肌肉亚部移植在阴茎再造勃起功能重建中的应用
|
摘要
阴茎再造手术被广泛应用于治疗阴茎缺损、先天性性别畸形,以及女性易性病患者,具有重大的意义。当前,医学界在重塑阴茎外形、确保皮瓣存活与尿路通畅、植入支撑物获取硬度、甚至重建阴茎感觉功能等方面,均已形成比较成熟的临床治疗共识。但是,对于模拟阴茎在主观意识的控制下的勃起功能重建,其研究进展却相对滞后。为了克服依赖人工膨胀式假体可能出现的不良反应,并避免患者对纯外力依赖的勃起发动机制可能产生的心理阴影,帮助其实现主观自控的阴茎勃起发动过程,本实验采用保留神经支配、具备收缩功能的肌瓣移植来重建再造阴茎的勃起功能。
长期以来,股薄肌因其解剖学特点及切除后对供区功能影响较小,已成为临床上常用的肌(皮)瓣,广泛应用于组织缺损修复与器官功能重建。1972年,Orticochea曾报道了1例利用股薄肌肌皮瓣再造阴茎的手术,术后通过股薄肌主动收缩,再造阴茎在假体支撑下较好地模拟了阴茎的勃起发动过程。然而,该手术操作复杂、疗程长,术后再造阴茎外观臃肿,影响了该术式的推广。当前,显微外科技术与皮瓣预制技术不断发展,手术操作大大简化,缩短了手术进程。而肌肉亚部化概念的提出与相应研究成果又为避免再造阴茎臃肿的外观带来希望,股薄肌的节段性应用已逐渐成为一种趋势。为了找到在改善术后外观与保留肌肉收缩功能之间的最佳平衡点,有必要进一步加深相关的解剖学与生理学研究。
[研究目的]
研究兔股薄肌肌内的神经支配与血管分布的解剖学特征,寻找能将其安全、简便地完全劈开的具体方式,构建应用节段性股薄肌肌皮瓣移植再造阴茎重建勃起功能的合适的动物模型,兼顾改善术后外观与保留肌肉收缩功能的手术要求。
[研究方法]
1、应用改良的Sihler's肌内神经染色与乳胶血管灌注显色技术,研究兔股薄肌肌内神经支配与血管分布的解剖学特征。
2、依照解剖学研究的结果,按照肌亚部的原则,将兔股薄肌近似二等分纵向完全劈开。应用HE染色观察术后肌束横断面的整体形态、Masson三色染色观察肌束内部发生结缔组织纤维化的程度、EnVision法检测肌细胞的增殖情况、TUNEL法检测肌细胞的凋亡情况、Western Blot检测肌内细胞增殖水平的动态变化；并运用多道生理信号采集处理系统同步检测劈开后肌束的等长收缩肌力与复合肌肉动作电位(CMAP)。
3、构建应用节段性股薄肌肌皮瓣再造阴茎重建勃起功能的动物模型,并观测人为刺激肌束支配神经后再造阴茎的形态变化与CMAP。
[实验结果]
1、肌内神经染色与血管灌注显示：兔股薄肌的支配神经入肌后,各一级分支大体上相互平行由近端走向远端,基本上都有相应的血管分支伴行,不同来源的营养血管形成肌内丰富的吻合网。前部1/3-1/2肌肉的血供主要来自股动脉的分支,受股薄肌前侧的3支一级神经分支支配,后部1/2-2/3肌肉的血供主要依赖股深动脉的分支,其神经支配来自股薄肌支配神经后侧的2-3支一级分支。
2、HE染色显示肌肉劈开后初期,肌束可发生较明显的水肿；Masson三色染色显示此时肌内纤维结缔组织增生活跃；增殖细胞核抗原(PCNA)的免疫组化检测与TUNEL法细胞凋亡检测显示肌纤维细胞与结缔组织细胞增殖、凋亡均较活跃,而凋亡更多发生于间质细胞内；肌束代偿性的肥大,两部分肌束湿重的总和增加。随术后时间延长,HE染色显示水肿逐渐消退；PCNA与TUNEL检测显示肌纤维与间质细胞的增殖均逐渐减弱,纤维结缔组织中凋亡阳性核的检出率更多,这与Masson三色染色所反映的肌内增生纤维结缔组织减少、比重下降之表现一致；肌束湿重的总和降低至接近术前水平。Western Blot检测显示肌细胞PCNA的表达水平也随术后时间延长逐步下降,并提示将兔股薄肌纵向劈开的手术干预对肌内细胞增殖的影响很小。
3、在近似二等分纵向完全劈开兔股薄肌,应用前部肌束构建的相关动物模型中：通过电刺激支配神经直至肌束发生强直收缩,植入支撑假体的初步模型可模拟阴茎勃起时的位置变化；单纯肌束构型的初步模型可模拟阴茎勃起时的硬度变化；而有表面皮肤包被并植入银丝电极的完整模型能比较理想地模拟阴茎勃起发动时的形态变化。
[结论]
1、兔股薄肌肌内神经与血管的分布情况得以清晰、直观地显示,发现其肌内神经大体上相互平行由近端走向远端,各神经分支基本上都有相应的血管伴行,根据血供与神经支配的特点,肌肉的前、后两部分可以分为相对独立的亚单位结构。
2、依据肌亚部原则,近似二等分纵向完全劈开兔股薄肌的手术操作不会明显影响肌束的长期存活；股薄肌分成两部分后,肌束各自的收缩功能也都能得到保留。
3、按上述方式劈开兔股薄肌,选用前部肌束进行恰当构型、植入硅胶支撑假体以制备阴茎再造勃起功能重建的动物模型,通过刺激再造阴茎根部的银丝电极/支配神经可以引起肌束收缩,并使再造阴茎的形态发生改变,比较满意地模拟了正常阴茎的勃起过程。
4、在按上述方法构建的再造阴茎勃起功能重建的动物模型中,能够观察到受动物自主控制的肌肉收缩与再造阴茎的阵发性持续抖动,充分体现了构建模型的手术方式的可行性,并佐证了兔股薄肌肌亚部划分的正确性。
本实验是对股薄肌肌亚部的解剖学与生理学基础研究的补充,构建了比较理想的具备勃起功能的再造阴茎动物模型,达到了兼顾外观与功能的预期实验目的,为临床上进一步改良阴茎再造的手术方法提供了理论基础,也可为临床上应用节段性的股薄肌肌皮瓣移植整复面瘫、重建舌功能等手术提供相应的方法借鉴。
Penis reconstruction surgery is widely used in the treatment of penile defects, congenital malformations of gender, and female to male sexually transmitted diseases, which is of great significance. Currently, doctors have formed a standardized clinical consensus in remodeling penis shape, ensuring flap survival and urinary tract unobstructed, implanting supportive structures for stiffness, and even the reconstruction of penile sensitivity, etc. However, the progress on simulating the situation from weakness to firmness when penis erectile happens under the patients' subjective control has relatively lagged behind. In order to overcome the possible complications of artificial expansive implants, and to avoid the psychological shadow may happened in some patients for a erection initiating mechanism purely depending on an external force, we plan to use the innerved muscle transplantation to reconstruct the erectile function of penis.
Gracilis has become a commonly used donor muscle for tissue defects and functional organ reconstruction, based on its anatomical characteristics and limited leg functional impact after its resection. In 1972, Orticochea reported a musculocutaneous gracilis transplanting surgery for penile reconstruction. Postoperatively, the reconstructive penis could move voluntarily when the initiative gracilis contraction happened. But the complicated surgical operation, rather long surgical duration, and the significantly overstaffed penis appearance had greatly affected the promotion of this surgical procedure. Recently, the progress on microsurgical techniques and flap prefabricating techniques makes it possible to simplify and shorten the surgical process. And the concept of muscle compartmentalization and its corresponding research achievements have brought hope to improve the overstaffed appearance of reconstructive penis at the same time. Yet, segmental flap application has also become a trend in musculocutaneous gracilis transplantation. In order to find the best balance between improving postoperative appearance and retaining muscle's contractive function, it is necessary to promote the anatomic and physiologic studies on gracilis.
[Objective]
Study the intramuscular nerve branches'and blood vessels'distribution of rabbit gracilis muscle and find a specific safe, simple way to split it completely. Build a suitable animal model for the reconstruction of penile erectile function with segmental gracilis flap transplantation, which can meet the requirements of both improving postoperative reconstructive penis's appearance and retaining muscle's contractive function.
[Methods]
1. Using a modified Sihler's intramuscular neural staining and red latex vascular perfusion technique to study the intramuscular nerve branches'and blood vessels' distribution of rabbit gracilis muscle.
2. According to the principles of muscle compartmentalization, vertically split the rabbit gracilis muscle into two approximately equal halves completely. Observe the overall postoperative situation of muscle bundles'cross-section with HE staining technique. Observe the connective tissue's fibrosis occurred within the split muscle bundles with Masson's three-color staining technique. Detect the proliferation of muscle cells with En Vision immunohistochemical technology. Detect the apoptosis of muscle cells with TUNEL. Detect the dynamic level of muscle cell's proliferation with Western Blot. And using a multi-channel physiological signal acquisition and processing system to measure the isometric contraction forces and CMAP of muscle bundles synchronously.
3. Build an animal model for the reconstruction of penile erectile function with segmental gracilis flap transplantation. Observe and record the morphologic changes and CMAP of the reconstructive penis when its nerve is electric stimulated.
[Results]
1. The intramuscular nerve primary branches of rabbit gracilis are generally parallel to each other and most of them are accompanied by a corresponding vessel branch. The blood vessels from different sources form an abundant microcirculation network through intramuscular vessel branches. The anterior 1/3-1/2 portion of the muscle is supplied by a branch of femoral artery and under the control of the anterior 3 primary nerve branches. While the posterior 1/2-2/3 portion of the muscle is supplied by a branch of profunda femoral artery and under the control of the anterior 2-3 primary nerve branches.
2. As the HE, Masson, En Vision IHC and TUNEL show:Early after the gracilis was split, the muscle bundles swelled obviously. The proliferation was active in both muscle cells and connective tissue cells. The activity of apoptosis was relatively higher in interstitial cells than it in muscle cells. The proportion of fibrous connective tissue increased greatly. The muscle bundles became compensatorily hypertrophy, which increased the muscle's wet weight obviously. With the passage of time, the muscle bundles'swelling relieved gradually. The proliferation activity dropped in both muscle cells and connective tissue cells, while the positive apoptosis cores were more often found in connective tissue cells. The proportion of fibrous connective tissue decreased and the muscle's wet weight reduced to near the preoperative level. The Western Blot showed an obvious trend that the PCNA expression level of muscle cells decreased gradually with postoperative time prolonged. It was found not only in the split muscle bundles, but also in the control side whole gracilis muscle. The Western Blot also implied that the surgical intervention of vertically splitting the rabbit gracilis muscle into two approximately equal halves would have little effect on the proliferation of muscle cells.
3. After the rabbit gracilis muscle was vertically split into two approximately equal halves completely, the front muscle bundle was architected to build an animal model for the reconstruction of penile erectile function. When its dominant nerve was electric stimulated, especially when the muscle bundles occurred tetanic contraction, the 3 type of model were able to simulat the position changes, hardness changes and morphologic changes respectively, just like a normal erectile penis.
[Conclusion]
1. The intramuscular nerve branches'and blood vessels'distribution of rabbit gracilis muscle was displayed clearly and intuitively. Intramuscular nerve branches are generally parallel to each other and most of them are accompanied by a corresponding vessel branch. The anterior and posterior part of rabbit gracilis muscle seems to be regarded as two relatively independent sub-unit structures.
2. The surgery according to the principles of muscle compartmentalization, which vertically split the rabbit gracilis muscle into two approximately equal halves completely, will not significantly affect the long-term survival of muscle bundles, nor shall it affect the contractive function of either muscle bundle respectively.
3. After the rabbit gracilis muscle was correctly split into two halves, the front muscle bundle was architected properly to build an animal model for reconstruction of penile erectile function, with a silicone stick implanted as a supporter. When its nerve was electric stimulated, the reconstructive penis could move satisfactorily, just simulating the way of a normal penis's erection.
4. We also observed that the reconstructive penis model was able to paroxysm dithering under the animal's own control, which certified the feasibility of our surgical methods and supported the rabbit gracilis muscle compartmentalization.
Our results have enriched the anatomic and physiologic study of gracilis compartmentalization. The reconstructive penis model has satisfactorily simulated the erectile function like that of a normal penis and has met the requirements of both improving postoperative reconstructive penis's appearance and retaining muscle's contractive function. It can be served as a useful reference for the further improvements of clinical penis reconstruction surgery. And it may also give some valuable advice on the application of segmental gracilis transplantation for the treatment of facial paralysis, the reconstruction of tongue function, and so on.
长期以来,股薄肌因其解剖学特点及切除后对供区功能影响较小,已成为临床上常用的肌(皮)瓣,广泛应用于组织缺损修复与器官功能重建。1972年,Orticochea曾报道了1例利用股薄肌肌皮瓣再造阴茎的手术,术后通过股薄肌主动收缩,再造阴茎在假体支撑下较好地模拟了阴茎的勃起发动过程。然而,该手术操作复杂、疗程长,术后再造阴茎外观臃肿,影响了该术式的推广。当前,显微外科技术与皮瓣预制技术不断发展,手术操作大大简化,缩短了手术进程。而肌肉亚部化概念的提出与相应研究成果又为避免再造阴茎臃肿的外观带来希望,股薄肌的节段性应用已逐渐成为一种趋势。为了找到在改善术后外观与保留肌肉收缩功能之间的最佳平衡点,有必要进一步加深相关的解剖学与生理学研究。
[研究目的]
研究兔股薄肌肌内的神经支配与血管分布的解剖学特征,寻找能将其安全、简便地完全劈开的具体方式,构建应用节段性股薄肌肌皮瓣移植再造阴茎重建勃起功能的合适的动物模型,兼顾改善术后外观与保留肌肉收缩功能的手术要求。
[研究方法]
1、应用改良的Sihler's肌内神经染色与乳胶血管灌注显色技术,研究兔股薄肌肌内神经支配与血管分布的解剖学特征。
2、依照解剖学研究的结果,按照肌亚部的原则,将兔股薄肌近似二等分纵向完全劈开。应用HE染色观察术后肌束横断面的整体形态、Masson三色染色观察肌束内部发生结缔组织纤维化的程度、EnVision法检测肌细胞的增殖情况、TUNEL法检测肌细胞的凋亡情况、Western Blot检测肌内细胞增殖水平的动态变化；并运用多道生理信号采集处理系统同步检测劈开后肌束的等长收缩肌力与复合肌肉动作电位(CMAP)。
3、构建应用节段性股薄肌肌皮瓣再造阴茎重建勃起功能的动物模型,并观测人为刺激肌束支配神经后再造阴茎的形态变化与CMAP。
[实验结果]
1、肌内神经染色与血管灌注显示：兔股薄肌的支配神经入肌后,各一级分支大体上相互平行由近端走向远端,基本上都有相应的血管分支伴行,不同来源的营养血管形成肌内丰富的吻合网。前部1/3-1/2肌肉的血供主要来自股动脉的分支,受股薄肌前侧的3支一级神经分支支配,后部1/2-2/3肌肉的血供主要依赖股深动脉的分支,其神经支配来自股薄肌支配神经后侧的2-3支一级分支。
2、HE染色显示肌肉劈开后初期,肌束可发生较明显的水肿；Masson三色染色显示此时肌内纤维结缔组织增生活跃；增殖细胞核抗原(PCNA)的免疫组化检测与TUNEL法细胞凋亡检测显示肌纤维细胞与结缔组织细胞增殖、凋亡均较活跃,而凋亡更多发生于间质细胞内；肌束代偿性的肥大,两部分肌束湿重的总和增加。随术后时间延长,HE染色显示水肿逐渐消退；PCNA与TUNEL检测显示肌纤维与间质细胞的增殖均逐渐减弱,纤维结缔组织中凋亡阳性核的检出率更多,这与Masson三色染色所反映的肌内增生纤维结缔组织减少、比重下降之表现一致；肌束湿重的总和降低至接近术前水平。Western Blot检测显示肌细胞PCNA的表达水平也随术后时间延长逐步下降,并提示将兔股薄肌纵向劈开的手术干预对肌内细胞增殖的影响很小。
3、在近似二等分纵向完全劈开兔股薄肌,应用前部肌束构建的相关动物模型中：通过电刺激支配神经直至肌束发生强直收缩,植入支撑假体的初步模型可模拟阴茎勃起时的位置变化；单纯肌束构型的初步模型可模拟阴茎勃起时的硬度变化；而有表面皮肤包被并植入银丝电极的完整模型能比较理想地模拟阴茎勃起发动时的形态变化。
[结论]
1、兔股薄肌肌内神经与血管的分布情况得以清晰、直观地显示,发现其肌内神经大体上相互平行由近端走向远端,各神经分支基本上都有相应的血管伴行,根据血供与神经支配的特点,肌肉的前、后两部分可以分为相对独立的亚单位结构。
2、依据肌亚部原则,近似二等分纵向完全劈开兔股薄肌的手术操作不会明显影响肌束的长期存活；股薄肌分成两部分后,肌束各自的收缩功能也都能得到保留。
3、按上述方式劈开兔股薄肌,选用前部肌束进行恰当构型、植入硅胶支撑假体以制备阴茎再造勃起功能重建的动物模型,通过刺激再造阴茎根部的银丝电极/支配神经可以引起肌束收缩,并使再造阴茎的形态发生改变,比较满意地模拟了正常阴茎的勃起过程。
4、在按上述方法构建的再造阴茎勃起功能重建的动物模型中,能够观察到受动物自主控制的肌肉收缩与再造阴茎的阵发性持续抖动,充分体现了构建模型的手术方式的可行性,并佐证了兔股薄肌肌亚部划分的正确性。
本实验是对股薄肌肌亚部的解剖学与生理学基础研究的补充,构建了比较理想的具备勃起功能的再造阴茎动物模型,达到了兼顾外观与功能的预期实验目的,为临床上进一步改良阴茎再造的手术方法提供了理论基础,也可为临床上应用节段性的股薄肌肌皮瓣移植整复面瘫、重建舌功能等手术提供相应的方法借鉴。
Penis reconstruction surgery is widely used in the treatment of penile defects, congenital malformations of gender, and female to male sexually transmitted diseases, which is of great significance. Currently, doctors have formed a standardized clinical consensus in remodeling penis shape, ensuring flap survival and urinary tract unobstructed, implanting supportive structures for stiffness, and even the reconstruction of penile sensitivity, etc. However, the progress on simulating the situation from weakness to firmness when penis erectile happens under the patients' subjective control has relatively lagged behind. In order to overcome the possible complications of artificial expansive implants, and to avoid the psychological shadow may happened in some patients for a erection initiating mechanism purely depending on an external force, we plan to use the innerved muscle transplantation to reconstruct the erectile function of penis.
Gracilis has become a commonly used donor muscle for tissue defects and functional organ reconstruction, based on its anatomical characteristics and limited leg functional impact after its resection. In 1972, Orticochea reported a musculocutaneous gracilis transplanting surgery for penile reconstruction. Postoperatively, the reconstructive penis could move voluntarily when the initiative gracilis contraction happened. But the complicated surgical operation, rather long surgical duration, and the significantly overstaffed penis appearance had greatly affected the promotion of this surgical procedure. Recently, the progress on microsurgical techniques and flap prefabricating techniques makes it possible to simplify and shorten the surgical process. And the concept of muscle compartmentalization and its corresponding research achievements have brought hope to improve the overstaffed appearance of reconstructive penis at the same time. Yet, segmental flap application has also become a trend in musculocutaneous gracilis transplantation. In order to find the best balance between improving postoperative appearance and retaining muscle's contractive function, it is necessary to promote the anatomic and physiologic studies on gracilis.
[Objective]
Study the intramuscular nerve branches'and blood vessels'distribution of rabbit gracilis muscle and find a specific safe, simple way to split it completely. Build a suitable animal model for the reconstruction of penile erectile function with segmental gracilis flap transplantation, which can meet the requirements of both improving postoperative reconstructive penis's appearance and retaining muscle's contractive function.
[Methods]
1. Using a modified Sihler's intramuscular neural staining and red latex vascular perfusion technique to study the intramuscular nerve branches'and blood vessels' distribution of rabbit gracilis muscle.
2. According to the principles of muscle compartmentalization, vertically split the rabbit gracilis muscle into two approximately equal halves completely. Observe the overall postoperative situation of muscle bundles'cross-section with HE staining technique. Observe the connective tissue's fibrosis occurred within the split muscle bundles with Masson's three-color staining technique. Detect the proliferation of muscle cells with En Vision immunohistochemical technology. Detect the apoptosis of muscle cells with TUNEL. Detect the dynamic level of muscle cell's proliferation with Western Blot. And using a multi-channel physiological signal acquisition and processing system to measure the isometric contraction forces and CMAP of muscle bundles synchronously.
3. Build an animal model for the reconstruction of penile erectile function with segmental gracilis flap transplantation. Observe and record the morphologic changes and CMAP of the reconstructive penis when its nerve is electric stimulated.
[Results]
1. The intramuscular nerve primary branches of rabbit gracilis are generally parallel to each other and most of them are accompanied by a corresponding vessel branch. The blood vessels from different sources form an abundant microcirculation network through intramuscular vessel branches. The anterior 1/3-1/2 portion of the muscle is supplied by a branch of femoral artery and under the control of the anterior 3 primary nerve branches. While the posterior 1/2-2/3 portion of the muscle is supplied by a branch of profunda femoral artery and under the control of the anterior 2-3 primary nerve branches.
2. As the HE, Masson, En Vision IHC and TUNEL show:Early after the gracilis was split, the muscle bundles swelled obviously. The proliferation was active in both muscle cells and connective tissue cells. The activity of apoptosis was relatively higher in interstitial cells than it in muscle cells. The proportion of fibrous connective tissue increased greatly. The muscle bundles became compensatorily hypertrophy, which increased the muscle's wet weight obviously. With the passage of time, the muscle bundles'swelling relieved gradually. The proliferation activity dropped in both muscle cells and connective tissue cells, while the positive apoptosis cores were more often found in connective tissue cells. The proportion of fibrous connective tissue decreased and the muscle's wet weight reduced to near the preoperative level. The Western Blot showed an obvious trend that the PCNA expression level of muscle cells decreased gradually with postoperative time prolonged. It was found not only in the split muscle bundles, but also in the control side whole gracilis muscle. The Western Blot also implied that the surgical intervention of vertically splitting the rabbit gracilis muscle into two approximately equal halves would have little effect on the proliferation of muscle cells.
3. After the rabbit gracilis muscle was vertically split into two approximately equal halves completely, the front muscle bundle was architected to build an animal model for the reconstruction of penile erectile function. When its dominant nerve was electric stimulated, especially when the muscle bundles occurred tetanic contraction, the 3 type of model were able to simulat the position changes, hardness changes and morphologic changes respectively, just like a normal erectile penis.
[Conclusion]
1. The intramuscular nerve branches'and blood vessels'distribution of rabbit gracilis muscle was displayed clearly and intuitively. Intramuscular nerve branches are generally parallel to each other and most of them are accompanied by a corresponding vessel branch. The anterior and posterior part of rabbit gracilis muscle seems to be regarded as two relatively independent sub-unit structures.
2. The surgery according to the principles of muscle compartmentalization, which vertically split the rabbit gracilis muscle into two approximately equal halves completely, will not significantly affect the long-term survival of muscle bundles, nor shall it affect the contractive function of either muscle bundle respectively.
3. After the rabbit gracilis muscle was correctly split into two halves, the front muscle bundle was architected properly to build an animal model for reconstruction of penile erectile function, with a silicone stick implanted as a supporter. When its nerve was electric stimulated, the reconstructive penis could move satisfactorily, just simulating the way of a normal penis's erection.
4. We also observed that the reconstructive penis model was able to paroxysm dithering under the animal's own control, which certified the feasibility of our surgical methods and supported the rabbit gracilis muscle compartmentalization.
Our results have enriched the anatomic and physiologic study of gracilis compartmentalization. The reconstructive penis model has satisfactorily simulated the erectile function like that of a normal penis and has met the requirements of both improving postoperative reconstructive penis's appearance and retaining muscle's contractive function. It can be served as a useful reference for the further improvements of clinical penis reconstruction surgery. And it may also give some valuable advice on the application of segmental gracilis transplantation for the treatment of facial paralysis, the reconstruction of tongue function, and so on.
引文
[1]李文鹏,江华.阴茎再造术的进展.中华男科学杂志.2004, (12{Pages}:937-940).
[2]张旭东,杨松林.阴茎再造术的进展.中华医学美学美容杂志.2003,9(6)：375.
[3]宋鲁杰(综述),潘连军(综述),徐月敏(审校).组织工程技术阴茎功能修复重建的研究.中华男科学杂志.2007,13(4)：352.
[4]王飞翔,张玲莉.勃起功能障碍的诊断方法及其进展.法医学杂志.2005,21(3)：216.
[5]玉田,ThomasMmills,等.抑制平滑肌的张力收缩：一种治疗勃起功能障碍的新途径.中华男科学杂志.2002,8(6)：391.
[6]Orticochea M. A new method of total reconstruction of the penis. Br J Plast Surg.1972,25(4): 347-366.
[7]Letbetter WD. Influence of intramuscular nerve branching on motor unit organization in medial gastrocnemius muscle. Anat Rec.1972,178:402.
[8]English AW,Letbetter WD. Anatomy and innervation patterns of cat lateral gastrocnemius and plantaris muscles. Am J Anat.1982,164(1):67-77.
[9]English AW,Wolf SL. The motor unit. Anatomy and physiology. Phys Then 1982,62(12): 1763-1772.
[10]蔡永清,李名扬,靳仕信.骨骼肌的亚部化研究.解剖学杂志.1989,(04{Pages}:319-321).
[11]Homma T,Sakai T. Thenar and hypothenar muscles and their innervation by the ulnar and median nerves in the human hand. Acta Anat (Basel).1992,145(1):44-49.
[12]Serlin DM,Schieber MH. Morphologic regions of the multitendoned extrinsic finger muscles in the monkey forearm. Acta Anat (Basel).1993,146(4):255-266.
[13]Wu BL,Sanders I. A technique for demonstrating the nerve supply of whole larynges. Arch Otolaryngol Head Neck Surg.1992,118(8):822-827.
[14]Drake W,3rd, Li Y, Rothschild MA, Wu BL, Biller HF,Sanders I. A technique for displaying the entire nerve branching pattern of a whole muscle:results in 10 canine posterior cricoarytenoid muscles. Laryngoscope.1993,103(2):141-148.
[15]Liu J, Kumar VP, Shen Y, Lau HK, Pereira BP,Pho RW. Modified Sihler's technique for studying the distribution of intramuscular nerve branches in mammalian skeletal muscle. Anat Rec.1997, 247(1):137-144.
[16]Kumar VP, Liu J, Lau HK, Pereira BP, Shen Y,Pho RW. Neurovascular supply of the gracilis muscle:a study in the monkey and human. Plast Reconstr Surg.1998,101(7):1854-1860.
[17]Yu DZ, Liu AT, Dang RS, Zhang CS, Zhang JL, Chen G, Yi J, Han T,Jiang H. Intramuscular innervations of muscle flaps that are commonly used in clinical settings. Surg Radiol Anat.2010, 32(7):637-646.
[18]王启明,薛黔,杨胜波. Sihler's肌内神经染色法的再改良.遵义医学院学报.2003,26(4)：322.
[19]Gupta R, Nelson SD, Baker J, Jones NF,Meals RA. The innervation of the triangular fibrocartilage complex:nitric acid maceration rediscovered. Plast Reconstr Surg.2001,107(1):135-139.
[20]Liem RS,Douwe van Willigen J. In toto staining and preservation of peripheral nervous tissue. Stain Technol.1988,63(2):113-120.
[21]李文.常用苏木素几种配方与染色结果的比较.解剖学杂志.2000,23(4)：393.
[22]秦王驰,许扬滨.以节段性肌肉移植为目的的股薄肌应用解剖.解剖学研究.2007,29(1)：52.
[23]Cavadas PC, Sanz-Gimenez-Rico JR, Landin L,Martinez-Soriano F. Segmental gracilis free flap based on secondary pedicles:anatomical study and clinical series. Plast Reconstr Surg.2004, 114(3):684-691.
[24]Erni D, Banic A,Sigurdsson GH. A dynamic study of the circulation in the gracilis muscle in humans. J Reconstr Microsurg.1996,12(8):515-519.
[25]Hussey AJ, Laing AJ,Regan PJ. An anatomical study of the gracilis muscle and its application in groin wounds. Ann Plast Surg.2007,59(4):404-409.
[26]Morris SF,Yang D. Gracilis muscle:arterial and neural basis for subdivision. Ann Plast Surg.1999, 42(6):630-633.
[27]舒先涛,许本柯,周文明,曾祥宏.股薄肌神经血管门的应用解剖.解剖与临床.2005,10(1)：28.
[28]于大志,江华,党瑞山,刘安堂.临床常用肌瓣肌内神经分布的研究.中国临床解剖学杂志.2008,26(6)：594.
[29]McCraw JB, Massey FM, Shanklin KD,Horton CE. Vaginal reconstruction with gracilis myocutaneous flaps. Plast Reconstr Surg.1976,58(2):176-183.
[30]Kayikcioglu A. A new technique in scrotal reconstruction:short gracilis flap. Urology.2003, 61(6):1254-1256.
[31]Pirro N, Sielezneff I, Sastre B,Di Marino V. [Reconstruction of the anus by the gracilis muscle reinnervated by the pudendal nerve. A preliminary anatomical study]. Morphologic 2004,88(282): 145-148.
[32]Harii K, Ohmori K,Torii S. Free gracilis muscle transplantation, with microneurovascular anastomoses for the treatment of facial paralysis. A preliminary report. Plast Reconstr Surg.1976, 57(2):133-143.
[33]史松(综述),刘浩(审校).股薄肌应用解剖学特点及在重建外科中的临床应用.实用医学杂志.2006,22(24)：2937.
[34]Yousif NJ, Dzwierzynski WW, Sanger JR, Matloub HS,Campbell BH. The innervated gracilis musculocutaneous flap for total tongue reconstruction. Plast Reconstr Surg.1999,104(4): 916-921.
[35]Wellisz T, Rechnic M, Dougherty W,Sherman R. Coverage of bilateral lower extremity calcaneal fractures with osteomyelitis using a single split free gracilis muscle transfer. Plast Reconstr Surg. 1990,85(3):457-460.
[36]Schoeller T, Meirer R, Gurunluoglu R, Piza-Katzer H,Wechselberger G. Gracilis muscle split into two free flaps. J Reconstr Microsurg.2003,19(5):295-298.
[37]Ronald MF. The neuromuscular compartments of the flexor carpi ulnaris Plast Reconstr Surg. 1999,103(3):1053-1054.
[38]Copeland LJ, Hancock KC, Gershenson DM, Stringer CA, Atkinson EN,Edwards CL. Gracilis myocutaneous vaginal reconstruction concurrent with total pelvic exenteration. Am J Obstet Gynecol.1989,160(5 Pt 1):1095-1101.
[39]Soper JT, Larson D, Hunter VJ, Berchuck A,Clarke-Pearson DL. Short gracilis myocutaneous flaps for vulvovaginal reconstruction after radical pelvic surgery. Obstet Gynecol.1989,74(5): 823-827.
[40]Soper JT, Rodriguez G, Berchuck A,Clarke-Pearson DL. Long and short gracilis myocutaneous flaps for vulvovaginal reconstruction after radical pelvic surgery:comparison of flap-specific complications. Gynecol Oncol.1995,56(2):271-275.
[41]Zuker RM, Goldberg CS,Manktelow RT. Facial animation in children with Mobius syndrome after segmental gracilis muscle transplant. Plast Reconstr Surg.2000,106(1):1-8; discussion 9.
[42]Hua J, Kumar VP, Pereira BP, Lim AY, Pho RW,Liu J. Split flexor carpi radialis muscle. Plast Reconstr Surg.1999,103(3):930-934.
[43]Lim AY, Pereira BP,Kumar VP. The long head of the triceps brachii as a free functioning muscle transfer. Plast Reconstr Surg.2001,107(7):1746-1752.
[44]Jiang H, Chen G,Liu AT. [The neuromuscular compartments of the flexor carpi ulnaris and the flexor carpi radialis]. Zhonghua Zheng Xing Wai Ke Za Zhi.2006,22(5):383-387.
[45]Lim AY, Kumar VP, Pereira BP,Hua J. Independent function in a tendon transfer of the split flexor carpi ulnaris. Plast Reconstr Surg.1999,104(6):1739-1741; discussion 1742-1733.
[46]郑江,陈富,邓忠良.肌内神经对股直肌损伤修复的作用.中国组织工程研究与临床康复.2008,12(24)：4623.
[47]Kimura J. Electrodiagnosis in diseases of nerve and muscle:principles and practice, Ed.3. edn. Philadelphia:Davis,2001.
[48]胡跃辉,施俊,郑永平.多参量的骨骼肌等长收缩初步研究.声学技术.2007,26(1)：46.
[49]刘洪广,刘旭东,蒋大宗.神经电刺激控制骨骼肌动态等长收缩产生力的模型研究.中华物理医学与康复杂志.2001,(03).
[50]Zajac FE. How musculotendon architecture and joint geometry affect the capacity of muscles to move and exert force on objects:a review with application to arm and forearm tendon transfer design. J Hand Surg Am.1992,17(5):799-804.
[51]Hester TR, Hill HL,Jurkiewicz MJ. One-stage reconstruction of the penis. Br J Plast Surg.1978, 31(4):279-285.
[52]Yousif NJ, Matloub HS, Kolachalam R, Grunert BK,Sanger JR. The transverse gracilis musculocutaneous flap. Ann Plast Surg.1992,29(6):482-490.
[53]陈宗基,高国兰,马福顺,胡爱民,陈焕然,李剑琴.闭孔动脉跨区供血的长型股薄肌肌皮瓣.中华整形外科杂志.2005,21(1)：5.
[54]阮默,徐达传,汪新民.闭孔动脉吻合支的解剖学研究及其临床意义.中国临床解剖学杂志.2003,21(3)：207.
[55]Macchi V, Vigato E, Porzionato A, Tiengo C, Stecco C, Parenti A, Morra A, Bassetto F, Mazzoleni F,De Caro R. The gracilis muscle and its use in clinical reconstruction:an anatomical, embryological, and radiological study. Clin Anat.2008,21(7):696-704.
[56]Hasen KV, Gallegos ML,Dumanian GA. Extended approach to the vascular pedicle of the gracilis muscle flap:anatomical and clinical study. Plast Reconstr Surg.2003,111(7):2203-2208.
[57]Lykoudis EG, Spyropoulou GA,Vlastou CC. The anatomic basis of the gracilis perforator flap. Br J Plast Surg.2005,58(8):1090-1094.
[58]Holtermann A, Roeleveld K, Mork PJ, Gronlund C, Karlsson JS, Andersen LL, Olsen HB, Zebis MK, Sjogaard G,Sogaard K. Selective activation of neuromuscular compartments within the human trapezius muscle. J Electromyogr Kinesiol.2009,19(5):896-902.
[59]English AW, Weeks OI. Compartmentalization of single muscle units in cat lateral gastrocnemius. Exp Brain Res.1984,56(2):361-368.
[60]English AW, Wolf SL,Segal RL. Compartmentalization of muscles and their motor nuclei:the partitioning hypothesis. Phys Ther.1993,73(12):857-867.
[61]Lykoudis EG, Spyropoulou GA,Vlastou CC. The conjoint medial circumflex femoral perforator and gracilis muscle free flap:anatomical study and clinical use for complex facial paralysis reconstruction. Plast Reconstr Surg.2005,116(6):1589-1595.
[62]Yang D, Morris SF, Tang M,Geddes CR. A modified longitudinally split segmental rectus femoris muscle flap transfer for facial reanimation:anatomic basis and clinical applications. J Plast Reconstr Aesthet Surg.2006,59(8):807-814.
[63]张志勇,袁文化.股薄肌皮瓣行舌再造术的临床研究.中华口腔医学杂志.1995,30(4)：198.
[64]Terzis JK,Olivares FS. Use of mini-temporalis transposition to improve free muscle outcomes for smile. Plast Reconstr Surg.2008,122(6):1723-1732.
[65]Terzis JK,Olivares FS. Mini-temporalis transfer as an adjunct procedure for smile restoration. Plast Reconstr Surg.2009,123(2):533-542.
[1]史松(综述),刘浩(审校).股薄肌应用解剖学特点及在重建外科中的临床应用.实用医学杂志.2006,22(24)：2937.
[2]秦王驰,许扬滨.以节段性肌肉移植为目的的股薄肌应用解剖.解剖学研究.2007,29(1)：52.
[3]张雪非,陈道运.内收短肌和股薄肌移位术治疗脑瘫剪刀步.中华骨科杂志.2006,26(1)：21.
[4]Hussey AJ, Laing AJ,Regan PJ. An anatomical study of the gracilis muscle and its application in groin wounds. Ann Plast Surg.2007,59(4):404-409.
[5]Morris SF,Yang D. Gracilis muscle:arterial and neural basis for subdivision. Ann Plast Surg.1999, 42(6):630-633.
[6]舒先涛,许本柯,周文明,曾祥宏.股薄肌神经血管门的应用解剖.解剖与临床.2005,10(1)：28.
[7]Schoeller T, Meirer R, Gurunluoglu R, Piza-Katzer H,Wechselberger G. Gracilis muscle split into two free flaps. J Reconstr Microsurg.2003,19(5):295-298.
[8]Cavadas PC, Sanz-Gimenez-Rico JR, Landin L,Martinez-Soriano F. Segmental gracilis free flap based on secondary pedicles:anatomical study and clinical series. Plast Reconstr Surg.2004, 114(3):684-691.
[9]Orticochea M. A new method of total reconstruction of the penis. Br J Plast Surg.1972,25(4): 347-366.
[10]Erni D, Banic A,Sigurdsson GH. A dynamic study of the circulation in the gracilis muscle in humans. J Reconstr Microsurg.1996,12(8):515-519.
[11]Yousif NJ, Matloub HS, Kolachalam R, Grunert BK,Sanger JR. The transverse gracilis musculocutaneous flap. Ann Plast Surg.1992,29(6):482-490.
[12]于大志,江华,党瑞山,刘安堂.临床常用肌瓣肌内神经分布的研究.中国临床解剖学杂志.2008,26(6)：594.
[13]阮默,徐达传,汪新民.闭孔动脉吻合支的解剖学研究及其临床意义.中国临床解剖学杂志.2003,21(3)：207.
[14]Soper JT, Larson D, Hunter VJ, Berchuck A,Clarke-Pearson DL. Short gracilis myocutaneous flaps for vulvovaginal reconstruction after radical pelvic surgery. Obstet Gynecol.1989,74(5): 823-827.
[15]陈宗基,高国兰,马福顺,胡爱民,陈焕然,李剑琴.闭孔动脉跨区供血的长型股薄肌肌皮瓣.中华整形外科杂志.2005,21(1)：5.
[16]Yousif NJ, Dzwierzynski WW, Sanger JR, Matloub HS,Campbell BH. The innervated gracilis musculocutaneous flap for total tongue reconstruction. Plast Reconstr Surg.1999,104(4): 916-921.
[17]Kumar VP, Liu J, Lau HK, Pereira BP, Shen Y,Pho RW. Neurovascular supply of the gracilis muscle:a study in the monkey and human. Plast Reconstr Surg.1998,101(7):1854-1860.
[18]Soper JT, Rodriguez G, Berchuck A,Clarke-Pearson DL. Long and short gracilis myocutaneous flaps for vulvovaginal reconstruction after radical pelvic surgery:comparison of flap-specific complications. Gynecol Oncol.1995,56(2):271-275.
[19]杨宝刚,李岱,康生军.脑瘫后遗症髋内收畸形手术矫治.吉林医学.2007,28(15)：1689.
[20]Wellisz T, Rechnic M, Dougherty W,Sherman R. Coverage of bilateral lower extremity calcaneal fractures with osteomyelitis using a single split free gracilis muscle transfer. Plast Reconstr Surg. 1990,85(3):457-460.
[21]McCraw JB, Massey FM, Shanklin KD,Horton CE. Vaginal reconstruction with gracilis myocutaneous flaps. Plast Reconstr Surg.1976,58(2):176-183.
[22]Copeland LJ, Hancock KC, Gershenson DM, Stringer CA, Atkinson EN,Edwards CL. Gracilis myocutaneous vaginal reconstruction concurrent with total pelvic exenteration. Am J Obstet Gynecol.1989,160(5 Pt 1):1095-1101.
[23]Kayikcioglu A. A new technique in scrotal reconstruction:short gracilis flap. Urology.2003, 61(6):1254-1256.
[24]Hester TR, Hill HL,Jurkiewicz MJ. One-stage reconstruction of the penis. Br J Plast Surg.1978, 31(4):279-285.
[25]Harii K, Ohmori K,Torii S. Free gracilis muscle transplantation, with microneurovascular anastomoses for the treatment of facial paralysis. A preliminary report. Plast Reconstr Surg.1976, 57(2):133-143.
[26]Zuker RM, Goldberg CS,Manktelow RT. Facial animation in children with Mobius syndrome after segmental gracilis muscle transplant. Plast Reconstr Surg.2000,106(1):1-8; discussion 9.
[27]Yang D, Morris SF, Tang M,Geddes CR. A modified longitudinally split segmental rectus femoris muscle flap transfer for facial reanimation:anatomic basis and clinical applications. J Plast Reconstr Aesthet Surg.2006,59(8):807-814.
[28]张志勇,袁文化.股薄肌皮瓣行舌再造术的临床研究.中华口腔医学杂志.1995,30(4)：198.
[2]张旭东,杨松林.阴茎再造术的进展.中华医学美学美容杂志.2003,9(6)：375.
[3]宋鲁杰(综述),潘连军(综述),徐月敏(审校).组织工程技术阴茎功能修复重建的研究.中华男科学杂志.2007,13(4)：352.
[4]王飞翔,张玲莉.勃起功能障碍的诊断方法及其进展.法医学杂志.2005,21(3)：216.
[5]玉田,ThomasMmills,等.抑制平滑肌的张力收缩：一种治疗勃起功能障碍的新途径.中华男科学杂志.2002,8(6)：391.
[6]Orticochea M. A new method of total reconstruction of the penis. Br J Plast Surg.1972,25(4): 347-366.
[7]Letbetter WD. Influence of intramuscular nerve branching on motor unit organization in medial gastrocnemius muscle. Anat Rec.1972,178:402.
[8]English AW,Letbetter WD. Anatomy and innervation patterns of cat lateral gastrocnemius and plantaris muscles. Am J Anat.1982,164(1):67-77.
[9]English AW,Wolf SL. The motor unit. Anatomy and physiology. Phys Then 1982,62(12): 1763-1772.
[10]蔡永清,李名扬,靳仕信.骨骼肌的亚部化研究.解剖学杂志.1989,(04{Pages}:319-321).
[11]Homma T,Sakai T. Thenar and hypothenar muscles and their innervation by the ulnar and median nerves in the human hand. Acta Anat (Basel).1992,145(1):44-49.
[12]Serlin DM,Schieber MH. Morphologic regions of the multitendoned extrinsic finger muscles in the monkey forearm. Acta Anat (Basel).1993,146(4):255-266.
[13]Wu BL,Sanders I. A technique for demonstrating the nerve supply of whole larynges. Arch Otolaryngol Head Neck Surg.1992,118(8):822-827.
[14]Drake W,3rd, Li Y, Rothschild MA, Wu BL, Biller HF,Sanders I. A technique for displaying the entire nerve branching pattern of a whole muscle:results in 10 canine posterior cricoarytenoid muscles. Laryngoscope.1993,103(2):141-148.
[15]Liu J, Kumar VP, Shen Y, Lau HK, Pereira BP,Pho RW. Modified Sihler's technique for studying the distribution of intramuscular nerve branches in mammalian skeletal muscle. Anat Rec.1997, 247(1):137-144.
[16]Kumar VP, Liu J, Lau HK, Pereira BP, Shen Y,Pho RW. Neurovascular supply of the gracilis muscle:a study in the monkey and human. Plast Reconstr Surg.1998,101(7):1854-1860.
[17]Yu DZ, Liu AT, Dang RS, Zhang CS, Zhang JL, Chen G, Yi J, Han T,Jiang H. Intramuscular innervations of muscle flaps that are commonly used in clinical settings. Surg Radiol Anat.2010, 32(7):637-646.
[18]王启明,薛黔,杨胜波. Sihler's肌内神经染色法的再改良.遵义医学院学报.2003,26(4)：322.
[19]Gupta R, Nelson SD, Baker J, Jones NF,Meals RA. The innervation of the triangular fibrocartilage complex:nitric acid maceration rediscovered. Plast Reconstr Surg.2001,107(1):135-139.
[20]Liem RS,Douwe van Willigen J. In toto staining and preservation of peripheral nervous tissue. Stain Technol.1988,63(2):113-120.
[21]李文.常用苏木素几种配方与染色结果的比较.解剖学杂志.2000,23(4)：393.
[22]秦王驰,许扬滨.以节段性肌肉移植为目的的股薄肌应用解剖.解剖学研究.2007,29(1)：52.
[23]Cavadas PC, Sanz-Gimenez-Rico JR, Landin L,Martinez-Soriano F. Segmental gracilis free flap based on secondary pedicles:anatomical study and clinical series. Plast Reconstr Surg.2004, 114(3):684-691.
[24]Erni D, Banic A,Sigurdsson GH. A dynamic study of the circulation in the gracilis muscle in humans. J Reconstr Microsurg.1996,12(8):515-519.
[25]Hussey AJ, Laing AJ,Regan PJ. An anatomical study of the gracilis muscle and its application in groin wounds. Ann Plast Surg.2007,59(4):404-409.
[26]Morris SF,Yang D. Gracilis muscle:arterial and neural basis for subdivision. Ann Plast Surg.1999, 42(6):630-633.
[27]舒先涛,许本柯,周文明,曾祥宏.股薄肌神经血管门的应用解剖.解剖与临床.2005,10(1)：28.
[28]于大志,江华,党瑞山,刘安堂.临床常用肌瓣肌内神经分布的研究.中国临床解剖学杂志.2008,26(6)：594.
[29]McCraw JB, Massey FM, Shanklin KD,Horton CE. Vaginal reconstruction with gracilis myocutaneous flaps. Plast Reconstr Surg.1976,58(2):176-183.
[30]Kayikcioglu A. A new technique in scrotal reconstruction:short gracilis flap. Urology.2003, 61(6):1254-1256.
[31]Pirro N, Sielezneff I, Sastre B,Di Marino V. [Reconstruction of the anus by the gracilis muscle reinnervated by the pudendal nerve. A preliminary anatomical study]. Morphologic 2004,88(282): 145-148.
[32]Harii K, Ohmori K,Torii S. Free gracilis muscle transplantation, with microneurovascular anastomoses for the treatment of facial paralysis. A preliminary report. Plast Reconstr Surg.1976, 57(2):133-143.
[33]史松(综述),刘浩(审校).股薄肌应用解剖学特点及在重建外科中的临床应用.实用医学杂志.2006,22(24)：2937.
[34]Yousif NJ, Dzwierzynski WW, Sanger JR, Matloub HS,Campbell BH. The innervated gracilis musculocutaneous flap for total tongue reconstruction. Plast Reconstr Surg.1999,104(4): 916-921.
[35]Wellisz T, Rechnic M, Dougherty W,Sherman R. Coverage of bilateral lower extremity calcaneal fractures with osteomyelitis using a single split free gracilis muscle transfer. Plast Reconstr Surg. 1990,85(3):457-460.
[36]Schoeller T, Meirer R, Gurunluoglu R, Piza-Katzer H,Wechselberger G. Gracilis muscle split into two free flaps. J Reconstr Microsurg.2003,19(5):295-298.
[37]Ronald MF. The neuromuscular compartments of the flexor carpi ulnaris Plast Reconstr Surg. 1999,103(3):1053-1054.
[38]Copeland LJ, Hancock KC, Gershenson DM, Stringer CA, Atkinson EN,Edwards CL. Gracilis myocutaneous vaginal reconstruction concurrent with total pelvic exenteration. Am J Obstet Gynecol.1989,160(5 Pt 1):1095-1101.
[39]Soper JT, Larson D, Hunter VJ, Berchuck A,Clarke-Pearson DL. Short gracilis myocutaneous flaps for vulvovaginal reconstruction after radical pelvic surgery. Obstet Gynecol.1989,74(5): 823-827.
[40]Soper JT, Rodriguez G, Berchuck A,Clarke-Pearson DL. Long and short gracilis myocutaneous flaps for vulvovaginal reconstruction after radical pelvic surgery:comparison of flap-specific complications. Gynecol Oncol.1995,56(2):271-275.
[41]Zuker RM, Goldberg CS,Manktelow RT. Facial animation in children with Mobius syndrome after segmental gracilis muscle transplant. Plast Reconstr Surg.2000,106(1):1-8; discussion 9.
[42]Hua J, Kumar VP, Pereira BP, Lim AY, Pho RW,Liu J. Split flexor carpi radialis muscle. Plast Reconstr Surg.1999,103(3):930-934.
[43]Lim AY, Pereira BP,Kumar VP. The long head of the triceps brachii as a free functioning muscle transfer. Plast Reconstr Surg.2001,107(7):1746-1752.
[44]Jiang H, Chen G,Liu AT. [The neuromuscular compartments of the flexor carpi ulnaris and the flexor carpi radialis]. Zhonghua Zheng Xing Wai Ke Za Zhi.2006,22(5):383-387.
[45]Lim AY, Kumar VP, Pereira BP,Hua J. Independent function in a tendon transfer of the split flexor carpi ulnaris. Plast Reconstr Surg.1999,104(6):1739-1741; discussion 1742-1733.
[46]郑江,陈富,邓忠良.肌内神经对股直肌损伤修复的作用.中国组织工程研究与临床康复.2008,12(24)：4623.
[47]Kimura J. Electrodiagnosis in diseases of nerve and muscle:principles and practice, Ed.3. edn. Philadelphia:Davis,2001.
[48]胡跃辉,施俊,郑永平.多参量的骨骼肌等长收缩初步研究.声学技术.2007,26(1)：46.
[49]刘洪广,刘旭东,蒋大宗.神经电刺激控制骨骼肌动态等长收缩产生力的模型研究.中华物理医学与康复杂志.2001,(03).
[50]Zajac FE. How musculotendon architecture and joint geometry affect the capacity of muscles to move and exert force on objects:a review with application to arm and forearm tendon transfer design. J Hand Surg Am.1992,17(5):799-804.
[51]Hester TR, Hill HL,Jurkiewicz MJ. One-stage reconstruction of the penis. Br J Plast Surg.1978, 31(4):279-285.
[52]Yousif NJ, Matloub HS, Kolachalam R, Grunert BK,Sanger JR. The transverse gracilis musculocutaneous flap. Ann Plast Surg.1992,29(6):482-490.
[53]陈宗基,高国兰,马福顺,胡爱民,陈焕然,李剑琴.闭孔动脉跨区供血的长型股薄肌肌皮瓣.中华整形外科杂志.2005,21(1)：5.
[54]阮默,徐达传,汪新民.闭孔动脉吻合支的解剖学研究及其临床意义.中国临床解剖学杂志.2003,21(3)：207.
[55]Macchi V, Vigato E, Porzionato A, Tiengo C, Stecco C, Parenti A, Morra A, Bassetto F, Mazzoleni F,De Caro R. The gracilis muscle and its use in clinical reconstruction:an anatomical, embryological, and radiological study. Clin Anat.2008,21(7):696-704.
[56]Hasen KV, Gallegos ML,Dumanian GA. Extended approach to the vascular pedicle of the gracilis muscle flap:anatomical and clinical study. Plast Reconstr Surg.2003,111(7):2203-2208.
[57]Lykoudis EG, Spyropoulou GA,Vlastou CC. The anatomic basis of the gracilis perforator flap. Br J Plast Surg.2005,58(8):1090-1094.
[58]Holtermann A, Roeleveld K, Mork PJ, Gronlund C, Karlsson JS, Andersen LL, Olsen HB, Zebis MK, Sjogaard G,Sogaard K. Selective activation of neuromuscular compartments within the human trapezius muscle. J Electromyogr Kinesiol.2009,19(5):896-902.
[59]English AW, Weeks OI. Compartmentalization of single muscle units in cat lateral gastrocnemius. Exp Brain Res.1984,56(2):361-368.
[60]English AW, Wolf SL,Segal RL. Compartmentalization of muscles and their motor nuclei:the partitioning hypothesis. Phys Ther.1993,73(12):857-867.
[61]Lykoudis EG, Spyropoulou GA,Vlastou CC. The conjoint medial circumflex femoral perforator and gracilis muscle free flap:anatomical study and clinical use for complex facial paralysis reconstruction. Plast Reconstr Surg.2005,116(6):1589-1595.
[62]Yang D, Morris SF, Tang M,Geddes CR. A modified longitudinally split segmental rectus femoris muscle flap transfer for facial reanimation:anatomic basis and clinical applications. J Plast Reconstr Aesthet Surg.2006,59(8):807-814.
[63]张志勇,袁文化.股薄肌皮瓣行舌再造术的临床研究.中华口腔医学杂志.1995,30(4)：198.
[64]Terzis JK,Olivares FS. Use of mini-temporalis transposition to improve free muscle outcomes for smile. Plast Reconstr Surg.2008,122(6):1723-1732.
[65]Terzis JK,Olivares FS. Mini-temporalis transfer as an adjunct procedure for smile restoration. Plast Reconstr Surg.2009,123(2):533-542.
[1]史松(综述),刘浩(审校).股薄肌应用解剖学特点及在重建外科中的临床应用.实用医学杂志.2006,22(24)：2937.
[2]秦王驰,许扬滨.以节段性肌肉移植为目的的股薄肌应用解剖.解剖学研究.2007,29(1)：52.
[3]张雪非,陈道运.内收短肌和股薄肌移位术治疗脑瘫剪刀步.中华骨科杂志.2006,26(1)：21.
[4]Hussey AJ, Laing AJ,Regan PJ. An anatomical study of the gracilis muscle and its application in groin wounds. Ann Plast Surg.2007,59(4):404-409.
[5]Morris SF,Yang D. Gracilis muscle:arterial and neural basis for subdivision. Ann Plast Surg.1999, 42(6):630-633.
[6]舒先涛,许本柯,周文明,曾祥宏.股薄肌神经血管门的应用解剖.解剖与临床.2005,10(1)：28.
[7]Schoeller T, Meirer R, Gurunluoglu R, Piza-Katzer H,Wechselberger G. Gracilis muscle split into two free flaps. J Reconstr Microsurg.2003,19(5):295-298.
[8]Cavadas PC, Sanz-Gimenez-Rico JR, Landin L,Martinez-Soriano F. Segmental gracilis free flap based on secondary pedicles:anatomical study and clinical series. Plast Reconstr Surg.2004, 114(3):684-691.
[9]Orticochea M. A new method of total reconstruction of the penis. Br J Plast Surg.1972,25(4): 347-366.
[10]Erni D, Banic A,Sigurdsson GH. A dynamic study of the circulation in the gracilis muscle in humans. J Reconstr Microsurg.1996,12(8):515-519.
[11]Yousif NJ, Matloub HS, Kolachalam R, Grunert BK,Sanger JR. The transverse gracilis musculocutaneous flap. Ann Plast Surg.1992,29(6):482-490.
[12]于大志,江华,党瑞山,刘安堂.临床常用肌瓣肌内神经分布的研究.中国临床解剖学杂志.2008,26(6)：594.
[13]阮默,徐达传,汪新民.闭孔动脉吻合支的解剖学研究及其临床意义.中国临床解剖学杂志.2003,21(3)：207.
[14]Soper JT, Larson D, Hunter VJ, Berchuck A,Clarke-Pearson DL. Short gracilis myocutaneous flaps for vulvovaginal reconstruction after radical pelvic surgery. Obstet Gynecol.1989,74(5): 823-827.
[15]陈宗基,高国兰,马福顺,胡爱民,陈焕然,李剑琴.闭孔动脉跨区供血的长型股薄肌肌皮瓣.中华整形外科杂志.2005,21(1)：5.
[16]Yousif NJ, Dzwierzynski WW, Sanger JR, Matloub HS,Campbell BH. The innervated gracilis musculocutaneous flap for total tongue reconstruction. Plast Reconstr Surg.1999,104(4): 916-921.
[17]Kumar VP, Liu J, Lau HK, Pereira BP, Shen Y,Pho RW. Neurovascular supply of the gracilis muscle:a study in the monkey and human. Plast Reconstr Surg.1998,101(7):1854-1860.
[18]Soper JT, Rodriguez G, Berchuck A,Clarke-Pearson DL. Long and short gracilis myocutaneous flaps for vulvovaginal reconstruction after radical pelvic surgery:comparison of flap-specific complications. Gynecol Oncol.1995,56(2):271-275.
[19]杨宝刚,李岱,康生军.脑瘫后遗症髋内收畸形手术矫治.吉林医学.2007,28(15)：1689.
[20]Wellisz T, Rechnic M, Dougherty W,Sherman R. Coverage of bilateral lower extremity calcaneal fractures with osteomyelitis using a single split free gracilis muscle transfer. Plast Reconstr Surg. 1990,85(3):457-460.
[21]McCraw JB, Massey FM, Shanklin KD,Horton CE. Vaginal reconstruction with gracilis myocutaneous flaps. Plast Reconstr Surg.1976,58(2):176-183.
[22]Copeland LJ, Hancock KC, Gershenson DM, Stringer CA, Atkinson EN,Edwards CL. Gracilis myocutaneous vaginal reconstruction concurrent with total pelvic exenteration. Am J Obstet Gynecol.1989,160(5 Pt 1):1095-1101.
[23]Kayikcioglu A. A new technique in scrotal reconstruction:short gracilis flap. Urology.2003, 61(6):1254-1256.
[24]Hester TR, Hill HL,Jurkiewicz MJ. One-stage reconstruction of the penis. Br J Plast Surg.1978, 31(4):279-285.
[25]Harii K, Ohmori K,Torii S. Free gracilis muscle transplantation, with microneurovascular anastomoses for the treatment of facial paralysis. A preliminary report. Plast Reconstr Surg.1976, 57(2):133-143.
[26]Zuker RM, Goldberg CS,Manktelow RT. Facial animation in children with Mobius syndrome after segmental gracilis muscle transplant. Plast Reconstr Surg.2000,106(1):1-8; discussion 9.
[27]Yang D, Morris SF, Tang M,Geddes CR. A modified longitudinally split segmental rectus femoris muscle flap transfer for facial reanimation:anatomic basis and clinical applications. J Plast Reconstr Aesthet Surg.2006,59(8):807-814.
[28]张志勇,袁文化.股薄肌皮瓣行舌再造术的临床研究.中华口腔医学杂志.1995,30(4)：198.