大圆肌的神经入肌点定位及其临床意义

目的　准确定位大圆肌神经入肌点（NEP）的体表位置和穿刺深度。 方法　12具中国成年人尸体。设计紧贴皮肤连接颈静脉切迹最低点至肩峰尖为横向参考线（H线）、颈静脉切迹最低点至剑胸结合处为纵向参考线（L线）。解剖暴露大圆肌NEP,涂抹硫酸钡,逐层复位缝合,CT扫描与三维重建。Syngo系统下确定大圆肌NEP的体表投影点（P）;P通过NEP投影至背部皮肤上的点为P'点;经P的垂线与H线的交点记为PH,经P的水平线与L线的交点记为PL;分别测量PH和PL在H和L线上的百分位置及NEP的百分深度。 结果　大圆肌NEP的PH位于H线的（9.59±1.24）%处,PL位于L线的（39.37±2.45）%处;NEP深度位于PP'线的（41.83±2.98）%处。 结论　这些参数可为提高大圆肌痉挛的神经阻滞效率和疗效提供指导。     

利用神经入肌点定位小腿三头肌痉挛的神经阻滞靶点

目的　准确定位小腿三头肌的神经入肌点（N点）位置,为临床该肌痉挛神经阻滞提供解剖学基础。 方法　10具20侧成年人尸体下肢,俯卧。紧贴皮肤连接股骨外上髁与内上髁和股骨外上髁与外踝的线分别为N点的横向参考线（H线）和纵向参考线（L线）。解剖暴露小腿三头肌各神经肌支的N点,涂抹硫酸钡,CT扫描。Syngo系统下确定N点在体表的投影点（P点）;P点通过N点后投射至对侧皮肤上的P'点;经P点的垂线与H线、水平线与L线的交点分别记为PH和PL。分别测量PH和PL在H和L线上的百分位置及N点的深度。 结果　腓肠肌内侧头、外侧头和比目鱼肌的PH分别位于H线的（46.89±2.73）%、（40.90±3.05）%和（42.56±2.59）%处,PL分别位于L线的（7.58±2.88）%、（8.15±2.52）%和（17.42±3.31）%处;N点深度分别位于PP'线的（16.32±2.52）%、（13.83±1.77）%和（29.93±2.89）%处。 结论　这些参数可提高小腿三头肌痉挛神经溶解术的疗效和效率。     

小腿前群肌神经入肌点定位及在阻滞肌痉挛中的意义

目的准确地定位小腿前群肌神经入肌点(NEP)的体表位置和深度。方法 20具中国成年人尸体。设计紧贴皮肤连接股骨外上髁与腓骨外踝的曲线为纵向参考线(L),连接股骨外上髁与内上髁的曲线为横向参考线(H)。解剖暴露NEP,硫酸钡标记,螺旋CT扫描,三维重建,Syngo系统下确定NEP在体表前后的投影点(P和P'点),P点投射到L和H线上的位置(PL和PH点)及NEP的深度。结果胫骨前肌、长伸肌、趾长伸肌均有一个较为恒定的NEP,其中PL点分别位于L线的(23.63±2.43)%、(52.46±2.94)%和(36.07±2.99)%处;PH点分别位于体表H线上的(27.27±2.58)%、(34.41±2.38)%和(32.11±2.52)%处;深度分别位于PP'线的(45.32±3.06)%、(36.20±2.84)%和(33.72±3.18)%处。结论这些NEP的体表位置和深度的界定将为提高小腿前群肌痉挛肌外神经溶解术靶点定位的效率与疗效提供形态学指导。     

成人前臂前群肌的神经入肌点定位及意义

目的 准确定位成人前臂前群肌神经入肌点（NEP）的体表位置和深度。 方法 成人尸体12具,仰卧。紧贴皮肤连接肱骨外上髁和内上髁间的曲线为横向参考线(H),肱骨外上髁和桡骨茎突间的曲线为纵向参考线(L)。解剖暴露NEP,硫酸钡标记,螺旋CT扫描与三维重建。将NEP在体表上的投影点记为P点,P点通过NEP后投射至前臂后体表上的点为P'点。P点投射到H线与L线上的位置分别记为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 旋前圆肌、桡侧腕屈肌、掌长肌、尺侧腕屈肌、指浅屈肌、拇长屈肌、指深屈肌（正中神经支）、指深屈肌（尺神经支）、旋前方肌NEP的PH分别位于H线上的58.08%、64.17%、75.14%、61.14%、62.26%、52.07%、50.81%、63.38%和51.37%处;PL分别位于L线上的9.79%、3.97%、16.37%、4.42%、17.88%、34.17%、30.27%、11.48%和75.32%处;穿刺深度分别位于PP'线的26.80%、25.06%、27.68%、28.13%、37.30%、39.85%、49.26%、70.86%和44.25% 处。以上数据均为平均值。 结论 这些NEP的体表穿刺位置与深度的界定可为提高前臂前群肌痉挛肌外神经溶解术靶点阻滞的效率、手术切断神经肌支治疗肌痉挛的微创切口设计、作为供肌的功能评估、以及肌移植术中对神经的保护等提供形态学指导。     

成人前臂后群肌神经入肌点定位及意义

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。     

成人大圆肌肌内神经密集区中心的定位及在肌痉挛阻滞中的意义

目的　确定大圆肌肌内神经密集区中心（centers of intramuscular nerve dense regions,CINDR）的位置和标记方法。 方法　选取24具成人尸体。设计紧贴皮肤连接肩胛上角和肩峰及肩胛下角的曲线分别为横向（H）和纵向（L）参考线。改良的Sihler’s染色法显示一侧大圆肌肌内神经密集区,解剖暴露另一侧肌的肌内神经密集区相应位置,硫酸钡标记其CINDR,螺旋CT扫描确定CINDR在背部和胸部的体表投影点（P和P'点）。Syngo系统确定通过P点的垂线分别与H和L线的交点（PH和PL点）的位置和CINDR的深度。 结果　大圆肌内仅有1个肌内神经密集区,其CINDR的PH位于H线的（86.71±0.85）%处,PL位于L线的（72.07±1.08）%处。CINDR的深度位于P-P'线的（40.06±2.44）%处。 结论　这些结果可作为肌内注射肉毒毒素A阻滞大圆肌痉挛的指导依据。     

成人缝匠肌痉挛的肌外和肌内神经阻滞靶点定位

目的:定位缝匠肌的神经入肌点(NEP)和肌内神经密集区中心(CINDR)位置,为缝匠肌痉挛神经阻滞术提供形态学指导。方法:12具24侧成年尸体下肢。连接股骨大转子与耻骨结节和股骨外上髁间的曲线分别为NEP的横向参考线(H线)和纵向参考线(L1线);髂前上棘和股骨内上髁间的曲线为CINDR的纵向参考线(L2线)。Sihler染色CINDR,硫酸钡标记NEP和CINDR,CT扫描。NEP和CINDR在股前、后体表上的投影点分别为P和P′点,经P点的垂线与H线、水平线与L线的交点分别记为PH和PL点。结果:缝匠肌的2个NEP的PH点分别位于H线的51.57%、63.93%处;PL点位于L1线的1.71%、0.71%处;深度分别位于PP′线的7.32%、8.10%处。缝匠肌内5个CINDR的P点分别位于L2线的17.18%、26.56%、42.18%、56.25%和72.65%处;深度分别位于PP′线的5.1%、14.81%、19.23%、22.5%和45.45%处。结论:这些位置应为成人缝匠肌痉挛肌外和肌内神经阻滞术的最佳靶点部位。     

枕下肌的神经入肌点定位

目的 准确定位枕下肌的神经入肌点(NEP)，为枕下肌肌张力增高所致疾病的肌外神经阻滞提供解剖学基础。方法 24具成人尸体。解剖暴露枕下肌(头后小直肌、头后大直肌、头上斜肌和头下斜肌)的NEP，硫酸钡标记，原位缝合。螺旋CT扫描与三维重建。经皮连接枕外隆突与第7颈椎棘突的曲线为纵向(L)参考线，乳突与第7颈椎棘突的曲线为横向(H)参考线，NEP在项部和相反侧皮肤上的点分别记为P点和P’点，经P点分别向H线和L线作垂线，其交点分别记为P_H点和P_L点。Syngo系统下确定P_H点和P_L点分别在H线和L线上的百分位置及NEP的深度。结果 每块枕下肌(头后小直肌、头后大直肌、头上斜肌和头下斜肌)常只有1个NEP，其NEP的P_H分别位于H线上的46.29%、35.85%、28.88%和32.29%处；P_L分别位于L线上的27.39%、39.06%、35.06%和40.42%处。NEP的深度分别位于PP’线上的21.21%、24.02%、14.59%和21.44%处。上述...     

利用神经入肌点定位肩胛下肌痉挛的阻滞靶点

目的 准确定位肩胛下肌神经入肌点（NEP）的体表位置和穿刺深度,为实现肩胛下肌痉挛乙醇或苯酚注射的化学神经溶解术提供指导。方法 20具中国成年人尸体,仰卧。紧贴皮肤连接颈静脉切迹最下点与肩峰尖和颈静脉切迹最下点与剑胸结合处的曲线分别为NEP的横向参考线（H线）和纵向参考线（L线）。解剖暴露肩胛下肌各神经肌支的NEP,涂抹硫酸钡,螺旋计算机断层扫描（CT）与三维重建。Syngo系统下确定NEP在体表的投影点（P）,P通过NEP投射至背部皮肤上的P’点;经P的垂线与H线、经P的水平线与L线的交点分别记为P_H和P_L,测量P_H和P_L在H和L线上的百分位置及NEP的深度。结果 肩胛下肌上神经支和下神经支的P_H分别位于H线的（46.89±2.73）%和（42.56±2.59）%处,P_L分别位于L线的（7.58±2.88）%和（17.42±3.31）%处;NEP深度分别位于PP’线的（16.32±2.52）%和（29.93±2.89）%处。结论 上述结果可为提高肩胛下肌痉挛化学神经溶解术的疗效和效率提供指导。     

大腿肌内侧群痉挛肌外神经阻滞靶点的定位

目的 精确定位大腿肌内侧群痉挛肌外神经阻滞靶点的位置。 方法 设计经耻骨结节至股骨大转子外侧皮肤的连线为横向的H参考线,经耻骨结节至股骨内上髁水平的连线为纵向的L参考线。解剖暴露经甲醛固定的10具成人尸体的20侧闭孔神经及其肌支,涂抹硫酸钡于它们表面,烘干,X线摄片,PACS软件测量闭孔神经肌支肌外阻滞靶点在H线和L线上的百分位置。 结果 闭孔神经股薄肌支、长收肌支、短收肌支以及大收肌支在肌外的近侧运动点（P点）分别位于距耻骨结节外侧的大腿宽度（H线）的（21.48±1.80）％、（25.85±1.23）％、（28.07±1.65）％和（29.18±2.07）％处,位于距耻骨结节远侧的大腿长度（L线）的（8.83±1.01）％、（8.83±1.01）％、（7.57±0.63）％和（7.57±0.63）％处;远侧运动点（D点）分别位于距耻骨结节外侧大腿宽度（H线）的（16.9±1.33）％、（27.70±2.15）％、（31.18±2.18）％和（35.78±2.79）％处,位于距耻骨结节远侧大腿长度（L线）的（35.57±2.77）％、（26.9±1.96）％、（24.26±1.91）％和（28.04±2.17）％处。 结论 这些靶点的准确定位可提高大腿肌内侧群痉挛肌外神经靶点阻滞的安全性和有效性。     

Localization of nerve entry points as targets to block spasticity of the deep posterior compartment muscles of the leg

To identify the optimal body surface puncture locations and the depths of nerve entry points (NEPs) in the deep posterior compartment muscles of the leg, 60 lower limbs of thirty adult cadavers were dissected in prone position. A curved line on the skin surface joining the lateral to the medial epicondyles of the femur was taken as a horizontal reference line (H). Another curved line joining the lateral epicondyle of the femur to the lateral malleolus was designated the longitudinal reference line (L). Following dissection, the NEPs were labeled with barium sulfate and then subjected to spiral computed tomography scanning. The projection point of the NEP on the posterior skin surface of the leg was designated P, and the projection in the opposite direction across the transverse plane was designated P'. The intersections of P on H and L were identified as P_H and P_L, and their positions and the depth of the NEP on PP' were measured using the Syngo system and expressed as percentages of H, L, and PP'. The P_H points of the tibial posterior, flexor hallucis longus and flexor digitorum longus muscles were located at 38.10, 46.20, and 55.21% of H, respectively. The P_L points were located at 25.35, 41.30, and 45.39% of L, respectively. The depths of the NEPs were 49.11, 54.64, and 55.95% of PP', respectively. The accurate location of these NEPs should improve the efficacy and efficiency of chemical neurolysis for treating spasticity of the deep posterior compartment muscles of the leg. Clin. Anat. 30:855–860, 2017. © 2017 Wiley Periodicals, Inc.     

臂前群肌神经入肌点的定位

目的:借骨性标志确定肌皮神经肌支神经入肌点(N点)的位置。方法:成年尸体上肢,肩峰至颈静脉切迹连线为喙肱肌支N点的横向参考线(H_1),肱骨外上髁至内上髁连线为肱二头肌和肱肌支N点的横向参考线(H_2);肩峰至肱骨外上髁连线为纵向参考线(L)。解剖暴露N点,涂抹硫酸钡,CT扫描。N点在臂前体表上的投影点为P,P点通过N点后投射至臂后体表上的点为P′。经P的垂线与H线、水平线与L线的交点分别记为P_H和P_L。Syngo系统下确定P_H和P_L在H和L线上的位置及N点的深度。结果:喙肱肌支、肱二头肌短头、肱二头肌长头及肱肌支的P_H分别位于H_1的18.38%、H_2的56.85%、52.81%和57.52%处;P_L位于L的24.86%、50.20%、55.91%和64.31%处;经过P点的N点深度分别位于PP′线的23.16%、24.68%、26.32%和38.19%处。结论:这些神经入肌点的定位可提高臂前群肌痉挛神经溶解术的疗效和效率。     

The distal hindlimb musculature of the cat

Summary Chronic recordings were made of electromyographic (EMG) activity, tension, and length of distal hindlimb muscles in six cats performing a variety of normal motor tasks. Muscles studied thoroughly or in part were medial gastrocnemius, lateral gastrocnemius, plantaris, soleus, flexor digitorum brevis, flexor digitorum longus, flexor hallucis longus, tibialis posterior, tibialis anterior, extensor digitorum longus, peroneus longus, and peroneus brevis. Postural and locomotor activities were examined, as well as jumping, landing, scratching, and paw shaking. In general, muscles could be assigned to traditional groupings (e.g. extensor, flexor) related to the demands of the motor task. Patterns of muscle activity were most often consistent with current understanding of muscle mechanics and neural coordination. However, purely functional distinctions between flexor digitorum longus and flexor hallucis longus (anatomical synergists) were made on the basis of activity patterns. Likewise, the activity of plantaris and flexor digitorum brevis, which are attached in series, was differentiated in certain tasks. The rhythmical oscillatory patterns of scratching and paw shaking were found to differ temporally in a manner consistent with the limb mechanics. In several cases, mechanical explanations of specific muscle activity required length and force records, as well as EMG patterns. Future efforts to study motor patterns should incorporate information about the relationships between muscle activation, tension, length and velocity.Abbreviations EDL extensor digitorum longus - FDB flexor digitorum brevis - FDL flexor digitorum longus - FHL flexor hallucis longus - LG lateral gastrocnemius - MG medial gastrocnemius - PB peroneus brevis - PL peroneus longus - PLT plantaris - SOL soleus - TA tibialis anterior - TP tibialis posterior Limbs A ankle - K knee - LF left forelimb - LH left hindlimb - RF right forelimb - RH right hindlimb Step Cycle Phases E₁ first extension, late swing phase prior to footfall - E₂ second extension, early stance phase - E₃ third extension, late stance phase - F flexion, early swing phase     

腓骨短肌肌瓣的血供研究与临床应用

目的 了解腓骨短肌血供的解剖学特征,探讨临床应用腓骨短肌肌瓣和以腓骨短肌为蒂的组织瓣内移修复踝周软组织缺损或治疗胫骨骨不连的可行性。 方法 30例经10%福尔马林固定的成人下肢标本,动脉灌注红色乳胶,解剖观察腓骨短肌的血管来源、走行及分布情况;临床上设计切口取腓动脉的弓形动脉分支为蒂,修复踝周软组织缺损和胫骨骨不连患者10例。 结果 腓骨短肌血管呈节段性分布,主要来自腓动脉的弓形动脉,最远侧的分支平均位于外踝上(50.81±5.45) mm;根据腓骨短肌及血供特点,临床设计的腓骨短肌肌瓣应用于10例患者,均获成功。 结论 腓骨短肌血供丰富,逆行腓骨短肌肌瓣血供可靠,是修复踝周软组织缺损和胫骨骨不连的一种理想肌瓣。     

The consistent presence of the human accessory deep peroneal nerve

Twenty-four human legs were dissected macroscopically to study the morphological details of the accessory deep peroneal nerve. This nerve arose from the superficial peroneal nerve and descended in the lateral compartment of the leg, deep to peroneus longus along the posterior border of peroneus brevis. Approaching the ankle joint, this nerve passed through the peroneal tunnels to wind around the lateral malleolus; it then crossed beneath the peroneus brevis tendon anteriorly to reach the dorsum of the foot. The accessory deep peroneal nerve was found in every case examined and constantly gave off muscular branches to peroneus brevis and sensory branches to the ankle region. In addition, this nerve occasionally had muscular branches to peroneus longus and extensor digitorum brevis, and sensory branches to the fibula and the foot. The anomalous muscles around the lateral malleolus were also innervated by this nerve. Neither cutaneous branches nor communicating branches with other nerves were found. The present study reveals that the accessory deep peroneal nerve is consistently present and possesses a proper motor and sensory distribution in the lateral region of the leg and ankle. It is not an anomalous nerve as has previously been suggested.