家兔胸大肌肌内神经、运动终板与肌梭的分布

目的 :探究家兔胸大肌肌内神经、运动终板与肌梭的分布。方法 :改良的Sihler染色法、乙酰胆碱酯酶染色法及HE染色法。结果 :家兔胸大肌接受胸前神经和胸后神经支配。胸前神经主要支配横行纤维 ,并在其中部形成一“U”形的神经襻。胸后神经主要司斜行纤维 ,与胸前神经间存在吻合 ;胸大肌表面可见多条运动终板短带 ,弥散分布 ,似“虎皮样”外观 ;胸大肌的肌梭密度为 1 2 .98± 1 .85个 /克 ,但各部位的肌梭密度不同 ,以横行纤维中部最高。结论 :在家兔胸大肌内 ,肌内神经分支密集的部位 ,运动终板与肌梭分布密度亦高 ;该肌内肌梭的分布不均匀。     

人翼外肌肌内神经肌梭的分布及其意义

目的:研究人翼外肌肌内神经和肌梭配布特征,以期深入了解翼外肌上、下头的功能特性。方法:对10具成人尸体的翼外肌肌梭以及肌内神经分支、分布进行了观察。结果:改良Sihler氏神经染色显示翼外肌上、下头有各自独立的神经支。支配翼外肌上头的神经支较短而细小,入肌后分出两个次级分支,与肌纤维排列方向成一定的角度向肌止点处走行;支配下头的神经支较粗,入肌后在肌纤维之间迂曲走行,发出呈树支状的多个次级分支,分支间无吻合。翼外肌肌梭仅分布在上头肌腹中央,下头未发现肌梭。结论:翼外肌具有划分亚部的形态学特征,每一亚部作为一个功能独立体在整肌功能中行使作用。     

人缝匠肌肌内神经、肌梭分布和神经入肌点定位

目的:观察人缝匠肌肌内神经分支分布;肌梭的分布部位、范围及密度,分析肌梭与肌内神经分布间的功能联系;测定神经入肌点,为临床外科提供肌形态学资料.方法:用大体解剖法观察20具尸体缝匠肌的形态学特点,并以髂前上棘为骨性标志,定位缝匠肌神经入肌点;用组织学H-E染色法研究5具尸体缝匠肌肌梭分布;用改良Sihler's 肌内神经染色法,探讨10具尸体缝匠肌肌内神经分支分布.结果:缝匠肌是1块由长肌束平行排列构成的带状肌.缝匠肌有2支1级神经支支配,发出分支支配肌的上、中和下部.缝匠肌的神经入肌点距髂前上棘(9.75±1.30)cm.结论:缝匠肌有2支一级神经支支配,神经支配有一定的区域性;缝匠肌肌内神经的分支分布与肌构筑学特点有关;缝匠肌的上部比中部和下部肌梭密度高;缝匠肌的神经入肌点集中在股前部上2/5区内.     

小鱼际肌肌内神经和肌梭密度分布

目的揭示小鱼际肌肌内神经和肌梭密度的分布规律。方法对成年20具尸体(40例)小鱼际标本用改良Sihler肌内神经染色法和苏木精-伊红(HE)染色法。结果小鱼际肌肌外神经干长0.49～1.64 cm,从肌起端深面入肌。小指展肌内尺侧和桡侧有独立的神经支配,可分为两个神经肌亚部;小指短屈肌的肌内神经干斜行穿越肌实质中央;小指对掌肌内神经吻合形式多样,"U"型吻合更明显。3块肌的桡侧部神经分支分布密集。小指对掌肌肌梭密度最高为(19.33±2.72)个/g;小指短屈肌其次,有(15.79±1.33)个/g;小指展肌最少,为(12.86±1.69)个/g。结论三块肌桡侧部更多地参与精细调节;肌块越小,肌梭密度越高。     

Sihler肌内神经染色的研究进展

Sihler肌内神经染色自提出以来,历经国内外学者几度改良,现已广泛应用于动物和人的肌内神经染色,以清晰观察肌内神经的各种分布,为临床提供基础资料。本文就近年对Sihler染色改良,以及临床应用现状做一综述。     

人鱼际肌的肌内神经分支分布和肌梭密度研究

目的探索鱼际肌肌肌内神经分支和肌梭密度的分布。方法采用改良Sihler’s肌内神经染色法和HE染色法进行解剖学研究。结果鱼际肌的神经常从肌起端深面入肌,神经入肌后在拇短展肌、拇对掌肌、拇收肌横头内与肌长轴垂直走向,拇收肌斜头和拇短屈肌内沿肌长轴平行走形。80%～82.5%的拇短屈肌和拇指对掌肌接受正中神经和尺神经的双重支配。拇短屈肌浅头和深头、拇收肌横头和斜头有独立的神经支配,可分出神经肌肉亚部。4块肌内神经分支分布密集区多在肌的中部与近端,可见"Y"、"O"、"H"或"U"型等不同的神经吻合形式。鱼际肌肌梭密度高达16.19～27.14个/g,高低顺序为拇指对掌肌拇短屈肌拇短展肌拇收肌。结论鱼际肌肌内神经吻合丰富,肌梭密度高,除拇对掌肌外,其余肌块可作整肌或半肌移植的供体。     

人冈上肌肌形态、肌内神经和肌梭分布的研究

目的为进一步探讨冈上肌的生理功能和临床应用提供形态学依据。方法大体解剖法、改良的Sihler＇s肌内神经染色法、HE染色法。结果（1）肌中部有一白色腱板,肌束呈辐凑状排列于腱板周围,似环羽肌。（2）肌内有三支初级神经支,其中肌中支最粗大,支配范围最广。在肌中部多形成交通支。（3）冈上肌的平均肌梭密度为63．94±4．73个／cm^3。结论（1）冈上肌是环羽肌,倾向力量型设计。（2）神经分支主要分布在肌内腱板的深面,在肌中部多形成神经交通支。（3）冈上肌与三角肌可构成“平行肌组”。     

家兔跖肌肌内神经、运动终板及肌梭的分布

目的 :探究家兔跖肌肌内神经、运动终板及肌梭的分布。方法 :改良Sihler’s染色法、乙酰胆碱酯酶染色法及HE染色法。结果 :肌的起端 ,神经主干上发出若干细小分支 ,尤以内侧部为多 ;肌的中上部 ,可见 2～ 4条“L”形初级支 ,分布到内侧部肌纤维 ;3～ 5条初级支 ,穿越肌内腱膜板后司外侧部肌纤维。运动终板呈线状排列于跖肌两缘 ,矢状和冠状切面上可见“V”形终板带 ,横断面上呈“S”型。肌梭密度为 (16 .94± 1.72 )个 / g。 结论 :家兔跖肌的肌内神经、运动终板和肌梭分布与肌纤维排列有关 ;肌内神经分支密集的部位 ,运动终板聚集呈带状 ,肌梭密度高 ;跖肌具有划分亚部的特征。     

足底内侧和外侧群肌的肌内神经整体分布模式及临床意义

目的 揭示足底内侧和外侧群肌的肌内神经整体分布模式,探讨其临床意义.方法 24具成年尸体,完整取下足底内侧和外侧群肌,采用改良Sihler染色显示肌内神经分布模式.结果 (足母)收肌的神经支从肌止端的深面入肌,而(足母)展肌、(足母)短屈肌、小趾展肌和小趾短屈肌的神经支常从肌起端的深面入肌.(足母)展肌中有1个半月形和...     

家兔趾长伸肌肌内神经、运动终板和肌梭的分布

目的：探究家兔趾长伸肌肌内神经、运动终板与肌梭的分布。方法：改良Sihler’s染色法、乙酰胆碱酯酶染色法及HE染色法。结果：趾长伸肌是短肌束构成的长肌,肌束起点高的,止点相应亦较高。连于第2趾的肌纤维占据了肌腹上1／3,止于其余3趾的肌纤维位于下2／3。趾长伸肌的神经来自2条肌外神经干,上支及其分支支配第2趾的肌纤维,下支司其余3趾。运动终板分布除冠状切面上为弥漫的黑色颗粒外,其余各切面均为一条连续的运动终板带。各部的肌梭密度分别是：起端33.95个／g、肌腹中部44.76个／g、止端为零。结论：家兔趾长伸肌内,肌梭分布不均匀。肌内神经分支密集的部位,运动终板集聚、肌梭密度亦高。家兔趾长伸肌具有划分亚部的特征。     

家兔腓肠肌亚部神经切断对其肌内神经、运动终板和肌梭的影响

目的　切断家兔腓肠肌外侧头肌亚部神经后 ,观察肌内神经、肌梭、运动终板带、肌湿重等的形态学变化。方法　 4 0只家兔随机分成对照组和神经切断组。用Sihler s肌内神经染色法染肌内神经 ;用乙酰胆碱脂酶整肌染色法染肌运动终板 ;用HE染色法染肌梭。结果　 (1)术后 2周亚部肌湿重明显下降 (P <0 0 5 ) ,肌运动终板带模糊不清 ,肌内神经染色变浅 ,三级分支消失 ,但肌梭形态及梭内肌纤维尚无明显改变 ;(2 )术后 4周肌湿重进一步下降 (P <0 0 1) ,运动终板带完全消失 ,肌内二级分支染色无 ,肌梭形态及数量有改变 ;(3)术后 12周肌肉明显萎缩 ,发生纤维化 ,运动终板带无 ,肌内神经染色无 ,仅留有鞘管样结构 ,未见神经再生 ,肌梭形态、数量明显改变 ;(4)术后 16周各参数与 12周相比差异无显著性。邻近正常肌未见有侧支神经支配失神经的亚部。结论　 (1)家兔腓肠肌外侧头各亚部在神经切断术后 4周 ,运动终板、肌梭的数量和形态有改变 ;(2 ) 12周后肌内神经染色仅有神经外膜鞘管样结构残存 ;(3)术后 16周末见原位的神经再生和相邻亚部神经侧支的再支配。     

The course of the inferior gluteal nerve and surgical landmarks for its localization during posterior approaches to hip

The position of the inferior gluteal nerve (IGN) makes it vulnerable to iatrogenic injury during posterior and posterolateral approaches to the hip. Although the posterior approach has been reported to be the most frequently used technique, it is most likely to be associated with damage to the IGN. As there is scant information in the literature regarding the course and the anatomic relationships of the IGN, we aimed to investigate the anatomic course of the IGN and define the anatomical landmarks that can be used by surgeons during posterior approaches to the hip. Thirty-six gluteal regions from adult fixed cadavers were used for this study. A triangular-shaped anatomic area that contains the IGN was defined. This geometric area was formed by connecting the following points: posterior inferior iliac spine (PIIS) (apex), ischial tuberosity (IT) and greater trochanter (GT). This triangle can further be divided into two, the upper triangle being the “danger zone” since it contains the IGN and its branches. The closest mean distance between the point of IGN origin and the PIIS, IT and the GT was 3.2, 4.8 and 5.4 cm, respectively. In all specimens, the nerve entered the deep surface of the gluteus maximus approximately 5.4 cm from the apex of the GT and approached the GT as close as 0.8 cm, on average. Based on our study, dividing the gluteus maximus with standard techniques may damage the IGN. Posterior minimally invasive approaches to the hip should take into account the point of entry of the IGN into the gluteus maximus. Localization of the IGN by using the anatomic triangle defined in this study may decrease surgical morbidity.     

Morphogenesis of the human gluteus maximus muscle arising from two muscle primordia

Summary In human embryos and fetuses a supernumerary muscle was found situated on the distal margin of the gluteus maximus muscle and supplied by the most distal main branch of the inferior gluteus nerve. According to its origin and insertion it is being named the coccygeofemoralis muscle.In embryos and fetuses of up to 40 mm in CR length the coccygeofemoralis muscle is separated by loose connective tissue from neighbouring fetal muscles. Later on, close contact between the coccygeofemoralis and the distal margin of the fetal gluteus maximus muscle develops, and during the prenatal period both fetal muscles gradually fuse. Postnatally, the coccygeofemoralis muscle is incorporated into the gluteus maximus muscle of which the pars sacroiliaca corresponds to the fetal gluteus maximus itself and the pars coccygea represents the fetal coccygeofemoralis muscle.With respect to the general process of muscle morphogenesis, the developmental pattern described for the gluteus maximus muscle demonstrates that adult muscles may be formed by a fusion of several fetal muscles.     

Double gluteus maximus muscle with associated variations in the gluteal region

Summary We report bilateral muscular and neurovascular anomalies of the gluteal region in a cadaver. On the right side, the gluteus maximus muscle had two parts, one of which was fibrous and the other muscular. In addition, there were duplicated piriformis muscles and high division of the sciatic nerve. The common peroneal nerve passed between the two parts of the piriformis muscle, and the tibial nerve emerged from under the lower piriformis muscle (infrapiriform foramen). At the same time the internal pudendal vessels and pudendal nerve passed over the sacrotuberous ligament on the left side. The double piriformis muscles and high division of the nerve are known as an anomaly which is believed to cause a nerve compression syndrome called the syndrome of the piriformis muscle. To the best of our knowledge anomalies of the gluteus maximus muscle and pudendal structures have not yet been reported. This complex anomaly should be kept in mind in connection with intramuscular injections of the gluteal region, the piriformis syndrome, and the surgery of this region.     

Double gluteus maximus muscle with associated variations in the gluteal region

Summary We report bilateral muscular and neurovascular anomalies of the gluteal region in a cadaver. On the right side, the gluteus maximus muscle had two parts, one of which was fibrous and the other muscular. In addition, there were duplicated piriformis muscles and high division of the sciatic nerve. The common peroneal nerve passed between the two parts of the piriformis muscle, and the tibial nerve emerged from under the lower piriformis muscle (infrapiriform foramen). At the same time the internal pudendal vessels and pudendal nerve passed over the sacrotuberous ligament on the left side. The double piriformis muscles and high division of the nerve are known as an anomaly which is believed to cause a nerve compression syndrome called the syndrome of the piriformis muscle. To the best of our knowledge anomalies of the gluteus maximus muscle and pudendal structures have not yet been reported. This complex anomaly should be kept in mind in connection with intramuscular injections of the gluteal region, the piriformis syndrome, and the surgery of this region.

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Muscle grand fessier dédoublé et variations associées de la région fessière

Résumé Les auteurs rapportent les anomalies musculaires et vasculo-nerveuses observées sur les deux régions fessières d'un même cadavre. À droite, le muscle grand fessier présentait deux portions, l'une fibreuse, l'autre musculaire. S'y associaient un m. piriforme double et une division haute du nerf sciatique. Le nerf fibulaire commun traversait le muscle piriforme entre ses deux chefs, le nerf tibial émergeait audessous de la partie inférieure du muscle piriforme (foramen infra-piriforme) (canal sous-pyramidal). Parallèlement, les vaisseaux honteux internes et le nerf honteux passaient au-dessus du ligament sacro-tubéral du côté gauche. Le m. piriforme double et la division haute du nerf sciatique sont des anomalies connues. La première est accusée d'être à l'origine d'une compression nerveuse appelée «syndrome du muscle piriforme». À notre connaissance l'association de l'anomalie du muscle grand fessier et des éléments honteux internes que nous présentons n'a encore jamais été décrite. Il faut avoir présente à l'esprit cette variation complexe lors d'anomalies dans la réalisation d'injections intramusculaires fessières, devant un syndrome du piriforme et lors de la chirurgie dans la région fessière.

     

The ramification of the superficial branch of the superior gluteal artery. Anatomical basis of a new gluteus maximus myocutaneous flap

Summary In order to design a new gluteus maximus myocutaneous flap, the ramification of the superficial branch of the superior gluteal artery was investigated in 56 sides of 33 Japanese cadavers. The superficial branch constantly divides into two main branches, which are called the ascending and transverse branches in this study. Of the ascending and transverse branches, one or both usually give off at least one well developed division running on the undersurface of the gluteus maximus muscle (98.2%). This division, which is called the intermediate branch in this study, generally reaches the superior edge of the muscle giving off only a couple of muscular branches and pierces the muscle and its deep fascia to supply skin (83.6%). Perforators of the intermediate branch constantly emerge from the fascia near the middle or lower one-third point on a line extending from the middle of the iliac crest to the tip of the greater trochanter.

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Les ramifications de la branche superficielle de l'artère gluteale supérieure. Bases anatomiques d'un nouveau lambeau myocutane de muscle grand fessier

Résumé Dans le but de créer un nouveau lambeau myocutané de muscle grand fessier, les ramifications de la branche superficielle de l'artère glutéale supérieure ont été étudiées chez 33 sujets japonais (56 cotés). La branche superficielle se divise de façon constante en deux rameaux principaux, qui seront appelés dans cette étude les branches ascendante et transverse. De l'une de ces deux branches, ou parfois des deux, naît souvent au moins un rameau bien développé courant sous le muscle grand fessier (98,2%). Cette branche de division, qui est nommée dans cette étude le rameau intermédiaire, atteint généralement la limite supérieure du muscle, en abandonnant seulement quelques rameaux musculaires, et perfore le muscle et son fascia profond pour vasculariser la peau (83,6%). Les branches perforantes du rameau intermédiaire traversent le fascia, de façon constante, au niveau du milieu ou du tiers inférieur d'une ligne tendue du milieu de la crête iliaque au sommet du grand trochanter.

     

小腿外侧群肌神经入肌点和肌梭丰度最高区中心的定位及其意义

目的　准确定位小腿外侧群肌的神经入肌点（NEP）和肌梭丰度最高区中心（CHRMSA）的位置。 方法　12具成人尸体,侧卧。经皮肤连接股骨外上髁与内上髁和股骨外上髁与外踝的连线分别为横向参考线（H）和纵向参考线（L）。解剖暴露NEP;Sihler's染色显示肌内神经分支密集区;HE染色肌梭,计算肌梭丰度;硫酸钡标记NEP和CHRMSA,CT扫描。NEP在体表的投影点为P,P通过NEP后投射至相反侧皮肤上的点为P',经P的垂线与H线、水平线与L线的交点分别记为PH 和PL,确定PH和PL在H和L线上的百分位置及NEP的深度。 结果　腓骨长、短肌的NEP的PH分别位于H线的13.41%和10.35%处,PL分别位于L线的21.81%和52.6%处;深度分别位于PP'线的50.89%和25.7%处。腓骨长、短肌的CHRMSA的PH分别位于H线的14.45%和12.86%处,PL分别位于L线的35.11%和71.49%处;深度分别位于PP'线的18.16%和20.40%处。 结论　这些结果可为小腿外侧群肌痉挛治疗中准确定位阻滞靶点提供解剖学指导。