29例先天性肌性斜颈术后复发病例的诊治

目的：对29例先天性肌性斜颈手术后复发病例的治疗进行总结。方法回顾性分析1998年1月至2013年1月收治的29例先天性肌性斜颈手术后复发病例的临床和随访资料。29例均行胸锁乳突肌双极松解术,术后予枕颌牵引1个月,佩戴胸颈联合支具3-6个月。结果29例均获得长期随访（11个月至10年）,患者头颈偏斜症状消失,颈活动正常,效果优良。结论胸锁乳突肌双极松解术,联合术后枕颌吊带牵引、佩戴胸颈联合支具,是治疗先天性肌性斜颈术后复发病例的有效方法。     

胸锁乳突肌锁骨头蒂半片锁骨瓣修复锁骨肩峰端的应用解剖学

目的 为修复锁骨中远端骨不连提供新的手术方法，方法 在４０例成人颈部标本上，观察胸锁乳突肌锁骨头的形态，血供及其与锁骨的关系，结果 锁骨头无损伤可分离长度为８．１ｃｍ，其主要血供为甲状腺上动脉胸锁孔突肌支，人肌点在该肌的肌前缘后１．７ｃｍ，距锁骨上缘６．８ｃｍ处结论 可设计以胸锁乳突肌锁骨头为蒂半片锁骨瓣移行行锁骨头中远端骨下连修复的术式。     

39例先天性肌性斜颈的手术治疗

目的:探讨先天性肌性斜颈的手术治疗方法。 方法 :对 39例先天性肌性斜颈患者采用胸锁乳突肌切断松解进行治疗 ,术中强调彻底松解 ,使胸锁乳突肌充分回缩 ,术后采用侧卧式训练方法。结果:2 8例经 1～ 5年随访 ,效果较好 ,优良率 96 %。 结论 :3～ 5岁为先天性肌性斜颈最佳手术年龄段 ,而胸锁乳突肌切断松解为首选术式。     

胸锁乳突肌乳突部形态学特征及其临床意义

目的为胸锁乳突肌乳突部扳机点疼痛的体表定位及诊治提供形态学依据。方法选取新鲜成人尸体头颈部标本15例,防腐成人尸体头颈部标本1例,对胸锁乳突肌乳突部的解剖结构及神经血管毗邻关系进行测量,包括乳突尖部肌肉、筋膜结构的宽度、厚度及乳突尖至耳垂、颈动脉鞘等之间的垂直距离。结果乳突水平肌肉前缘厚度(9.63±0.05)mm、肌肉中部厚度(10.36±0.07)mm、肌肉后缘厚度3.74±0.01mm,乳突止点部肌肉前缘至耳垂距离(17.42±2.53)mm、肌肉后缘至耳垂距离(62.74±12.53)mm,皮肤点至颈动脉鞘的(3.74±0.01)平均深度为(35.52±6.31)mm。结论从胸锁乳突肌乳突部的解剖特征来看,乳突后部行扳机点注射或针刺较为安全,乳突下及乳突前行扳机点注射时垂直进针、深度不宜超过20.00mm。     

人胸锁乳突肌的亚部化研究

目的 对人胸锁乳突肌进行亚部划分，为胸锁乳突肌移植的取材提供形态学资料。方法 ①用20例(40例)成人尸体的胸锁乳突肌进行骨骼肌亚部化研究。②用5例(10侧)童尸的胸锁乳突肌进行Sihler‘s肌内神经染色。结果 人胸锁乳突肌可分为胸骨头亚部、锁骨头浅亚部、锁骨头深亚部3个亚部，每个亚部都有一级神经支支配，且在每个亚部的中部各自有一明显的神经终末分支密集区。结论 胸锁乳突肌可分3个亚部，在临床上可根据受区肌力和动幅的要求按亚部取材。     

Myofascial trigger points, neck mobility, and forward head posture in episodic tension-type headache

OBJECTIVE: To assess the differences in the presence of trigger points (TrPs) in head and neck muscles, forward head posture (FHP) and neck mobility between episodic tension-type headache (ETTH) subjects and healthy controls. In addition, we assess the relationship between these muscle TrPs, FHP, neck mobility, and several clinical variables concerning the intensity and the temporal profile of headache. BACKGROUND: TTH is a headache in which musculoskeletal disorders of the craniocervical region might play an important role in its pathogenesis. Design.-A blinded, controlled pilot study. METHODS: Fifteen ETTH subjects and 15 matched controls without headache were studied. TrPs in both upper trapezius, both sternocleidomastoids, and both temporalis muscles were identified according to Simons and Gerwin diagnostic criteria (tenderness in a hypersensible spot within a palpable taut band, local twitch response elicited by snapping palpation, and elicited referred pain with palpation). Side-view pictures of each subject were taken in both sitting and standing positions, in order to assess FHP by measuring the craniovertebral angle. A cervical goniometer was employed to measure neck mobility. All measures were taken by a blinded assessor. A headache diary was kept for 4 weeks in order to assess headache intensity, frequency, and duration. RESULTS: The mean number of TrPs for each ETTH subject was 3.7 (SD: 1.3), of which 1.9 (SD: 0.9) were active, and 1.8 (SD: 0.9) were latent. Control subjects only had latent TrPs (mean: 1.5; SD: 1). TrP occurrence between the 2 groups was significantly different for active TrPs (P < .001), but not for latent TrPs (P > .05). Differences in the distribution of TrPs were significant for the right upper trapezius muscles (P= .04), the left sternocleidomastoid (P= .03), and both temporalis muscles (P < .001). Within the ETTH group, headache intensity, frequency, and duration outcomes did not differ depending on TrP activity, whether the TrP was active or latent. The craniovertebral angle was smaller, ie, there was a greater FHP, in ETTH patients than in healthy controls for both sitting and standing positions (P < .05). ETTH subjects with active TrPs in the analyzed muscles had a greater FHP than those with latent TrPs in both sitting and standing positions, though differences were only significant for certain muscles. Finally, ETTH patients also showed lesser neck mobility than healthy controls in the total range of motion as well as in half-cycles (except for cervical extension), although neck mobility did not seem to influence headache parameters. CONCLUSIONS: Active TrPs in the upper trapezius, sternocleidomastoid, and temporalis muscles were more common in ETTH subjects than in healthy controls, although TrP activity was not related to any clinical variable concerning the intensity and the temporal profile of headache. ETTH patients showed greater FHP and lesser neck mobility than healthy controls, although both disorders were not correlated with headache parameters.     

胸锁乳突肌瓣联合异体脱细胞真皮基质 预防腮腺部分切除术后Frey综合征的临床观察

目的:探讨胸锁乳突肌瓣联合应用异体脱细胞真皮基质(ADM)医用组织补片预防腮腺部分切除术后Frey综合征的临床应用效果。方法:103例腮腺良性肿瘤患者随机分成腮腺部分切除术+胸锁乳突肌肌筋膜瓣转移修复术组(A组)和腮腺部分切除术+胸锁乳突肌肌筋膜瓣转移修复术+ADM修复术组(B组)各35例,不采用任何修复方式直接关闭手术创面组(C组)33例。随访6～42个月。统计3组患者术后半年碘-淀粉试验阳性例数和主观评价阳性例数。结果:A组和C组复查时碘-淀粉试验阳性率和主观评价阳性率均明显高于B组(P<0.01),而C组患者碘-淀粉试验阳性率和主观评价阳性率均明显高于A组(P<0.01)。结论:应用胸锁乳突肌肌筋膜瓣转移修复术预防腮腺部分切除术后Frey综合征的效果满意,联合应用ADM则能取得更好的临床疗效。     

胸锁乳突肌三维有限元的建立

目的：采用三维有限元重建技术,建立出胸锁乳突肌的三维有限元模型。研究和分析颈部体位姿势对本模型各组成部分应力变化和分布特点的影响。方法：取材来自中国数字人I号头颈部断面切片图片,层距0.2mm,图片序号7800-8400,包含数字人胸锁乳突肌全长。对图片序号每间隔10张抽取1张,层厚2mm(0.2mm×10)。图片保存为BMP灰度图。采用Ansys8.0软件,分别以双侧轴向向上载荷100N,作用于乳突部,模拟头后仰时拉伸力;给一侧乳突部水平向前拉力100N,另一侧乳突部水平向后拉力100N,模拟头旋转时作     

86例腮腺混合瘤手术后Frey(L)综合征的临床分析

本文对86例腮腺混合瘤术后发生Frey(L)综合征的52例患者进行了分析。表明Frey(L)综合征发生与手术方式有关,保留面神经的肿瘤及部分腮腺切除术与肿瘤及全腮腺切除术二者之间有显著性差别,后者明显高于前者(P<0.01)。本文认为采用部分胸锁乳突肌肌瓣插入腮腺缺损部位的方法可预防或减少Frey(L)综合征的发生。