背阔肌与肱二头肌之间发现肌束一例

本人在局部解剖学的带教实验中,发现背阔肌与肱二头肌之间存在肌束一例,现报告如下：     

游离背阔肌皮瓣的感觉神经支配应用解剖

目的：为形成带感觉神经的游离背阔肌皮瓣提供解剖学基础。方法：在20例40侧成人躯干标本上,观测了分布于背阔肌区域的肋间神经、胸脊神经的来源、走行及分布规律。结果：T5～10神经外侧支的后支在腋前线1～2cm相应肋间穿出,呈节段性重叠性分布肩胛线以外的背阔肌区皮肤;其中T6～8分布于皮瓣范围较大、神经蒂较长并距血管蒂接近。第6～11胸脊神经后支穿出骶棘肌后,在胸腰筋膜中走行4～5cm距离,后穿出在背阔肌浅层行3～5cm,呈重叠性节段性分布于肩胛线内侧的背阔肌区的皮肤。其中以第8、9胸脊神经后支在皮瓣中分布较大。结论：可设计以第6～8肋间神经外侧支的后支和/或以第8、9胸脊神经后支为神经蒂的感觉背阔肌皮瓣。     

背阔肌及其血管,神经供给的解剖观察

在５０例福尔马林固定的尸体上，经动脉内灌注红色乳胶后，解剖观测了背阔肌上缘、内侧缘、前缘的长度及面积和厚度，并对背阔肌的主要营养动脉－胸背动脉走行、分布做了观测。     

背阔肌作动力性心肌成形术的应用解剖

在２５例成人尸体上，对左侧背阔肌的形态、血管、神经进行了观测。对以骨阔肌作动力性心肌成形术的有关应用解剖学进行了研究。我们设计了以胸背动脉外侧支为蒂的背阔肌瓣，该瓣长３７．４±３．２ｃｍ，肌瓣的心脏部面积约为（２６．０＋２．４）×１２．０÷２ｃｍ＾２。胸壁开窗背阔肌进入胸腔部位，选择在左侧腋中线至腋前线之间的第３肋骨，更有利于心肌成形术。     

肱二头肌副头及其应用解剖

解剖观察了 80具成年尸体 (男 ,5 1,女 2 9) ,共有 16具尸体 (男 10 ,女 6 )的 18侧上肢存在肱二头肌副头 ,侧发生率为 11 2 5 % ,其中 4头者仅 1例。观测了副头的起止、肌腹形态、神经支配与动脉来源等特点。发现有 83 33%肱二头肌副头的起点集中于肱骨中段上部的前面 ,起点在距离喙肱肌止点最下部 1～ 4cm的区域 ;肌腹形态以圆 (条 )索状最多、带状次之。肱二头肌副头的神经由肌皮神经发支者占 86 6 7% ,其余由正中神经发支 ;副头动脉由肱动脉发出者占 75 % ,其余由肱二头肌动脉发出者占 2 5 %。分析了肱二头肌副头的临床意义     

肱二头肌长头肌腱病变与肩袖损伤的相关性及临床意义分析

目的 分析肱二头肌长头肌腱（long head of the biceps brachii tendon,LHBT）病变与肩袖损伤的相关性及临床意义。 方法　分析2010~2017年间西南医科大学附属中医医院经关节镜修复的126例肩袖损伤患者,术中对LHBT进行检查和评价,记录LHBT病变种类,分析LHBT病变与肩袖撕裂时间、撕裂大小和累及肌腱的相关性。 结果　发现LHBT I型病变（肌腱炎）51例（40.5%）,II型病变（半脱位）12例（9.5%）,III型病变（全脱位）12例（9.5%）,IV型病变（部分撕裂）15例（11.9%）,V型病变（完全撕裂）6例（4.8%）,30例（23.8%）无明显LHBT病理改变;病史超过12周的慢性肩袖撕裂患者均伴有LHBT病变;伴肩胛下肌（subscapularis,SSC）撕裂的肩袖损伤患者更易出现LHBT病变,且SSC撕裂程度越大,LHBT病变发生率越高,差异有统计学意义（P<0.05）。 结论 LHBT病变与肩袖损伤特别是合并SSC撕裂者密切相关,LHBT病变与SSC撕裂程度呈正相关;检查肩袖损伤的病例时,应注意LHBT的情况,避免漏诊;肩袖损伤的早期识别与修复可防止LHBT病变进一步恶化。     

第三趾屈肌腱及趾背腱膜的断面解剖

目的：为解剖学及断趾再植提供第三趾断面解剖学资料。方法：经组织学处理切片，在显微镜下进行观测。结果：根据屈肌腱和趾背腱膜的形态，各分为8种和4种类型。屈肌腱的平均厚度在1．90mm左右，趾背腱膜I、Ⅱ断面分别为0．86m和0．54m。结论：屈肌腱和趾背腱膜的面积由近到远逐步变小。     

背阔肌肌皮瓣的血管解剖及其临床应用

目的 探讨背阔肌肌皮瓣与血供的关系,为肌皮瓣的再划分、转位及移植提供解剖学基础。方法 用大体解剖学、血管X 线造影方法,对48例尸体背阔肌进行观察,并回顾背阔肌肌皮瓣进行临床应用31例的效果。结果 背阔肌肌皮瓣有多个血供来源,其中胸背动脉主干分布于背阔肌外上部。恒定地分出内侧支和外侧支,具有各自分布区域。背阔肌内下部由肋间动脉和腰动脉供应。据X 线造影所见,它们与胸背动脉分支间吻合明显,口径在320～550 μm之间。背阔肌表面皮肤血供均来自深方肌皮穿支,越向内下方,穿支间吻合稀疏,口径亦细小。临床应用肌皮瓣做肿物切除后创面修复,乳房再造,修复小腿缺损等共31例,术后肌皮瓣30例完全成活,1例肌皮瓣远端早期出现部分血运障碍征象,经对症处理后,血运逐步改善,伤口延期愈合。 结论 背阔肌肌皮瓣,按其动脉分支及其吻合特点可分为3个部分,为整体或部分分离、转位或移植,保持肌功能提供血管解剖基础。     

肱二头肌额外头的形态学观察及其应用解剖

目的为肱二头肌短头转位治疗肩锁关节脱位手术入路提供解剖学基础。方法观察52具成人尸体(104侧)的肱二头肌额外头的形态、神经支配和动脉供应。结果52具尸体中14具有肱二头肌额外头,出现率为26.9%±1.6%,其中1具为双侧性。15侧肱二头肌额外头均由肌皮神经支配。由肱动脉分支供血。结论本地区人群中,肱二头肌额外头的出现率为26.9%,根据其起止点可分为4种类型。肱二头肌额外头的存在原因可从种系发生与个体发生两方面来解释。在肱骨骨折时考虑是否有肱二头肌额外头的存在来进行生物力学分析,取肱二头短头转位治疗肩锁关节脱位手术入路时应注意肱二头肌额外头的动脉分支。     

跖肌腱移植的应用解剖

目的:为临床进行跖肌腱移植提供解剖学依据。方法:对68例(共120侧,其中男84侧,女36侧)防腐固定标本下肢进行跖肌腱移植的应用解剖及形态学测量。结果:跖肌腱长(30.59±2.49)cm,与下肢长度之比为0.38±0.02。根据外形特点跖肌腱可划分为上、中、下3段,宽度分别为(3.58±0.76)mm,(2.44±0.52)mm,(1.67±0.30)mm;厚度分别为(0.45±0.11)mm,(0.56±0.13)mm,(0.74±0.17)mm。跖肌腱终止方式分为A,B,C,D4型,构成比分别为55.00%,28.33%,13.33%和3.33%;跖肌腱止端横截面积为(11.52±7.45)mm2。结论:提供的跖肌腱解剖学数据,为临床跖肌腱取材提供了形态学依据。     

Unilateral absence of latissimus dorsi muscle

Latissimus dorsi (LD) is the broadest muscle of the back responsible for extension and adduction of shoulder. The authors report a case of isolated unilateral absence of the latissimus dorsi muscle observed during an ablative surgical procedure and flap reconstruction. The left LD muscle was completely absent in our patient and no tendon fibers belonging to this muscle could be observable on further dissection. The surrounding muscle anatomy was normal and in place suggesting a developmental etiology for its absence. Awareness of this possible variation is of importance in considering reconstructive options. Clin. Anat. 25:966–968, 2012. © 2012 Wiley Periodicals, Inc.     

Elevator muscle of the tendon of latissimus dorsi muscle

Muscular dispositions in the axilla acquire importance under certain surgical procedures that involve the axillary artery ligature. These supernumerary muscles make the approach to the axillary fossa and their content difficult. We dissected 108 formalized corpses from adult male individuals. The specimens belong to the topographic Anatomy Unit of the Faculty of Medicine, Universidad de La Frontera, Chile. In all dissections, a rare and infrequent muscular variation attributed to the presence of a elevator muscle at the dorsal part of the latissimus muscle on the right upper limb from an adult individual was found. This muscle was fusiform and originated at the coracoid process by a short tendon of cylindrical form inserted in the dorsal superior part of the tendon of the latissimus dorsi muscle. Muscular belly and tendons of origin and insertion were closely related to the brachial plexus and the axillar vessels that they crossed.     

背阔肌节段肌瓣移植修复面瘫的应用解剖

对86侧背闼肌及其内部血管进行了分段观测。1.背阔肌的节段动脉在肌肉的分布具有一定的规律性。2.根据节段动脉的支数可将背阔肌分为4～6个节段肌瓣,其中以外3、4段最薄,血管蒂最长。3.胸背动脉分出内、外侧支的位置在肩胛骨下角平面上方18.5mm、背阔肌外侧缘内侧21.5mm.文中设计了四种形态的节段肌瓣供临床选用参考,并讨论了截取肌瓣的手术入路。     

慢性低频电刺激对背阔肌超微结构的影响

对４只家兔背阔肌以２ＨＺ的频率电刺激４Ｗ，在电镜下观察超微结构的变化，并作计量分析。慢性电刺激可使线粒体含量明显增加，在Ⅰ型纤维内由４．５３％增至６．２４％；在Ⅱ型纤维内由２．９５％增至３．７８％。肌糖原颗粒的数目也显著增加。并就骨骼肌耐疲劳转化的机理及电刺激条件进行了探讨，为骨骼肌动力型心肌成形术中耐疲劳转化提供实验形态学依据。     

The number of intercostal artery perforators over the distal latissimus dorsi muscle

With the increasing popularity of perforator flaps as “musculocutaneous flaps without muscle,” a new interest in the intercostal vessels as source vessels for perforator flaps has arisen. In a recent study, the branches of the three lowermost intercostal vessels to the latissimus dorsi were studied in detail. Now that these muscular branches are well understood, the present study examines how many of these branches reach the overlying skin as musculocutaneous perforators. We identified the intercostal artery perforators in the ninth, tenth, and eleventh interspaces, in 42 hemithoraces. Only branches that measured 0.5 mm or more in external diameter were included. The course of the perforators was followed from their exit from the latissimus dorsi muscle up to the entrance at the undersurface of the skin. This entrance point was punctured by a pin and thus marked on the skin. This study showed that at least three musculocutaneous perforators were present over the intercostal spaces IX–XI in every dorsal hemithorax (average 8 ± 3, range 3–16). Potentially, each of these vessels can be used as a pedicle for a separate perforator flap, leaving the more proximal parts of the latissimus dorsi intact for a second flap based on the dominant thoracodorsal vessels. Clin. Anat. 23:216–221, 2010. © 2010 Wiley‐Liss, Inc.     

Arterial supply of the latissimus dorsi muscle: A comparative study in human,sheep, dog,and pig

The latissimus dorsi muscle (LD) has been the subject of numerous studies, especially because of its variety of possible applications in plastic and reconstructive surgery. The clinical use of functional electrical stimulation (FES) and cardiomyoplasty has raised completely new questions in recent years. It was the aim of our study to find an optimal model for animal experiments for this cardiosurgical method, in which the LD is completely removed from its origin and transferred into the thorax. For this purpose, we compared the LD's arterial supply in animals used in experimental surgery, the sheep, dog, and pig, with the LD's supply in human. For studying the arteries of the LD macroscopically and by X-ray, we used an injection solution of latex and barium sulfate. After injection of the solution the vascularization was photographically documented. Subsequently, the muscle was detached from the neurovascular pedicle and prepared for radiological examination of the arterial vascularization. The planimetric computer-assisted identification of the various areas supplied by arterial branches was based on these radiograms. In order to also assess the weight of the supplied parts, the muscles were gravimetrically analyzed. The study showed that the blood supply in pig is very similar to that of man. This species, therefore, would be best suited for experimental cardiomyoplasty. © 1994 Wiley-Liss, Inc.     

Dendritic fibromyxolipoma in the latissimus dorsi: a case report and review of the literature

Dendritic fibromyxolipoma is an uncommon benign soft tissue tumor. Here, we report a case in a 53-year-old man presenting a painless mass located deep in the latissimus dorsi of the right back. Microscopically, the tumor was mainly consisted of small spindle and stellate cells, abundant myxoid stroma, collagen bundles and mature adipose tissue. Immunohistochemical study showed the spindle and stellate cells were positive for CD34, Bcl-2 and Vimentim, but not for Keratin, EMA, SMA and Desmin. To date, one year after operation, the patient is well without evidence of recurrence or metastasis. The implication of this report is to provide insights into further understanding of this rare tumor with review of the literature.     

人背阔肌肌内神经分布和肌构筑特征及其临床意义

目的:为背阔肌亚部肌移植的临床应用提供形态学基础。方法:改良Sihler’s肌内神经染色法和肌构筑法。结果:(1)支配背阔肌的胸背神经发出2～3支一级神经支入肌,入肌后发出呈树枝状分支分布到该肌,在肌中部构成网格状的神经分支密集区。(2)背阔肌内上部肌重(58.91±10.29)g、肌长(18.76±1.67)cm、生理横切面积(3.39±0.65)cm2,外下部肌重(119.60±20.89)g、肌长(29.33±1.70)cm、生理横切面积(4.69±0.92)cm2。结论:(1)背阔肌有恒定的肌内神经分支分布,可分为两个亚部:内上部和外下部。(2)背阔肌内上部在肢体运动中更多的维持肩关节的稳定;而背阔肌外下部则更多参与肢体的速度运动。     

慢性低频电刺激对背阔肌纤维类型、组织化学特性及血供的影响

目的：为探讨慢性低频电刺激影响骨骼肌耐疲劳性的机理。方法：用频率为２Ｈｚ的电脉冲刺激家兔背阔肌４周，采用组织化学和血管灌注组织切片、图像分析方法，观测背阔肌纤维类型及能量代谢、血供等方面的变化。结果：背阔肌经慢性低频电刺激，其Ⅰ型纤维所占比例由１８．４±２．２％增加至２９．３±３．４％。琥珀酸脱氢酶的活性、肌糖原含量及毛细血管密度均明显增加。结论：２Ｈｚ的电刺激可以使背阔肌耐疲劳性增强，为背阔肌动力型心肌成形术提供了实验形态学依据     

背阔肌皮瓣的微血管构筑

目的：研究背阔肌皮瓣的微血管构筑形式及一些区域的血管网眼密度等。方法：用２具新鲜成人尸体，把背阔肌皮瓣染色范围分成１０个区，在各区中部切取组织块，常规染色、切片，在显微镜下观察，用电子计算机进行图象分析及测量。结果：该皮瓣血管网共分五层即：深筋膜层、浅筋膜层、真皮深层、乳头下层和乳头层血管网。各层血管网眼密度（个／ｍｍ２）平均值分别为：１４０．５±１５．２、１１３．７±１０．６、１３１．７±９．５、１５．６±１．２和４８．２±４．６。各区相比较以１、２、３、４、６、７、８区血管网眼较密，５、９、１０区较稀疏。