蛋白酶腐蚀法在保留肌腱的血管铸型中的应用研究

目的　使用蛋白酶消化技术制作保留肌腱的血管铸型,拓展解剖学标本类型,丰富肌腱相关的临床解剖学研究方法。 方法　分别使用浓度为0.5%、1.0%、1.5%和2.0%的蛋白酶混合液对掌长肌进行分解实验,选出适合分解肌组织的基础浓度;以丙烯酸树脂为填充剂,灌注新鲜前臂标本的血管,制作铸型标本。填充剂凝固后,将前臂标本浸泡于起始浓度为1.0%的蛋白酶溶液,每24 h在混合液里加入35 g碱性蛋白酶粉,腐蚀5 d后获得保留肌腱的前臂血管铸型标本。 结果　通过对掌长肌组织进行分解实验发现,浓度为1.0%的蛋白酶混合液在肌腱断裂前能更充分地分解肌腹组织;通过对保留肌腱的血管铸型观察发现,其皮肤、脂肪组织和肌组织的肌腹基本消失,而骨骼、肌腱和铸型血管基本保存完好,可以清晰地观察皮肤及浅层、肌腱和肌腹丰富的血供来源、走向及其分布,清晰地观察铸型血管与皮肤及浅层、肌腱和肌腹的立体关系。 结论　以1.0%为起始浓度,每24 h加入1次起始浓度所需溶质（碱性蛋白酶）剂量的50%所配制的蛋白酶混合液,是制作保留肌腱的血管铸型的合适腐蚀液;保留肌腱的血管铸型为新的解剖学标本类型,并丰富了肌腱相关的临床解剖学研究方法。     

掌长肌变异1例

掌长肌变异１例马岩①在解剖学教学过程中，在１例中年男性尸体标本上见其右侧前臂掌长肌变异较大，掌长肌的起始端和抵止端均为肌腱型，而中间的肌腹较大，现报道如下。掌长肌变异特点为大肌腹，起止两端肌腱长度相对该肌腹较短（附图）。掌长肌由肌腱起于肱骨的内上髁，...     

左侧指浅屈肌并拇长屈肌变异一例

<正>笔者在进行局部解剖学实验教学即尸体标本解剖中发现左侧指浅屈肌形态异常并拇长屈肌起点异常1例,此2种变异同时存在较为少见,为丰富国人解剖学资料并为临床工作提供解剖学依据,现报道如下。本例为常规甲醛固定2年以上的老年男性陈尸,来源于泰山医学院人体解剖学教研室。该标本左侧前臂掌侧指浅屈肌肌腹分为浅深2层。浅层较为宽扁,肌腹延续为肌腱并最终至中、环指,未见明显异常;深层较粗,呈条索状,肌腹     

桡掌肌一例

解剖男性成人尸体标本,见其右前臂有桡掌肌,起于桡骨远侧段的掌面,前臂中点下0．2cm,穿腕管止于第2掌骨底、桡侧腕屈肌腱止点的内侧;肌腹呈梭形,中部最宽13mm,长6．2cm;肌健长7．0cm,宽1．6mm,肌总长13．2cm。在前臂掌面远侧部,肌的浅层有桡动脉,深层为旋前方肌。在腕管内,肌的浅层有桡侧腕屈肌腱和拇长屈肌腱越过,深层为桡腕韧带。     

单侧小指展肌变异1例

<正>笔者在局部解剖学尸体解剖过程中发现成年男性右上肢单侧小指展肌变异1例。查阅文献,国内最早1例报道在1996年[1],近十年未见相同变异报道,为丰富国人解剖学资料,报道如下:变异肌位于右侧,小指展肌经腕横韧带浅面向近侧越过腕部,肌腹向上延续至前臂尺侧的浅层,左前臂未见相同变异(图1)。该肌位于掌长肌肌腱与尺侧腕屈肌之间,指浅屈肌     

全身保留骨骼血管铸型标本明胶加固自然腐蚀法

保留骨骼的血管铸型技术是解剖学标本制作技术中最富有表现力的一种特殊技术,也是最难以掌握的解剖学技术之一,尤其是制作全身整体保留骨骼的血管铸型技术难度很大。其主要难点为:灌注不均匀,在腐蚀过程中易断枝,要保留全身骨骼更是困难。我们采用多点分部灌注法制作童尸全身血管铸型标本取得成功[1]。在此基础上,经过进一步实验研究,探索出了用明胶加固自然腐蚀法成功地制作出了保留骨骼成人整体血管铸型标本,报道如下。1材料和方法1·1尸体材料选用身高1·55~1·65 m非外伤致死的新鲜尸体材料。1·2填充剂低浓度填充剂:过氯乙烯10~15 g,乙…     

正中神经前臂段浅层肌支的应用解剖

目的测量正中神经前臂段浅层肌支的解剖学数据,为正中神经的创伤修复提供形态学依据。方法采用解剖剥离测量方法,对30侧10%甲醛固定的成人上肢标本正中神经发出的前臂段浅层肌支进行解剖学观察。结果正中神经前臂段浅层肌支的分支类型有1支型、2支型、3支型和4支型。其中,旋前圆肌支以3支型(87%),指浅屈肌支(90%)以4支型,桡侧腕屈肌支(96.7%)和掌长肌支(96.7%)以1支型出现率最多。正中神经前臂段浅层肌支主要集中于前臂的4%～65%。结论确定了正中神经前臂段浅层肌支在前臂的危险区间;讨论了有利于开展带神经血管蒂肌瓣移植的肌支类型。     

前臂后外侧穿支皮瓣游离移植修复手指皮肤缺损的应用解剖

目的　介绍前臂后外侧穿支皮瓣游离移植修复手指皮肤缺损的应用解剖。 方法　解剖观测40侧成人尸体上肢标本,在手术显微镜下进行局部解剖。观测前臂后外侧皮肤的营养动脉、回流静脉、神经支配。 结果　自桡骨Lister结节及肱骨外侧髁连线中点附近指伸肌和桡侧伸腕肌肌间隙内有一恒定的皮支动脉营养前臂后外侧皮肤,该动脉有两条伴行静脉,神经支配为前臂后皮神经分支,血管蒂长度为（4.12±0.26）cm,血管起始处外径为（0.91±0.07）mm,管径与指动脉相仿。 结论　前臂后外侧可以形成以桡骨lister结节及肱骨外侧髁连线中点附近的指伸肌和桡侧腕伸肌肌间隙穿支为蒂的穿支皮瓣游离移植修复手指皮肤缺损。     

双掌长肌1例

在解剖学教学过程中,在1例中年男性尸体标本上见其右侧前臂双掌长肌变异(图1)。现报道如下:双掌长肌均由肌腱起于肱骨的内上髁,桡侧掌长肌腱     

桡动脉掌浅支蒂腕横纹皮瓣的应用解剖

目的　为临床设计切取腕横纹皮瓣提供解剖学基础。 方法　选取6只新鲜手标本进行红色乳胶灌注,解剖观察桡动脉掌浅支的走行及皮支分布规律和特点。 结果　桡动脉掌浅支于桡骨茎突掌尺侧自桡动脉发出,起始处直径（1.26±0.36）mm,向鱼际肌走行。桡动脉掌浅支于舟骨结节近侧中间腕横纹处发出皮支,皮支发出处直径（0.23±0.06）mm,供养腕横纹皮肤。 结论　以桡动脉掌浅支腕横纹皮支供血,以腕横纹皮肤为供区切取游离皮瓣或带蒂转移可以修复手部皮肤软组织缺损,该术式具有血供可靠、不牺牲主干血管,切取安全等优点。     

A Case of the Bilateral Duplicate Palmaris Longus Muscles Coupled with the Palmaris Profundus Muscle

The palmaris longus muscle is one of the most variable muscles in human anatomy. During a routine anatomical dissection for medical students at Tottori University, we found duplicate palmaris longus muscles in the bilateral forearms together with the palmaris profundus muscle in the right forearm. The bilateral aberrant palmaris longus muscles were observed at the ulnar side of the palmaris longus muscle and their distal tendons were attached to the flexor retinaculum. The palmaris profundus muscle found in the right forearm was located at the radial side of the flexor digitorum superficialis muscle. The proximal tendon was originated from the anterior surface in the middle of the radius, while the distal tendon coursed radial to the median nerve through the carpal tunnel, finally inserting into the distal part of the flexor retinaculum. Both the palmaris longus and aberrant palmaris longus muscles were innervated by the median nerve. The palmaris profundus muscle was presumably supplied by the median nerve.     

Muscle variations and abnormal branching and course of the ulnar nerve in the forearm and hand

During dissection of the right forearm of a 27-year-old female cadaver, variations in the form and insertion of the palmaris longus muscle were observed. The tendon of the palmaris longus muscle, which demonstrated a centrally placed belly, split into two tendons: one inserted into the palmar aponeurosis and the other into the proximal part of the flexor retinaculum. Additionally, we found an accessory muscle extending between the flexor retinaculum and the tendon of the abductor digiti minimi muscle. This accessory muscle was located deep to the ulnar artery but superficial to the superficial and deep branches of the ulnar nerve at the wrist. Finally, an aberrant branch of the ulnar nerve was identified in the forearm; it traveled distally alongside the ulnar artery and in the palm demonstrated communications with common palmar digital nerves from the ulnar and the median nerves. No variations were observed in the contralateral upper limb.     

An accessory belly of the abductor digiti minimi muscle: a case report and embryologic aspects

Accessory fasciculi of the hypothenar muscles have been involved in vascular and nerve compressions. During a routine dissection an accessory belly of the abductor digiti minimi muscle arising from the tendon of the palmaris longus muscle was found in the lower third of the forearm. The accessory fasciculus ran through Guyon’s canal enclosing the ulnar nerve and vessels. It was attached by means of two tendons where the fibres of the abductor digiti minimi muscle ended in a single pennate form. This anatomic variation was associated with a marked reduction of the caliber of the fourth tendon of the flexor digitorum superficialis muscle and a split of the median nerve. The nerve supply arose from the ulnar nerve. A fibrous band originating from this accessory muscular belly was found covering the median nerve. Based on the development of muscles and fibrous structures within the hand and forearm, as well as on our results, we consider the present anomalies as an unusual persistence of an undifferentiated group of mesenchymal cells. These belong to the superficial muscular anlagen layer of the hand, just between the flexor digitorum superficialis muscle blastema (which has the capacity of migration) and that for the abductor digiti minimi muscle.     

Epifascial accessory palmaris longus muscle

In hand reconstructive surgery the palmaris longus muscle is one of the most utilized donor site for tendon reconstruction procedures. However, its anatomic position is variable and anatomic variations may be responsible for median nerve compression. We report the case of a 40-year-old, right-handed woman, who presented with numbness and paresthesias in the palm and in the flexor aspect of the first, second, and third fingers of her right hand for the preceding 5 months, coinciding with increase of office work (typing). The clinical examination and radiological investigations (ultrasound and magnetic resonance) revealed a subcutaneous mass (15 mm x 2.3 mm x 6 cm), with a lenticular shape and definite edges at the level of the volar aspect of the distal third of the forearm. The fine-needle aspiration biopsy revealed the presence of striated muscle fibers. During surgery, a muscle belly was found in the epifascial plane. This muscle originated from subcutaneous septa in the middle forearm and inserted on to the superficial palmar aponeurosis with fine short tendon fibers. Exposure of the antebrachial fascia did not reveal any area of weakness or muscle herniation. The palmaris longus tendon, flexor digitorum superficialis tendons, and flexor carpi radialis tendon showed usual topography under the antebrachial fascia. The accessory muscle was excised and histology revealed unremarkable striated muscle fibers, limited by a thin connective sheath. The presence of an accessory palmaris longus (APL) located in the epifascial plane could be ascribed to an unusual migration of myoblasts during the morphogenesis. Although extremely rare, APL is worth bearing in mind as a possible cause of median nerve compression and etiology of a volar mass in the distal forearm.     

Extensor pollicis et indicis communis or extensor indicis radialis muscle

Anatomical variations of the fingers extensor tendons are not uncommon and have been described by several authors. Participation of intertendinous band of fascia in this kind of variation can change muscle functionality. However, this element is scarcely described in the literature. In this case report, we describe the finding of an accessory tendon located between the extensor digitorum communis muscle tendon, destined for the index finger, and the extensor pollicis longus tendon. In an anatomical analysis, we observed a connection between the radial portion of the accessory tendon and the ulnar portion of the extensor pollicis longus tendon by intertendinous fascia. This finding corresponds anatomically to the supernumerary muscle denominated extensor indicis radialis, but due to the fascial connections observed with the extensor pollicis longus, this muscle would behave functionally as a supernumerary muscle denominated extensor pollicis et indicis communis. This report suggests that participation of fascia in muscular variation in this anatomical segment is essential to establish the correct morpho-functional denomination of muscular variants.     

The clinical surface anatomy anomalies of the palmaris longus muscle in the Black African population of Zimbabwe and a proposed new testing technique

The presence of the palmaris longus muscle (PLM) is highly variable. Rates of absence vary from 0.6% in the Korean population to as high as 63.9% in the Turkish population. The tendon of PLM may be absent on one or both forearms, may have duplicated tendons on one forearm or may be laterally shifted to the extent that the tendon of the PLM lies superficial to that of flexor carpi radialis muscle. Among Black American populations, in which there is usually mixed ancestry, rates of absence are 3.5%. Only two studies have been performed on Black African populations: in Republic of Congo and Uganda, and each showed widely differing rates of absence of 3.0% and 14.6%, respectively. In this study, a total of 890 Black Zimbabwean subjects in Harare aged between 8 and 13 years, were examined for clinical surface anatomy anomalies of the tendon of PLM. The results showed that the tendon of the PLM was absent unilaterally in 0.9% of the population, and bilaterally absent in 0.6% with an overall rate of absence of 1.5%. Other variations noted were a laterally shifted PLM in 1.1% of subjects and duplicated tendons on one forearm, which was the least prevalent anomaly, in 0.2% of subjects. The author proposes a new technique to test the tendon of PLM, which combines resisted thumb abduction and resisted wrist flexion. The proposed technique capitalizes on the role of the PLM as an important abductor of the thumb. Clin. Anat. 22:230–235, 2009. © 2009 Wiley‐Liss, Inc.     

Symptomatic palmaris longus muscle variation with MRI and surgical correlation report of a single case

Abstract A young woman presented with a painful soft tissue swelling of the anterior aspect of the distal forearm. MRI revealed a hypertrophied reversed palmaris longus muscle confirmed by surgery, which also showed a second insertion to the flexor carpi radialis tendon. Variants of the palmaris longus muscle are discussed.     

Isolated flexor muscles of the little toe in the feet of an individual with atrophied or lacking 4 head of the M. extensor digitorum brevis and lacking the 4 tendon of the M. extensor digitorum longus

While dissecting the body of a 75-year-old male we observed variations in the Mm. flexor digitorum brevis and longus of both feet. In the left foot, the 4th tendon of the M. flexor digitorum brevis was atrophied and the respective tendon of the M. flexor digitorum longus to the little toe was absent. In the right foot, the 4th tendons of both the Mm. flexor digitorum brevis and longus to the little toe were absent. The lacking deep flexor tendon to the little toe in the left foot was replaced by an isolated flexor muscle originating from the medial and lateral processes of the calcaneal tuberosity, which additionally had connections to the tendinous plate of the M. flexor digitorum longus and the M. quadratus plantae. The absent superficial and deep flexor tendons to the little toe in the right foot were replaced by an isolated flexor muscle arising from the M. quadratus plantae distal from the medial process of the calcaneal tuberosity. The tendon of both isolated flexor muscles inserted in the distal phalanx of the little toe. The left isolated flexor muscle for the little toe had connections to the M. flexor digitorum longus and the M. quadratus plantae. From these results it seems likely that the M. quadratus plantae could be regarded as additional flexor head (caput breve or plantare) of the M. flexor digitorum longus as is described in classic textbooks. In the individual's lifetime the described variation perhaps led to the possibility of an isolated flexion of the little toe.