前臂肌内神经血管构筑的解剖学研究

发布时间：2018-06-04 05:06

  本文选题：肌内神经分布 + 血管造影　； 参考：《第二军医大学》2006年博士论文

【摘要】：目的 观察前臂肌内神经血管分布，明确前臂神经各肌支的解剖学特征，并结合其肌内神经和血管的分布关系对其进行分类，探讨前臂肌能否被分割为若干个功能单位，以提供新的功能性骨骼肌游离移植供区。方法 解剖5具10％甲醛固定的成年尸体共10侧前臂肌，观察其肌外神经血管的分布形式。5具新鲜成年尸体标本共10侧前臂肌，将其每块肌肉完整剥离后用Sihler's染色法行肌内神经的染色。4具新鲜成年尸体标本共8侧前臂肌，经肱动脉30％硫酸钡、乳胶混悬液灌注后，分割切取每块肌肉并行X线钼靶摄片。观察和研究前臂诸肌肌内神经、血管的分布及其关系。结果 肌内各级神经分支被染成蓝紫色，清晰可见神经在肌内的分布。按前臂肌肌内神经血管分布的特点，分为3类，各类再分为a、b两个亚类。Ⅰ类肌肉，为一支主要的神经干支配，，可再分为：Ⅰa类：该类肌肉其血供多为优势血管蒂型，其肌内动脉分支的走行和分布特点与神经分支相似，此类肌肉外形多为扁平形或梯形。Ⅰb类：血供多为节段血管蒂型，肌内血管之间有丰富的吻合支，此类肌肉外形多为纺锤形。Ⅱ类肌肉，均为纺锤形肌，肌内神经呈多支型分布，有相同的神经来源。此类肌肉可再分为：Ⅱa类：为单羽肌，神经偏于肌腱的一侧走行。血供多为节段血管蒂型，肌内血管之间有丰富的吻合支。Ⅱb类：有较明显的肌内腱板，以腱为界可自然分出两个部分，每个部分都有独立的神经和血管支配，血供多为节段血管蒂型，与神经伴行的动脉入肌后往往沿中央腱两侧走行，分布区域与神经支配区域大致相同，各血管分支间有良好的吻合。Ⅲ类，主要包括多个起点和多个止点的肌肉。可再分为，Ⅲa类：为多个起点，每个头都有独立的神经支配，血供为节段血管蒂型，肌内血管之间有丰富的吻合支。Ⅲb类：为多个止点，在肌肉起始处，有神经返支支配肌腹的上1／3，部分肌肉接受不同来源的神经支配。血供多为优势血管蒂型加节段血管蒂型，且以共干支配形式为主，肌内血管之间有丰富的吻合支。结论 ①明确了前臂诸肌神经支配的特点；②前臂肌内中Ⅱb类肌肉和某些Ⅲ类肌肉，可将其分为不同的功能单位，供节段性游离肌肉移植。
[Abstract]:Objective to observe the distribution of nerve and blood vessels in the forearm muscle, to determine the anatomical characteristics of the branches of the forearm nerve, and to classify it according to the distribution relationship between the intramuscular nerve and the blood vessel, and to explore whether the forearm muscle can be divided into several functional units. To provide a new free donor area for functional skeletal muscle transplantation. Methods 10 forearm muscles were dissected from 5 adult cadavers fixed with 10% formaldehyde. The distribution of extramuscular nerve and blood vessels was observed in 5 fresh adult cadavers with 10 forearm muscles. After each muscle was completely stripped, 8 forearm muscles were stained with Sihler's staining method in 4 fresh adult cadavers. The brachial artery was perfused with 30% barium sulfate and emulsion suspension. Each muscle was segmented and taken with X ray molybdenum target. To observe and study the distribution and relationship of intramuscular nerves and blood vessels in forearm muscles. Results the nerve branches were stained blue-purple and the distribution of nerves in the muscle was clearly visible. According to the distribution of intramuscular nerve and blood vessel in forearm muscle, there are three types of muscle, each of which is subdivided into two subgroups of afib. Type I muscle is a main nerve trunk innervation, and can be subdivided into class 鈪

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