指浅屈肌神经阻滞精确区域定位与尺、桡侧腕屈肌肌肉神经构筑学临床应用研究

发布时间：2018-01-12 21:36

本文关键词：指浅屈肌神经阻滞精确区域定位与尺、桡侧腕屈肌肌肉神经构筑学临床应用研究　出处：《吉林大学》2011年博士论文　论文类型：学位论文

【摘要】：脑外伤病、大脑性瘫痪、血管性偏瘫的病人,很多都伴随有去功能化的上肢痉挛,这一并发症,经常影响到上肢前臂的屈肌肌肉群。在众多上肢肌肉痉挛性残疾中,尤其以手指屈肌痉挛,因为其限制了手腕的活动幅度和手指的精细运动,最影响日常的生活。在通过神经肌肉阻滞降低手指屈肌痉挛的治疗实践中,指浅屈肌是个重要的目的肌肉。指浅屈肌的神经入肌点和肌肉内神经末梢的准确定位对于用肉毒毒素治疗手指屈肌痉挛是必不可少的,但目前尚无报道实现对指浅屈肌的上述解剖位置的准确定位。我们的研究阐明指浅屈肌的肌肉外的支配神经的分支特征、精准的神经入肌点分布以及肌肉内神经末梢的分布特点及分布区域,以此为肉毒毒素以及其他去神经阻滞剂对指浅屈肌的注射提供一个准确的指导区域,在研究中,我们还论述了指浅屈肌近端神经分支作为神经移位供体重建旋前圆肌旋前功能的可能性。随着临床上应用带血管神经的肌瓣游离移植以及原位的肌腱神经移位功能重建开展,以及神经肌肉功能独立亚部(Neuromuscular compartment, NMCs)概念的提出,学者们提出是否可以将肌肉分割成若干亚部进行游离移植或者原位移位功能重建,使得在不过于损伤供体肌肉功能的前提下,充分利用前臂肌肉的动力资源,实现多重的功能重建。我们的实验重点研究了尺侧腕屈肌和桡侧腕屈肌的肌肉构筑学特征,以及显微视野下的神经断面构筑学特征,对尺桡侧腕屈肌的神经肌肉分布特征临床应用前景给予了的深入研究,阐明了肌肉形态与功能的一致性,为肌腱、神经移位的临床设计提供了重要思路,为深入研究肌肉的形态特征和生理功能提供可靠的临床应用解剖学依据,为临床实践中,更理想供体肌肉的选择,提供了理论基础。
[Abstract]:Many patients with brain trauma, cerebral palsy, and hemiplegia are accompanied by disabling upper limb spasms, a complication. The flexor muscle group of the forearm of the upper limb is often affected. In many upper limb muscle spastic disabilities, especially the finger flexor spasm, it limits the range of wrist movement and the fine movement of the finger. Most affect daily life. In the treatment of reducing finger flexor spasm through neuromuscular block. Flexor digitorum superficial muscle is an important target muscle. The exact location of nerve entry point and nerve endings of flexor digitorum muscle is essential for the treatment of finger flexor spasm with botulinum toxin. However, there is no report on the exact location of the above anatomical position of flexor digitorum. Our study elucidates the branching characteristics of the innervated nerve outside the flexor digitorum digitorum muscle. The accurate distribution of nerve entry points and the distribution of nerve endings in muscle provides an accurate guidance area for the injection of botulinum toxin and other denervating agents to flexor digitorum. In our study, we also discussed the possibility of reconstructing the supinator function of the flexor digitorum muscle proximal nerve branch as a nerve transfer donor. With the clinical application of vascularized muscle flap free transplantation and orthotopic tendon nerve transfer function reconstruction. And the concept of Neuromusculus compartmentalization (NMCs), an independent subunit of neuromuscular function. Scholars have proposed whether muscle can be divided into several subparts for free transplantation or orthotopic transposition to make full use of the power resources of the forearm muscles without too much damage to the muscle function of the donor. Our experiments focused on the muscular architecture of flexor Carpi ulnaris and flexor Carpi radialis, as well as the characteristics of nerve sectional architecture in microscopic view. The clinical application prospect of neuromuscular distribution of flexor Carpi ulnaris was studied, and the consistency of muscle morphology and function was elucidated, which provided an important idea for the clinical design of tendon and nerve transposition. It provides a reliable anatomical basis for the study of morphologic features and physiological functions of muscles, and provides a theoretical basis for the better choice of donor muscles in clinical practice.
【学位授予单位】：吉林大学
【学位级别】：博士
【学位授予年份】：2011
【分类号】：R322

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