临床常用肌瓣及小腿肌肉的神经支配及相关研究

发布时间：2018-04-17 16:17

  本文选题：骨骼肌 + 肌亚部　； 参考：《第二军医大学》2007年硕士论文

【摘要】： [目的] ①观察并测量临床常用肌瓣,即足拇展肌、背阔肌、股薄肌、胸小肌、腹直肌和缝匠肌,及小腿各肌肉的形态和肌肉起止点。明确支配各肌肉的神经来源、肌外神经走行,测定各神经分支的入肌点。观察肌肉解剖肌亚部的划分。 ②通过Sihler’s肌内神经染色,观察神经入肌后的走行、分布及神经肌亚部的划分。 ③根据大体解剖及肌内神经染色的结果对肌肉进行综合分类。 ④探讨临床常用肌瓣及小腿诸肌能否被分割为若干个肌亚部,填补解剖学的空白,为临床切取部分肌肉用于移植和指导手术入路提供解剖学依据。 [方法] 1大体解剖学研究: 解剖15侧经10%甲醛固定的成年尸体小腿及8侧成年尸体的临床常用肌瓣,观测肌肉的形态和肌束排列走行方向;研究支配肌肉的神经来源及走行,记录肌外神经分支。以腓骨头水平为基准测定肌肉起点和各神经分支的入肌点,将肌肉做矢状切和水平切,观察肌肉内部肌束的排列和肌内腱板走行情况。 2肌内神经染色: 切取新鲜成年尸体的92块小腿肌和24块临床常用肌瓣共116块骨骼肌。采用Sihler’s肌内神经染色方法,经过取材、固定、浸软、除色素、脱钙、染色、脱色、中和以及透明等一系列过程,达到透明肌肉,着色神经的目的,观察神经在肌内的走行及分布。 3肌肉分类的方法: 根据Lim等人对上肢肌的分类方法,再结合本实验大体解剖和肌内神经染色的结果,对本实验中的肌肉进行分类,提出肌肉的亚部化观点。 [结果] 1大体解剖学结果剖肌亚部划分,这些肌肉包括扁肌(乆肌、胸小肌、背阔肌)、双羽肌(腓骨长肌、比目鱼肌、部分趾长屈肌)、多头肌(腓肠肌)、环羽肌(胫骨前肌、胫骨后肌)和多腹肌(腹直肌)。 2肌内神经染色结果 Sihler’s染色后,肌肉呈透明或半透明状,外形完整,肌束的走行方向肉眼可见,肌肉内的神经各级分支被染成紫蓝色,在肌肉内的分支及走行清晰可见。 最适合临床上进行亚部移植的小腿肌肉有腓肠肌、比目鱼肌、胫骨前肌、胫骨后肌和腓骨长肌。 临床常用肌瓣的神经亚部划分:①足拇展肌可以分为前中后三个亚部;②背阔肌可以按肌纤维走行方向将其分为3～4个亚部;③股薄肌可以分为上中下三个亚部;④腹直肌可以取其中一个节段作为移植供体,也可以纵行劈开一个或者几个节段进行移植;⑤胸小肌可以将其分为上下两个肌亚部;⑥缝匠肌可以取下亚部的内侧或者外侧次亚部进行移植。 3肌肉综合分类结果 4肌内神经分布规律 ①当神经在肌肉的起点入肌,且方向与肌肉长轴平行时,神经将沿肌肉方向向前延伸,分支呈平行或放射状排列(如拇长伸肌、背阔肌)。当肌肉被肌内腱膜延伸分成几部分时,神经分支也将分为几组,分别支配被分割的几部分(如腓骨长肌、胫骨前肌)。 ②当神经的入肌点在距离肌肉起点一定距离,且和肌肉的长轴呈一定夹角时,神经将发出两支以上分支,其中一支向肌肉起点方向回返,支配肌肉近端亚部,其余分支向前行,支配远侧肌肉(如股薄肌、缝匠肌)。 ③当神经入肌点在肌肉的中部,且和肌肉长轴垂直或近乎垂直时,神经将发出两侧分支和前方分支,支配肌肉的三个部分(如足拇展肌、乆肌) [结论] ①对临床常用肌瓣及小腿肌肉的大体解剖测定及神经入肌点的测定具有重要的临床意义,能够指导临床避免神经损伤及对肌肉进行亚部移植。 ②Sihler’s肌内神经染色方法结合大体解剖及显微解剖方法是研究肌内神经分布及走行的理想方法。 ③骨骼肌可以根据大体解剖及肌内神经染色结果进行综合分类,其中除单羽肌中第一型外均能进行亚部移植。 ④神经在肌肉内的分布及走行是有规律可循的。
[Abstract]:Purpose of the project






( 1 ) To observe and measure the clinical commonly used muscle flap , namely the foot abductor muscle , the dorsomus dorsi muscle , the thigh thin muscle , the pectus minimus , the rectus abdominis muscle and the sartorius muscle , and the shape and the muscle starting point of each muscle of the calf .






( 2 ) Through the Sihler ' s intramuscular nerve staining , we observed the running , distribution and division of the neuromuscular sub - division after the nerve was entered into the muscle .






( 3 ) performing comprehensive classification on muscles according to the gross anatomy and the result of intramuscular nerve staining .






Objective To study whether the muscles of common muscle flap and small leg can be divided into several sub - parts , fill the blank of anatomy , and provide anatomical basis for clinical cutting of partial muscles for transplantation and guidance of surgical approach .






Methodology






1 Gross anatomical study :






The muscle flap of adult corpses fixed by 10 % formaldehyde on 15 sides of anatomy was dissected , the morphology of muscle was observed and the direction of muscle bundle arrangement was observed .






2 Intramuscular nerve staining :






A total of 116 skeletal muscles were obtained from 92 small leg muscles and 24 pieces of clinically common muscle flap from fresh adult corpses . Using the method of Sihler ' s intramuscular nerve staining , a series of processes such as material selection , fixation , softening , depigmenting , calcium removal , staining , decolouring , neutralization and transparency were used to achieve the purpose of transparent muscle and colored nerve to observe the running and distribution of nerve in the muscle .






3 Method of muscle classification :






According to the classification method of the upper limb muscles by Lim et al . , the muscle in the experiment was classified according to the gross anatomy of the experiment and the results of intramuscular nerve staining .






The result is not valid .






1 General anatomical results are divided into sub - division , these muscles include flat muscle ( musculus rectus muscle , pectus minimus , dorsi mus dorsi muscle ) , bifeather muscle ( long muscle of fibula , soleus muscle , partial toe long flexor muscle ) , multi - head muscle ( fibula muscle ) , ring feather muscle ( tibialis anterior muscle , posterior tibial muscle ) , and multi - abdominal muscle ( rectus abdominis muscle ) .






2 Intramuscular nerve staining results






After Sihler ' s staining , the muscle is transparent or translucent , the appearance is intact , the walking direction of the muscle bundle is visible to the naked eye , and the branches of the nerves at all levels in the muscle are dyed into purple blue , and branches and walking lines in the muscle are clearly visible .






The most suitable calf muscle that is most suitable for clinical sub - transplantation is muscle of fibula , soleus muscle , anterior tibial muscle , posterior tibial muscle and long muscle of fibula .






It is divided into three sub - parts : 鈶，

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