成人前臂后群肌神经入肌点定位及意义
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摘要
目的:利用螺旋CT准确定位成人前臂后群肌神经入肌点(NEP)的位置。方法:成人尸体上肢,俯卧。紧贴皮肤连接肱骨外上髁至桡骨茎突间的曲线为纵向参考线(L);肱骨外上髁与内上髁间的连线为横向参考线(H)。大体解剖暴露NEP,硫酸钡标记,螺旋CT扫描,三维重建图像。NEP在体表上的投影点定为P点,P点通过NEP后投射至前臂前面体表上的点为P'点。经P点垂于H的线、水平线与L线的交点分别记为PH和PL。Syngo系统下确定PH和PL在H和L线上的位置及NEP的深度。结果:指伸肌、小指伸肌、尺侧腕伸肌、旋后肌、拇长展肌、拇短伸肌、拇长伸肌、示指伸肌的NEP的PH分别位于H线上的54.47%、39.26%、42.5%、21.24%、42.03%、44.39%、42.65%和54.47%处,PL分别位于L线上的31.99%、35.34%、31.18%、11.47%、53.08%、51.88%、55.71%和64.75%处,穿刺深度分别位于PP'线的34.82%、34.70%、28.75%、30.87%、26.81%、24.15%、31.34%和20.69%处。结论:这些NEP的定位可为提高前臂后群肌靶点阻滞的效率与疗效提供指导。
Objective :To identify the precise location of nerve entry points(NEP) of adult posterior forearm muscles by using spiral computed tomography(CT). Methods :Twenty-four upper extremities of 12 adult cadavers were used in the prone. The curve between the lateral epicondyle of humerus and the styloid process of radius was designated as the longitudinal reference line(L),and the line between the lateral epicondyle and the medial epicondyle of humerus was designated as the horizontal reference line(H). Following dissection,NEPs were exposed and labeled with barium sulfate,and then,spiral CT scanning and 3 D reconstruction were performed. The projection points of NEP on the body surface were determined as P,P by NEP projecting on the anterior surface of the forearm was designated as P'. The intersection points through P that perpendicular to H line and the H and through P of the horizontal line and the L line were designated as PH and PL,respectively. The location of PH and PL on the H and L and the depth of NEP were measured under Syngo system. Results :The PH for the NEP of the extensor digitorum,extensor digitorum minimi,extensor carpi ulnaris,supinator,abductor pollicis longus,extensor pollicis brevis,extensor pollicis longus and extensor digitorum indicis was located at 54.47%,39.26%,42.5%,21.24%,42.03%,44.39%,42.65% and54.47% of H line,respectively,and the PL was located at 31.99%,35.34%,31.18%,11.47%,53.08%,53.08%,51.88%,55.71% and 64.75%,respectively. The puncture depth was at 34.82%,34.70%,28.75%,30.87%,26.81%,24.15%,31.34% and 20.69% of the PP' line. Conclusion :The localization of these NEP may provide guidance for improving the efficiency and efficacy of target block of forearm posterior muscles.
Objective :To identify the precise location of nerve entry points(NEP) of adult posterior forearm muscles by using spiral computed tomography(CT). Methods :Twenty-four upper extremities of 12 adult cadavers were used in the prone. The curve between the lateral epicondyle of humerus and the styloid process of radius was designated as the longitudinal reference line(L),and the line between the lateral epicondyle and the medial epicondyle of humerus was designated as the horizontal reference line(H). Following dissection,NEPs were exposed and labeled with barium sulfate,and then,spiral CT scanning and 3 D reconstruction were performed. The projection points of NEP on the body surface were determined as P,P by NEP projecting on the anterior surface of the forearm was designated as P'. The intersection points through P that perpendicular to H line and the H and through P of the horizontal line and the L line were designated as PH and PL,respectively. The location of PH and PL on the H and L and the depth of NEP were measured under Syngo system. Results :The PH for the NEP of the extensor digitorum,extensor digitorum minimi,extensor carpi ulnaris,supinator,abductor pollicis longus,extensor pollicis brevis,extensor pollicis longus and extensor digitorum indicis was located at 54.47%,39.26%,42.5%,21.24%,42.03%,44.39%,42.65% and54.47% of H line,respectively,and the PL was located at 31.99%,35.34%,31.18%,11.47%,53.08%,53.08%,51.88%,55.71% and 64.75%,respectively. The puncture depth was at 34.82%,34.70%,28.75%,30.87%,26.81%,24.15%,31.34% and 20.69% of the PP' line. Conclusion :The localization of these NEP may provide guidance for improving the efficiency and efficacy of target block of forearm posterior muscles.
引文
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[15]黄涛,刘大庸,秦建强,等.桡神经前臂各肌支的解剖学研究[J].中华骨科杂志,2002,22(3):158-160.
[16]陈士文,周晓,王文艳,等.前臂后群伸肌的神经分布及意义[J].中国临床解剖学杂志,2013,31(1):11-24.
[17]Kretschmer T,Antoniadis G,Braun V,et a1.Evaluation of iatrogenic lesions in 722 surgically treated cases of peripheral nerve trauma[J].J Neurosurg,2001,94(6):905-912.
[18]Calfee R P,Wilson J M,Wong A H.Variations in the anatomic relations of the posterior interosseous nerve associated with proximal forearm trauma[J].J Bone Joint Surg Am,2011,93(1):81-90.
[2]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.
[3]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.
[4]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.
[5]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.
[6]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.
[7]Yang S,Hu S,Li B,et al.Localization of nerve entry point and intram uscular nerve-dense regions as targets to block brachioradialis muscle spasticity[J].Int J Clin Exp Med,2017,10(8):11912-11920.
[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.
[9]Musselman K E,Manns P,Dawe J,et al.The feasibility of functional electrical stimulation to improve upper extremity function in a two-year-old child with perinatal stroke:a case report[J].Phys Occup Ther Pediatr,2018,38(1):97-112.
[10]Chiou-Tan F,Cianca J,John J,et al.Procedure oriented torsional anatomy of the forearm for spasticity injection[J].JComput Assist Tomogr,2015,39(5):820-823.
[11]Pontén E,Gantelius S,Lieber R L.Intraoperative muscle measurements reveal a relationship between contracture formation and muscle remodeling[J].Muscle Nerve,2007,36(1):47-54.
[12]薄占东,洪光祥,王发斌.尺侧腕伸肌及拇长伸肌移位重建拇指对掌功能[J].中国康复理论与实践,2003,9(12):711-712.
[13]崔岩,李均,陈波,等.尺侧腕伸肌联合拇短伸肌腱转移重建拇指对掌功能[J].中国修复重建外科杂志,2011,25(2):209-211.
[14]熊革,郑炜,孙燕琨,等.示指固有伸肌腱移位重建伸拇功能的疗效及解剖学研究[J].中国骨与关节杂志,2014,3(3):206-209.
[15]黄涛,刘大庸,秦建强,等.桡神经前臂各肌支的解剖学研究[J].中华骨科杂志,2002,22(3):158-160.
[16]陈士文,周晓,王文艳,等.前臂后群伸肌的神经分布及意义[J].中国临床解剖学杂志,2013,31(1):11-24.
[17]Kretschmer T,Antoniadis G,Braun V,et a1.Evaluation of iatrogenic lesions in 722 surgically treated cases of peripheral nerve trauma[J].J Neurosurg,2001,94(6):905-912.
[18]Calfee R P,Wilson J M,Wong A H.Variations in the anatomic relations of the posterior interosseous nerve associated with proximal forearm trauma[J].J Bone Joint Surg Am,2011,93(1):81-90.