模拟足拇展肌与拇收肌移位吻接术生物力学性质实验研究

研究了正常拇展肌、拇收肌拉伸力学性质和模拟拇外翻拇展肌，拇收肌移位吻接术后拇展肌和拇收肌的力学性质。取10个足标本，解剖后暴露拇展肌与拇收肌，将标本固定于电子万能试验机底座上，由钢丝绳吊钩沿拇收肌、拇展肌纵行方向钩住、钢丝绳上端固定于试验机上夹头上，驱动机器，对标本施加拉应力，直至拇收肌或拇展肌断裂，得出拉伸最大载荷、应力、应变等数据。对断裂后的拇收肌和拇展肌模拟临床手术进行移位吻接，10个拇展肌标本做了腱与腱移位吻接，另取10个拇收肌标本做了腱与腱吻接，10个拇收肌标本做了腱与骨膜吻接。分别对吻接后的标本进行拉伸实验，分别得出了吻接术后各组的拉伸最大载荷、应力、应变等数据和曲线。 以多项式，用最小二乘法得出了各组标本的应力-变关系表达式及应力应变曲线。实验结果表明，拇收肌的应力与拇展肌接近。拇收肌应变大于拇展肌。模拟临床手术拇展肌腱与腱吻合拉伸强度大于拇收肌腱与腱吻合。应变小于拇收肌腱与腱吻合，拇收肌移位腱与骨膜吻接强度低于腱与腱吻合，二者应变较接近。得出了一些重要结论。对实验结果进行分析讨论。     

拇收肌后间隙内独立肌束的形态学研究

解剖观察成人手标本94侧（左52，右42），在拇收肌后间隙内独立肌束的存在率为72．34％，肌束远端肌腿终止于拇收肌腱近侧及拇指指背腱膜，依肌束近端附着位置和状态分为第一掌骨型（57．35％，第二掌骨型（7．35％），掌筋膜型（5．88％）及混合型（29．42％），肌束由尺神经支配，可视为拇内收肌的重要协同肌。     

带蒂拇展肌移植修复晚期面瘫的应用解剖研究

目的：为拇展肌移植治疗晚期面瘫提供形态学资料。方法：在５０侧成人下肢中观察了每展肌的形态,血供和神经支配。结果：拇展肌位置表浅,位于足底肌的第一层,其血供和神经支配分别来自足底内侧动脉和神经,两者伴行,走行恒定。结论：拇展肌是修复晚期面瘫的理想供肌。     

环指屈肌腱损伤吻接术前、后力学性能测试研究

研究正常环指屈肌腱拉伸力学性能和模拟屈肌腱损伤后吻接术后屈肌腱的力学性能,为临床提供生物力学参数。取10个手环指标本,解剖后暴露环指,将标本固定于电子万能试验机底座上,由钢丝绳吊钩沿屈肌腱纵行方向钩住、钢丝绳上端固定于试验机上夹头上,驱动机器,对标本进行拉伸实验,施加拉应力,直至屈肌腱断裂。对断裂后的屈肌腱模拟临床手术进行移位吻接,对10个标本做了腱与腱移位吻接。再对吻接后的标本进行拉伸实验。分别得出了正常组标本和吻接术后标本的拉伸最大载荷、应力、应变等数据。表明:屈肌腱腱与腱吻合组最大载荷、应力、应变均小于正常对照组,但模拟末端编织法吻接术腱与腱吻合组标本,仍具有较好的拉伸力学性能指标。     

拇短展肌双肌腹双起始变异1例

拇短展肌具有外展、外旋拇指及使拇指腕掌关节屈曲的作用.拇短展肌一般为单肌腹,双肌腹变异极为罕见.我们在新鲜标本的解剖中,发现拇短展肌存在双肌腹双起点变异,报道如下:该标本系青年男性前臂远端肢体标本,我们解剖发现拇短展肌具有两个肌腹,按其位置关系可分为尺侧肌腹和桡侧肌腹,其中足侧肌腹的桡侧被桡侧肌腹的尺侧部分覆盖.     

罗库溴铵对眼轮匝肌和拇收肌临床药效学比较

目的 比较罗库溴铵对眼轮匝肌和拇收肌临床药效学的差异.方法 选择心、肺、肝、肾和神经肌肉功能基本正常的30～50岁全麻普外及妇科手术患者男女各10例,丙泊酚和芬太尼维持麻醉.静注罗库溴铵0.3 mg/kg后,记录同侧眼轮匝肌和拇收肌诱发颤搐反应的抑制过程和恢复过程.结果 拇收肌的显效时间和达到最大抑制程度的时间[(41.0±8.3)s和(241.3±60.8)s]与眼轮匝肌[(42.0±7.9)s和(276.0±62.6)s]基本相同(P＞0.05),而最大抑制程度(95.3%±5.2%)比服轮匝肌(67.7%±15.3%)显著增高(P＜0.01).T1(4个成串刺激中的第1个肌颤搐反应)恢复到基础值50%和75%的时间,拇收肌[(19.8±5.1)min和(24.1±6.2)min]与眼轮匝肌的[(17.5±8.7)min和(27.3±8.6)min]差异无统计学意义(P＞0.05),但T1恢复到基础值95%和100%的时间,拇收肌[(29.2±7.6)min和(31.1±8.3)min]明显比眼轮匝肌[(37.4±9.0)min和(40.0±9.1)min]快,差异有统计学意义(P＜0.01).TOFr恢复到基础值80%的时间,拇收肌[(30.2±8.1)min]和眼轮匝肌[(28.8±8.8)min]基本相同(P＞0.05).结论 中青年患者给予1倍ED95罗库溴铵对眼轮匝肌和拇收肌阻滞过程的差异主要表现在眼轮匝肌最大阻滞程度显著比拇收肌低,以及肌肉松弛效应完全消除时间显著比拇收肌长,而起效时间则基本相同.     

双侧拇长展肌、拇短伸肌变异一例

作者在解剖操作中于一男性尸体上发现一例双侧拇长展肌双肌腹、三肌腱,拇长展肌肌腹与拇短伸肌肌腹相融合变异,与早前报道的一例相关变异案例相比[1],此变异的肌腱数移行为3根（早前报道的为2根）,同时出现了两肌肌腹融合的情况（早前报道并未涉及）,故此变异类型较为罕见,现报道如下。1一般资料左侧拇长展肌（图1）于肌腹中下1/3处分出第     

小指屈肌腱损伤吻接术拉伸实验研究

目的研究正常国人小指屈肌腱模拟损伤吻接术后的力学特性,为临床提供生物力学参数。方法取急性头部外伤致死成年人新鲜尸体的20个整手标本,解剖暴露小指屈肌腱,采用电子万能试验机进行拉伸实验,直至屈肌腱断裂(Ⅰ组),然后分二组,分别用腱与腱末端编织法吻合(Ⅱ组,10例),和腱与展腱膜末端编织法吻合(Ⅲ组,10例),再进行拉伸实验至断裂,记录断裂时的破坏载荷、应力、应变。结果正常组(Ⅰ组)的破坏载荷为237.4N、应力24.5MPa、应变12.6%,Ⅱ组分别为100.6N、2.4MPa、11.5%。Ⅲ组为63N、12.6MPa、14.7%。结论小指肌腱断裂以腱-腱末端编织法吻合能取得最佳的力学效果,适合临床采用。     

拇短展肌对拇指指骨间关节背伸作用的解剖学研究

目的　为解决胸小肌移植重建拇对掌功能术后出现拇指指骨间关节屈曲畸形提供解剖学依据并寻找解决办法。 方法　在15具尸体手标本上,使拇指处于对掌位时,测量拇指指骨间关节在拇短展肌未切断及切断两种情况下的自然屈曲角度;同时,通过外力作用使拇指指骨间关节分别屈曲处于45°及60°时,分析拇短展肌对拇指指骨间关节屈伸功能的影响。 结果　拇指处于对掌位时,拇短展肌在未切断及切断两种情况下,拇指指骨间关节自然屈曲角度分别为（13.30±2.13）°及（24.03±1.25）°;同时,使拇指指骨间关节屈曲处于45°时,所用外力分别约（0.50±0.08）N及（0.22±0.07）N,而使拇指指骨间关节屈曲处于60°时,所用外力分别约（1.48±0.09）N及（1.15±0.04）N。 结论　拇短展肌对拇指指骨间关节主要起背伸作用,因此胸小肌移植重建拇对掌功能时,应同时重建拇短展肌功能,才有可能纠正在拇对掌功能重建术后出现的拇指指骨间关节屈曲畸形。     

展肌游离移植的应用解剖学

对20侧新鲜成年尸足解剖,观测展肌的形态、血供和神经支配。该肌血供和神经支配分别来自足底内侧动静脉和足底内侧神经.可设计以足底内侧血管和足底内侧神经为蒂的展肌瓣,以期游离移植修复和重建面瘫等功能缺失。     

展肌转位修复跟腱的应用解剖

在30侧成人下肢标本上,观测了拇展肌形态和血供。设计了以足底内侧动脉或其深支为蒂的拇展肌或肌皮瓣转位修复跟腱和皮肤缺损的术式。并作了拇展肌肌腱和跟腱的拉伸破坏试验:拇展肌肌腱载荷平均为66.4kg,跟腱载荷平均为235.2kg。两者载荷之比为1∶3.5.     

Anatomical study of human adductor hallucis muscle with respect to its origin and insertion

The adductor hallucis muscle (ADH) is evolutionally and functionally important, but no detailed morphological data about this muscle in the human body is available. In the present study, we examined the origin and insertion of the oblique and transverse heads of the ADH. Forty-five feet (20 right, 25 left) of 34 cadavers (13 men, 21 women, average age of 80 years old) were used in the present study. The origin, insertion and nerve supplies of the oblique and transverse heads of the ADH were macroscopically examined in detail. Most commonly, the oblique head of the ADH arose from the bases of the 2nd, 3rd and 4th metatarsal bones, the plantar metatarsal ligaments spanned between the bases of the 2nd, 3rd and 4th metatarsal bones, the lateral cuneiform bone, the fibrous sheath of the tendon of the peroneus longus muscle and the long plantar ligament, and inserted into the lateral sesamoid bone of the great toe and the capsule of the 1st metatarsophalangeal joint. Most commonly, the transverse head of the ADH originated from the capsules of the 3rd and 4th (and occasionally 5th) metatarsophalangeal joint and the deep transverse metatarsal ligaments, and inserted into the lateral sesamoid bone of the great toe, the capsule of the 1st metatarsophalangeal joint and lateral surface of the base of the 1st proximal phalanx. This muscle was classified into four types based on the origin of its oblique head and was classified into three types based on the origin of its transverse head. The percent ratio of the weight of the oblique head to the total weight of all the intrinsic muscles of the foot was 9.4% ± 1.5, and the transverse head was 1.5% ± 0.6 (n = 14). The transverse head of ADH tends to be reduced in size in the human, but the oblique head is well developed with no sign of reduction.     

Intramuscular nerve distribution pattern of the oblique and transverse heads of the adductor hallucis muscles in the human foot

To understand which layer of the intrinsic muscles of the foot the adductor hallucis muscle belongs to, it is essential to investigate the innervation patterns of this muscle. In the present study, we examined the innervation patterns of the adductor hallucis muscles in 17 feet of 15 Japanese cadavers. We investigated the intramuscular nerve supplies of the adductor hallucis muscles in six feet and performed nerve fiber analysis in three feet. The results indicate that: (i) the oblique head of the adductor hallucis muscle is divided into three compartments (i.e. lateral, dorsal and medial parts) or two compartments (i.e. dorsal and medial parts) based on its intramuscular nerve supplies, but we could not classify the transverse head into any parts; (ii) the communicating twig between the lateral and medial plantar nerves penetrated the oblique head of the adductor hallucis muscle in 13 of 17 feet (76.5%); (iii) the penetrating twig entered between the lateral and dorsal parts of the oblique head, passed between the lateral and medial parts of this muscle and then connected with the medial plantar nerve; and (iv) the majority of the nerve fibers of the penetrating twig derived from the lateral plantar nerve. The present study demonstrated that only the lateral part of the oblique head of the adductor hallucis muscle had a unique innervating pattern different from other parts of this muscle, suggesting that the lateral part of the oblique head has a different origin from other parts of this muscle.     

三维可视化重建 展肌上缘动脉弓为蒂的可移植岛状皮瓣

背景：目前以 展肌上缘动脉弓为蒂的岛状皮瓣设计依赖于临床医生的抽象思维,难以定量分析和交流学习,使其在临床上的推广使用受限。 目的：对 展肌上缘动脉弓为蒂的岛状皮瓣进行三维可视化重建,建立该皮瓣动脉的可视化模型。 方法：选取新鲜成人标本1具,经胫前动脉与胫后动脉行明胶-氧化铅混悬液灌注后,足部64排CT扫描,并通过mimics10.0软件重建内踝前动脉、跗内侧动脉、足底内侧动脉浅支及其吻合支,观察 展肌上缘动脉弓的形成、走形与分布情况。根据解剖结构的特点,对皮肤及其血管进行重建,获得立体形态的动脉皮瓣结构。 结果与结论：三维重建的各部位层次分明, 展肌上缘动脉弓显示良好、实体感强、皮肤和动脉的相互关系一目了然,在三维重建的图像中清楚的观察各解剖结构的形态,特别是 展肌上缘动脉弓的形成及其体表投影得到了很好的显示。结果表明 展肌上缘动脉弓为蒂的岛状皮瓣三维重建对基础研究、临床试验及手术规划具有重要价值,为临床个性化手术方式的选择提供直观的参考,从而提高手术成功率。     

Anomalous tibialis posterior muscle as an etiologic factor of hallux valgus

The role of an anomalous tibialis posterior (TP) tendon in the etiology of hallux valgus (HV) deformity was investigated in four stages: clinical, anatomical, neurological, and operative. In the clinical stage, the patients were instructed to planter flex and invert the foot to contract the TP tendon. Attempts to correct the deformity passively were not possible and resulted in, moderate pain in all patients (197 feet). When the foot was in dorsiflexion and everted (TP tendon was relaxed) the deformity was easily corrected without any pain in 196 feet (99.5%). In the second stage (anatomical), 10 cadavers (20 feet) with HV deformity and 10 cadavers (20 feet) without any foot deformity were dissected. An abnormal expansion of TP tendon into the oblique part of adductor hallucis was found consistently in all HV feet. The tendinous expansion was absent in all normal feet studied. Also when traction was applied to TP tendon, an increase in the metatarsophalangeal (MP) angle of the big toe was observed in all HV feet, but not in the control group. In the third group (neurological), faradic stimulation was applied to the TP muscle in 7 patients with HV deformity and 7 without deformity. The MP angle was increased in HV patients, but no change was observed in the control group. In the fourth stage, 11 patients (18 feet) surgically operated for HV deformity by proximal metatarsal osteotomy and excision of the band anchoring TP tendon to the oblique part of adductor hallucis. The results were excellent in 10 patients (17 feet) even after a minimum 2.5 year follow-up. Also, in two patients who were operated by different procedures with poor results, the TP tendon was lengthened by Z-plasty and they were completely pain free. Our data show the dynamic role of anomalous expansions of the TP tendon into the oblique part of adductor hallucis muscle in HV patients. We suggest this expansion be excised in addition to other operative procedures selected for the surgical treatment of HV patients. © 1994 Wiley-Liss, Inc.     

Anatomical variations of the flexor hallucis longus muscle and the consequences for tendon transfer. A cadaver study

The aim of this study was to evaluate the occurrence of anatomical variations of the musculotendinous junction of the flexor hallucis longus muscle. Eighty cadaver specimens preserved according to Thiels method were assessed. Following careful dissection, the distance between the musculotendinous junction and the bone–cartilage border of the distal tibia was determined. Three typical anatomical variations were found: (1) a long lateral and shorter medial muscle belly; (2) equal-length medial and lateral muscle bellies; (3) a long medial and shorter lateral muscle belly. As a special variation in two cases only one lateral muscle belly was found. When planning a flexor hallucis longus transfer, preoperative magnetic resonance tomography (MRT) should be carried out in order to guarantee sufficient coverage of an existing soft tissue defect. These anatomical characteristics have also to be considered when interpreting ultrasonic or MRT findings in this region.     

The adductor part of the adductor magnus is innervated by both obturator and sciatic nerves

The hip adductor group, innervated predominantly by the obturator nerve, occupies a large volume of the lower limb. However, case reports of patients with obturator nerve palsy or denervation have described no more than minimal gait disturbance. Those facts are surprising, given the architectural characteristics of the hip adductors. Our aim was to investigate which regions of the adductor magnus are innervated by the obturator nerve and by which sciatic nerve and to consider the clinical implications. Twenty‐one lower limbs were examined from 21 formalin‐fixed cadavers, 18 males and 3 females. The adductor magnus was dissected and was divided into four parts (AM1‐AM4) based on the locations of the perforating arteries and the adductor hiatus. AM1 was supplied solely by the obturator nerve. AM2, AM3, and AM4 received innervation from both the posterior branch of the obturator nerve and the tibial nerve portion of the sciatic nerve in 2 (9.5%), 20 (95.2%), and 6 (28.6%) of the cadavers, respectively. The double innervation in more than 90% of the AM3s is especially noteworthy. Generally, AM1–AM3 corresponds to the adductor part, traditionally characterized as innervated by the obturator nerve, and AM4 corresponds to the hamstrings part, innervated by the sciatic nerve. Here, we showed that the sciatic nerve supplies not only the hamstrings part but also the adductor part. These two nerves spread more widely than has generally been believed, which could have practical implications for the assessment and treatment of motor disability. Clin. Anat. 27:778–782, 2014. © 2013 Wiley Periodicals, Inc.     

The anatomy of the hip abductor muscles

The anatomy of the hip abductors has not been comprehensively examined, yet is important to understanding function and pathology in the gluteal region. For example, pathology of the hip abductor muscle‐tendon complexes can cause greater trochanteric pain syndrome, and may be associated with gluteal atrophy and fatty infiltration. The purpose of this study was to investigate the detailed morphology of gluteus medius (GMed), gluteus minimus (GMin), and tensor fascia lata (TFL), and determine whether the muscles comprised anatomical compartments. The gluteal region from 12 cadavers was dissected and data collected on attachment sites, volume, fascicular and tendinous anatomy, and innervation. Three sites of GMed origin were identified (gluteal fossa, gluteal aponeurosis, and posteroinferior edge of the iliac crest) and the distal tendon had lateral and posterior parts. GMed was the largest in volume (27.6 ± 11.6 cm³; GMin 14.1 ± 11.1 cm³; TFL 1.8 ± 0.8 cm³). Fascicles of GMin originated from the gluteal fossa, inserting onto the deep surface of its distal tendon and the hip joint capsule. TFL was encapsulated in the fascia lata, having no bony attachment. Primary innervation patterns varied for GMed, with three or four branches supplying different regions of muscle. Distinct secondary nerve branches entered four regions of GMin; no differential innervation was observed for TFL. On the basis of architectural parameters and innervation, GMed, and GMin each comprise of four compartments but TFL is a homogenous muscle. It is anticipated that these data will be useful for future clinical and functional studies of the hip abductors. Clin. Anat. 27:241–253, 2014. © 2013 Wiley Periodicals, Inc.