus abdominis muscle,there was a longitudinal nerve dense band above the midpoint of the inguinal ligament and a transverse nerve dense band above the iliac crest.In the transversus abdominis muscle,there was an arched nerve dense band between the anterior superior iliac spine and the junction of the ninth and eighth costal cartilage.The rectus abdominis muscle had one transverse nerve dense band in the middle of each muscle belly and the upper 3 muscle bellies had independent innervation.Conclusion The obliquus externus abdominis and rectus abdominis muscle can be divided into neuromuscular subdivisions.The nerve dense zone in each muscle should be considered as the optimal target site for botulinum toxin A injections and local anesthesia,and it should not be designed as the incision site for abdominal wall surgery.
引文
[1]Yang FJ,He B,Xue Q.The distribution and significance of the intramuscular nerve of rectus abdominis[J].Chinese Journal of Clinical Anatomy,2009,27(5):529-531.(in Chinese)杨方玖,何斌,薛黔.腹直肌形态与肌内神经分布研究及其临床意义[J].中国临床解剖学杂志,2009,27(5):529-531.
[2]Yu DZh,Jiang H,Dang RSh,et al.Applied anatomy of the rectus abdominis musculocutaneous flap and its intramuscular nerve distribution[J].Chinese Journal of Anatomy,30(6):777-779.(in Chinese)于大志,江华,党瑞山,等.腹直肌肌皮瓣的应用解剖及其肌内神经分布[J].解剖学杂志,2007,30(6):777-779.
[3]Yang ShB,Xue Q,Zhang Y.The distribution of intramuscular nerves in different skeletal muscles of the rabbit[J].Acta Anatomica Sinica,2005,36(4):4433-4435.(in Chinese)杨胜波,薛黔,张永.家兔不同形态骨骼肌的肌内神经分布[J].解剖学报,2005,36(4):4433-4435.
[4]Huang LY,Xue Q,Yang ShB.Intramuscular innervations pattern of the biceps femoris and location of nerve entry point to the muscle[J].Anatomy Research,2004,26(4):284-285.(in Chinese)黄燎原,薛黔,杨胜波.人股二头肌肌内神经分布和神经入肌点定位[J].解剖学研究,2004,26(4):284-285.
[5]Galvas PE,Gonyea WJ.Motor-end-plate and nerve distribution in a histochemically compartmentalized pennate muscle in the cat[J].Am J Anat,1980,159(2):147-156.
[6]Liu AT,Liu BL,Lu LX,et al.Architectural properties of the neuromuscular compartments in selected forearm skeletal muscles[J].J Anat,2014,225(1):12-18.
[7]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.
[8]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.
[9]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.
[10]Mao BY,Gai WB,Niu JD,et al.Combined use of musculus rectus abdominis and ilio-tibial band for the reconstruction of functions of flexor of the hip and quadriceps femoris[J].Chinese Journal of Surgery,1985,23(8):485-487.(in Chinese)毛宾尧,盖维缤,牛家度,等.腹直肌髂胫束联合重建屈髋肌和股四头肌功能[J].中华外科杂志,1985,23(8):485-487.
[11]Lisiecki J,Kozlow JH,Agarwal S,et al.Abdominal wall dynamics after component separation hernia repair[J].J Surg Res,2015,193(1):497-503.
[12]Suzuki Y,Yokoyama K,Terao M,et al.Pyoderma gangrenosum after breast mastectomy and primary rectus abdominis flap reconstruction[J].Tokai J Exp Clin Med,2017,42(3):133-138.
[13]Jian DL,Wu ZY,Zhang JJ,et al.Postoperative pain relief by bupicaraine in the rectus sheaf of cholecystectomized patients[J].Journal of Practical Medical Techniques,2004,11(5B):768-769.(in Chinese)简道林,吴遵元,张家骏,等.腹直鞘内注入局麻药用于胆囊切除术后镇痛[J].实用医技杂志,2004,11(5B):768-769.
[14]BelokonevⅥ,Volova LT,Ponomareva IuV,et al.Clinical and morphologic aspects of surgery choice by postoperative anterolateral and lateral ventral hernias[J].Khirurgiia(Mosk),2011,(9):60-63.
[15]Yang ShB,Xue Q,Zhang Y,et al.Study on muscular architecture and distributions of intramuscular nerves and motor endplates of the biceps brachii in rabbit[J].Journal of Zunyi Medical University,2003,26(4):316-318.(in Chinese)杨胜波,薛黔,张永,等.家兔肱二头肌的肌构筑、肌内神经和运动终板分布[J].遵义医学院学报,2003,26(4):316-318.
[16]Martinez RM.Efficacy of Cerebrolysin in the reduction of spasticity during stroke rehabilitation[J].J Med Life,2017,10(3):161-166.
[17]Zhang HY,Ma QR,Zhang Y,er al.Neural protective action of astragalus injection in intracerebral hemorrhage rats[J].Acta Anatomica Sinica,2010,41(3):353-357.(in Chinese)张海宇,马全瑞,张焱,等.黄芪注射液对大鼠脑出血后神经的保护作用[J].解剖学报,2010,41(3):353-357.
[18]Unger M,Jelsma J,Stark C.Effect of a trunk-targeted intervention using vibration on posture and gait in children with spastic type cerebral palsy:a randomized control trial[J].Dev Neurorehabil,2013,16(2):79-88.
[19]Shterenberg VE.State of the anterior abdominal wall in children with various forms of infantile cerebral palsy according to electrophysiological findings[J].Pediatria,1984,(8):37-38.
[20]Li J,Zhang R,Cui BL,et al.Therapeutic efficacy and safety of various botulinum toxin A doses and concentrations in spastic foot after stroke:a randomized controlled trial[J].Neural Regen Res,2017,12(9):1451-1457.
[2]Yu DZh,Jiang H,Dang RSh,et al.Applied anatomy of the rectus abdominis musculocutaneous flap and its intramuscular nerve distribution[J].Chinese Journal of Anatomy,30(6):777-779.(in Chinese)于大志,江华,党瑞山,等.腹直肌肌皮瓣的应用解剖及其肌内神经分布[J].解剖学杂志,2007,30(6):777-779.
[3]Yang ShB,Xue Q,Zhang Y.The distribution of intramuscular nerves in different skeletal muscles of the rabbit[J].Acta Anatomica Sinica,2005,36(4):4433-4435.(in Chinese)杨胜波,薛黔,张永.家兔不同形态骨骼肌的肌内神经分布[J].解剖学报,2005,36(4):4433-4435.
[4]Huang LY,Xue Q,Yang ShB.Intramuscular innervations pattern of the biceps femoris and location of nerve entry point to the muscle[J].Anatomy Research,2004,26(4):284-285.(in Chinese)黄燎原,薛黔,杨胜波.人股二头肌肌内神经分布和神经入肌点定位[J].解剖学研究,2004,26(4):284-285.
[5]Galvas PE,Gonyea WJ.Motor-end-plate and nerve distribution in a histochemically compartmentalized pennate muscle in the cat[J].Am J Anat,1980,159(2):147-156.
[6]Liu AT,Liu BL,Lu LX,et al.Architectural properties of the neuromuscular compartments in selected forearm skeletal muscles[J].J Anat,2014,225(1):12-18.
[7]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.
[8]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.
[9]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.
[10]Mao BY,Gai WB,Niu JD,et al.Combined use of musculus rectus abdominis and ilio-tibial band for the reconstruction of functions of flexor of the hip and quadriceps femoris[J].Chinese Journal of Surgery,1985,23(8):485-487.(in Chinese)毛宾尧,盖维缤,牛家度,等.腹直肌髂胫束联合重建屈髋肌和股四头肌功能[J].中华外科杂志,1985,23(8):485-487.
[11]Lisiecki J,Kozlow JH,Agarwal S,et al.Abdominal wall dynamics after component separation hernia repair[J].J Surg Res,2015,193(1):497-503.
[12]Suzuki Y,Yokoyama K,Terao M,et al.Pyoderma gangrenosum after breast mastectomy and primary rectus abdominis flap reconstruction[J].Tokai J Exp Clin Med,2017,42(3):133-138.
[13]Jian DL,Wu ZY,Zhang JJ,et al.Postoperative pain relief by bupicaraine in the rectus sheaf of cholecystectomized patients[J].Journal of Practical Medical Techniques,2004,11(5B):768-769.(in Chinese)简道林,吴遵元,张家骏,等.腹直鞘内注入局麻药用于胆囊切除术后镇痛[J].实用医技杂志,2004,11(5B):768-769.
[14]BelokonevⅥ,Volova LT,Ponomareva IuV,et al.Clinical and morphologic aspects of surgery choice by postoperative anterolateral and lateral ventral hernias[J].Khirurgiia(Mosk),2011,(9):60-63.
[15]Yang ShB,Xue Q,Zhang Y,et al.Study on muscular architecture and distributions of intramuscular nerves and motor endplates of the biceps brachii in rabbit[J].Journal of Zunyi Medical University,2003,26(4):316-318.(in Chinese)杨胜波,薛黔,张永,等.家兔肱二头肌的肌构筑、肌内神经和运动终板分布[J].遵义医学院学报,2003,26(4):316-318.
[16]Martinez RM.Efficacy of Cerebrolysin in the reduction of spasticity during stroke rehabilitation[J].J Med Life,2017,10(3):161-166.
[17]Zhang HY,Ma QR,Zhang Y,er al.Neural protective action of astragalus injection in intracerebral hemorrhage rats[J].Acta Anatomica Sinica,2010,41(3):353-357.(in Chinese)张海宇,马全瑞,张焱,等.黄芪注射液对大鼠脑出血后神经的保护作用[J].解剖学报,2010,41(3):353-357.
[18]Unger M,Jelsma J,Stark C.Effect of a trunk-targeted intervention using vibration on posture and gait in children with spastic type cerebral palsy:a randomized control trial[J].Dev Neurorehabil,2013,16(2):79-88.
[19]Shterenberg VE.State of the anterior abdominal wall in children with various forms of infantile cerebral palsy according to electrophysiological findings[J].Pediatria,1984,(8):37-38.
[20]Li J,Zhang R,Cui BL,et al.Therapeutic efficacy and safety of various botulinum toxin A doses and concentrations in spastic foot after stroke:a randomized controlled trial[J].Neural Regen Res,2017,12(9):1451-1457.