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。     

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...     

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。     

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。     

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。     

三角肌神经入肌点定位及肌内神经分布的研究

目的　揭示三角肌神经入肌点和肌内神经分支分布 ,为其临床应用提供较为详尽的形态学资料。方法　①用经甲醛固定 2年以上的成人尸体 (2 0～ 5 0岁 ) 12具 (男 9,女 3)共 2 4侧。以肩峰后角为骨性标志 ,测量三角肌各亚部神经支入肌点的位置。②用经甲醛固定 1年以内的童尸 3具 (3～ 10岁 )及成人尸体 2具 (2 0、4 0岁 )完整取下三角肌 ,采用Sihler′s肌内神经染色法观察肌内神经分支分布。结果　①三角肌各亚部神经入肌点的体表投影 :三角肌前亚部、中亚部、后亚部的神经入肌点分别在距肩峰后角下方 (5 7± 0 7)cm、(5 9± 0 8)cm、(4 8± 0 5 )cm处的水平线上 ,距三角肌前缘外后方 (3 6± 0 4 )cm处及距三角肌后缘外前方 (3 5± 0 6 )cm、(2 3± 0 3)cm处 ,上述三点均在肌的中 1/3部。②肌内神经分布 :三角肌前、后亚部的肌内神经支在肌内为直接横过肌纤维中部 ,沿途再发出分支与肌纤维并行走行 ;而中亚部肌内神经支在各个羽内 ,与肌纤维相交 ,行向短肌纤维的起止端。结论　①三角肌的神经入肌部位及入肌形式与该肌的形态和功能有关联 ;②三角肌的肌内神经分支分布可能与该肌的肌纤维长度及肌纤维型有关 ;③三角肌中亚部的肌内神经吻合网较宽而致密 ,推测有着更精细的神经调节。     

腹外斜肌的神经入肌点定位与肌内神经分布研究

目的　对人腹外斜肌的神经入肌点定位和肌内神经染色观察,为其临床应用提供形态学资料。 方法　成尸11具定位神经入肌点和5具行Sihler’s 肌内神经染色。 结果　腹外斜肌受下8对肋间神经外侧肌支支配,各个肌齿的神经入肌点距离相应肌齿起端中点(1.54±0.33)cm,位于锁骨中线与第5肋下缘的交界处至腋后线与第11肋下缘交界处的连线上。Sihler’s染色显示支配腹外斜肌的肋间神经外侧肌支入肌后分出小分支分布到各肌齿的起端1/3,然后约在各肌齿的近、中1/3交界处分出2支二级神经分支,即上支与下支,它们分出小分支分布到各肌齿的中间1/3,相邻两个肌齿的上支与下支在各肌齿中远部形成“U”形吻合,从“U”形吻合弓上分出小分支分布到各肌齿的止端1/3。在腹外斜肌上半部,各肌齿的神经分支分布到相应的肌齿,但在腹外斜肌下半部,上一肌齿的远侧下份是由下一肌齿的神经分支(上支)分布。 结论　①为临床上腹壁局部麻醉和术后切口疼痛的神经阻滞提供指导意义;②腹外斜肌中远部从上至下形成“波浪形”的神经分支密集区;③腹部手术切口建议不要超过四个肌齿。     

人股二头肌肌内神经分布和神经入肌点定位

目的查清人股二头肌长头和短头的肌内神经分布和神经入肌点定位,为其肌移植提供形态学依据。方法(1)观察20具尸体股二头肌长头和短头的神经分支数量,拟将坐骨结节与股骨外上髁连线分4等份,观测神经入肌点水平。(2)用3具童尸股二头肌做Sihler's肌神经染色,观察肌内神经分布。结果(1)长头神经来自坐骨神经胫侧,神经肌支一支型占22.5%,两支型72.5%,三支型5.0%,入肌点位于1/4区占22.1%,2/4区57.1%,3/4区20.8%。短头神经来自坐骨神经腓侧,一支型占95.0%,两支型5.0%,入肌点在肌的近部浅面。(2)长、短头肌内神经分支各形成一条神经支配带,横过各肌束中段。结论股二头肌长头和短头有单独神经支配。长头神经支配多见于两支型,神经入肌点多见于2/4区。     

前臂前群肌痉挛神经阻滞靶点定位的研究进展

<正>脑卒中、脊髓损伤、多发性侧索硬化、脑外伤等中枢神经系统疾病患者常随病情进展出现不同程度的肌痉挛。前臂前群肌属于高发痉挛肌,69%的脑卒中患者会出现明显肌痉挛^[1],表现为肘、掌指和指间关节屈曲以及前臂旋前等畸形,影响生活质量^[2]。     

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.     

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.     

Effect of electrical stimulation training on the contractile characteristics of the triceps surae muscle

Summary This study aimed to assess the effects of training using electrical stimulation (ES) on the contractile characteristics of the triceps surae muscle. A selection of 12 subjects was divided into two groups (6 control, 6 experimental). The ES sessions were carried out using a stimulator. Flexible elastomer electrodes were used. The current used discharged pulses lasting 200 s at 70 Hz. Contraction time was 5 s and rest time 15 s. The session lasted 10 min for each muscle. Training sessions were three times a week for 4 weeks. Biomechanical tests were performed using an isokinetic ergometer. Subjects performed plantar flexions of the ankle over a concentric range of movement at different angular velocities (60, 120, 180, 240, 300, 360°·s^–1) and held isometric contractions for 5 s at several ankle flexion angles (–30/–15/0/15°–0 corresponded to foot flexion of 90° relative to the leg axis). The force-velocity relationship was seen to shift evenly upwards under the influence of ES (P<0,05). The increased force during the after test was greater (P<0,05) for ankle angle positions of 15° and –30°, which demonstrated a link between the training angle and the gain in strength. No change was noted in the cross-sectional area of the muscle. The results showed that ES allowed the contractile qualities of muscle to be developed in isometric and dynamic conditions. Nervous mechanisms can account for most of these adaptations.     

To what extent is the tibia-calcaneum angle a reliable measurement of the triceps surae length? Radiological correction of the torque-angle curve (III)

Summary Previous papers gave some methods for the reliable measurement of the tibia-calcaneum angle. It is of common use to evaluate the physical properties of triceps surae on the basis of torque-angle curves. However this method is reliable only if each tibia-calcaneum angle corresponds to a defined distance between the insertions of the muscle in subjects of the same height. Evidence is given by radiological measurements that this correspondance is correct in normal children. However, this is no longer true in certain cerebral palsied children because of abnormal translation of the calcaneum and/or abnormal ratio of bone sizes. In this case the torque-angle curves do not define properly the torque-length curves. A method of correction is given. This correction may be as high as 15.MaÎtre de Recherche INSERM (Paris), grant No. 7411766 and U.E.R. Paris-Ouest     

Contributions of slow and fast muscles of triceps surae to a cyclic movement

Summary The relative contribution of synergistic muscles has been studied during pedalling on a bicycle. The electromyographic (EMG) activity of the different components of triceps surae (namely soleus or SOL and medial gastrocnemius or MG) has been recorded and analyzed for increasing pedalling speed performed against increasing resistance. The results indicate that SOL IEMG (integrated EMG) increases linearly (y=2x−12.1; r=0.98) with increasing load (10–70 N) at constant speed (60 rpm), whereas no change is noted in MG IEMG below 40 N. In contrast, wehen the pedalling speed is increased (from 30 to 170 rpm) at constant load, MG IEMG shows the largest increase. Furthermore, although in both muscles EMG activity appears earlier in the movement with increases in load and/or speed, the delay between the onset of both EMGs remains unchanged at constant speed and synchronization of MG with SOL is only observed when speed is increased above 140 rpm. These results suggest that the different muscles of the triceps surae make specific contributions to the development of the mechanical tension required to maintain or increase the speed of movement. This work was supported by the Fonds National de la Recherche Scientifique of Belgium and the Conseil de la Recherche of the University of Brussels     

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。     

Identification of time-varying dynamics of the human triceps surae stretch reflex

We examined the time-varying dynamics of the human triceps surae stretch reflex before, during, and after a large stretch was imposed upon the ankle joint, during a constant voluntary contraction of 15% of maximum voluntary contraction. Stretch reflex dynamics were estimated by superimposing a small stochastic displacement on many such stretches and using an ensemble-based time-varying identification procedure to compute impulse response functions relating the perturbation to the evoked electromyogram (EMG) at each point throughout the task. We found that stretch reflex magnitude (relating joint velocity to EMG) varied directly with baseline EMG activity during steady-state conditions before and after the large imposed stretch. Following the large stretch and the reflex activity it evoked, both background EMG and stretch reflex magnitude declined for up to 100 ms; changes in the stretch reflex were substantially greater in magnitude and followed a different time course from the corresponding changes in background EMG, however, indicating that stretch reflex properties were modulated independently of motoneuron pool activation level. Based on timing and the invariance of stretch reflex dynamics across time, it is argued that this behavior is largely mediated via peripheral neural mechanisms. This peripheral modulation of the stretch reflex presumably supplements various descending influences to adjust reflex properties.     

Comparison of the histochemical and contractile properties of human triceps surae

The purpose of the study was to compare the contractile properties determined from an electrically stimulated twitch with histochemically determined fibre type parameters of the human triceps surae. Muscle samples were obtained from the medial head of the gastrocnemius of ten male athletes. Ages ranged from 20 to 29 years. Muscle samples from the belly of the medial gastrocnemius muscle were obtained using the needle biopsy technique. The samples were treated histochemically for myosin ATPase to classify the fibres as either slow twitch (ST) or fast twitch (FT) and to determine fibre areas. Surface electrical stimulation was used to determine muscle twitch parameters. The contractile variables of the muscle twitch were latency (L), time to peak force (TPF), peak force (PF), half-contraction time (1/2 CT) and half-relaxation time (1/2 RT). Backward elimination procedures for dependent variables were used to determine which contractile properties best represented the histochemical profile of the muscles. Prediction formulas were developed for FT and ST percentages (R²=0·98, p<0·001), relative area percentage (R²=0·87, p<0·001), and ST area (R²=0·85, p<0·01). It was concluded that the use of the electrotensiometer (ETM) protocol was a valid testing procedure when studying physiological relationships of histochemical properties in intact human skeletal muscle. Protected by patent no. 4 688 581.