足底内侧和外侧群肌的肌内神经整体分布模式及临床意义

目的 揭示足底内侧和外侧群肌的肌内神经整体分布模式,探讨其临床意义.方法 24具成年尸体,完整取下足底内侧和外侧群肌,采用改良Sihler染色显示肌内神经分布模式.结果 (足母)收肌的神经支从肌止端的深面入肌,而(足母)展肌、(足母)短屈肌、小趾展肌和小趾短屈肌的神经支常从肌起端的深面入肌.(足母)展肌中有1个半月形和...     

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.     

Anomalous flexor digiti minimi brevis in Guyon's canal

In an adult male cadaver, the flexor digiti minimi brevis, a muscle of the hypothenar eminence, was found to arise from the superficial transverse septum (between the superficially placed flexor carpi ulnaris, palmaris longus, and flexor carpi radialis muscles, and the deeply placed flexor digitorum superficialis muscle) in the distal fourth of the flexor aspect of the left forearm. The muscle exhibited two strata of muscle fibers at its origin. The superficial stratum was a thin layer of transversely running fibers confined to the forearm, which has not been previously reported. The deep stratum, a thick layer of longitudinally running fibers, formed the bulk of the muscle. It traversed Guyon's canal superficial to the ulnar nerve and vessels to reach the hypothenar eminence. Its course through Guyon's canal could be a cause for ulnar tunnel syndrome. The ulnar nerve trunk innervated not only the anomalous flexor digiti minimi brevis muscle, but also abductor digiti minimi and palmaris brevis. This may be due to the common phylogeny of these three muscles from the same muscle mass.     

小趾展肌神经与神经源性跟痛症关系的解剖学基础

目的　探讨小趾展肌神经的局部解剖特点及其与神经源性跟痛症的关系,为临床诊断治疗提供解剖学依据。 方法　32侧防腐成人尸体下肢标本,解剖观察小趾展肌神经的起源、分支、走行和分布特点。 结果　小趾展肌神经81.25%起源于足底外侧神经,起点59.38%位于后上象限;起点与参考线的垂直深度,左侧（10.81±0.96）mm,右侧（10.24±1.10）mm;小趾展肌神经发出1～3支骨膜支到达跟骨结节内侧突的骨膜;小趾展肌神经与跟骨结节内侧突该的水平距离左侧（19.95±1.82）mm,右侧（20.89±2.48）　mm 。 结论　小趾展肌神经行经　展肌和足底方肌内侧头之间,跟骨结节内侧突前可能被卡压,卡压或病变（特别是骨膜支）可能与足底腱膜炎发生有关;跟骨骨刺不一定会造成神经源性跟痛症。     

An unusual accessory flexor (opponens) digiti minimi muscle

An accessory flexor (opponens) digiti minimi muscle is described with an origin from antebrachial fascia. In the same limb, a reversed palmaris longus muscle was noted inserting into the deep aspect of the flexor retinaculum.     

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。     

Unusual origin of the flexor digiti minimi brevis muscle

An unusual origin of the flexor digiti minimi brevis muscle of the right hand was discovered during cadaveric dissection. The muscle originated from the anterior aspect of the transverse fibers of the distal antebrachial fascia and inserted onto the base of the fifth proximal phalanx. When traction was applied to the proximal portion of the muscle, flexion was produced at the fifth metacarpophalangeal joint. Other intrinsic muscles of the hand and the muscles of the flexor forearm compartment had normal morphology. Although muscular anomalies in the hypothenar region have been described, the muscular variant described here was distinct in its origin and size from those previously reported. Knowledge of anomalous muscles in the hand has important clinical significance in routine surgery and in determining associated pathology.     

Doubled palmaris longus muscle (with accessorius ad flexorem minimi digiti)

An unusual combination of variations is described in a palmaris longus muscle. The muscle was completely doubled with a tendinous cross slip. Insertion was on the hypothenar and thenar fasciae, and carpal bones. One of the 2 tendons formed the origin of an accessorius ad flexorem minimi digiti muscle.     

An anomalous accessory flexor digiti minimi profundus muscle: A case study

A well-developed anomalous muscle within the forearm flexor compartment was discovered during a routine cadaveric dissection. The identified muscle originated from the intercompartmental septum on the medial side of the forearm just proximal to the wrist joint and inserted on the proximal phalanx of the fifth digit. When stressed, the tendon of the muscle produced flexion of the metacarpophalangeal joint of the fifth digit. Contiguous muscles, including the flexor digitorum profundus, displayed normal morphology. The muscle appeared to be an accessory belly of flexor digitorum profundus. The combination of an accessory flexor digitorum profundus muscle belly acting on the metacarpophalangeal joint of the little finger has not been previously reported. Based on its origin, insertion, and action we have named this variant accessory flexor digiti minimi profundus. This muscular variant could have clinical relevance, possibly affecting ulnar nerve function and circulation in the hand. Clin. Anat. 11:55–59, 1998. © 1998 Wiley-Liss, Inc.     

Comparison of motor unit action potentials using monopolar vs. concentric needle electrodes in the middle deltoid and abductor digiti minimi muscles

Electromyography readings are analyzed noting abnormalities in the parameters of amplitude, duration, and number of phases. Previous studies have demonstrated variability between monopolar needle electrodes (MNEs) and concentric needle electrodes (CNEs) in regard to the above parameters. We hypothesized that a difference in measured parameters would be observed due to the physical differences between the needles. Twenty-three subjects participated in this study. Five readings were recorded from the middle deltoid and the abductor digiti minimi muscles using the MNE, and five readings were recorded using the CNE. A minimal isometric contraction of the tested muscle in the subjects dominant arm was performed. A significant difference was found in amplitudes recorded by the MNE and CNE in both muscles. A significant difference was found in the ADM, and not in the deltoid, with regard to duration. The difference found in the number of phases was clinically insignificant. DISCUSSION: The MNE detected larger amplitudes and durations because of its larger recording territory. The duration may also be affected by the distance between the active/reference electrodes.     

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.     

Peroneus digiti minimi

298 human cadaver feet were dissected to determine the incidence of occurrence and size of the peroneus digiti minimi. It was found to be present in 59.7% of the specimens and ranged in size from 0.5 mm to 2 mm. This was a much higher incidence of occurrence than had previously been documented. The significance of this finding is in question at the present time and needs further investigation.     

小鱼际肌肌内神经和肌梭密度分布

目的揭示小鱼际肌肌内神经和肌梭密度的分布规律。方法对成年20具尸体(40例)小鱼际标本用改良Sihler肌内神经染色法和苏木精-伊红(HE)染色法。结果小鱼际肌肌外神经干长0.49～1.64 cm,从肌起端深面入肌。小指展肌内尺侧和桡侧有独立的神经支配,可分为两个神经肌亚部;小指短屈肌的肌内神经干斜行穿越肌实质中央;小指对掌肌内神经吻合形式多样,"U"型吻合更明显。3块肌的桡侧部神经分支分布密集。小指对掌肌肌梭密度最高为(19.33±2.72)个/g;小指短屈肌其次,有(15.79±1.33)个/g;小指展肌最少,为(12.86±1.69)个/g。结论三块肌桡侧部更多地参与精细调节;肌块越小,肌梭密度越高。     

Variation in the hypothenar muscles and its impact on ulnar tunnel syndrome

Compression of the ulnar nerve at Guyon’s canal can be caused not only by tumor-like structures, a fibrotic arch, a ganglion, lipoma, aneurysm or thrombosis but also by anomalous hypothenar muscles which are reviewed here. For the search of relevant papers, PubMed and crucial anatomical textbooks were consulted. The abductor digiti minimi is the most variable hypothenar muscle. It can possess one to three muscle bellies. Additional heads can arise from the flexor retinaculum, the palmaris longus tendon, the pronator quadratus tendon or the deep fascia of the palmar side of the forearm. Our own case of an aberrant abductor digiti minimi appearing like connective tissue and originating in the antebrachial fascia is included here. Hematoxylin and eosin staining revealed that macroscopically non-muscle-like tissue contained skeletal muscle tissue. The muscle itself resembled other described cases. In addition, at the flexor digiti minimi accessory heads with origin from the flexor retinaculum, the antebrachial fascia or the long flexor muscles of the forearm can be detected. By contrast, the opponens digiti minimi mostly lacks variations and is sometimes missing. In our opinion, this is due to its hidden location. However, in few cases an additional head can arise from the lower arm aponeurosis. Furthermore, additional (fourth) hypothenar muscles might be expressed. These muscles are characterized by origins in the forearm and insertions on the head of the 5th metacarpal bone or on the 5th proximal phalanx. It must be noted that accessory hypothenar muscles might look like connective tissue at first glance. Often their origin extends to the antebrachial fascia. This can be explained by the phylogenetic fact that all intrinsic muscles of the hand are derived from muscle masses that originated in the forearm. In the opinion of several authors, ulnar nerve compression mostly is evoked by hyper trophied variant hypothenar muscles due to overuse as for example in carpenters. In some rare cases, an aberrant hypothenar muscle can also evoke median nerve compression.     

Motor units and functional anatomy of the human musculus opponens digiti minimi

The present anatomical investigation showed that, in 4 musculus opponens digiti minimi beings studied, we found an average value of 158 motor units and 100 muscle fibres per motor unit. These data are in accordance with the execution of the complex action of the m. opponens as an articular stabilizer.     

Nerve conduction study of the medial and lateral plantar nerves

The medial and lateral plantar nerves may be evaluated through the recordings of the compound sensory nerve action potentials (CSNAP), compound mixed nerve action potentials (CMNAP) and compound muscular action potentials (CMAP). As some of these potentials are not easily and always obtainable in normal individuals, our purpose was to verify the consistency of these potentials for the study of these nerves. Fifty-one normal adult volunteers were examined. The CSNAP, CMNAP and CMAP, related to the medial and lateral plantar nerves were evaluated bilaterally. CSNAP were not obtained in 7.8% and in 17.6% from the medial and lateral plantar nerves respectively. CMNAP from the lateral plantar nerve were not obtained in 15.6%. CMNAP from the medial plantar nerves and CMAPs from the abductor hallucis and abductor digiti quinti were obtained for all nerves tested. Our results, therefore, suggest that these last 3 parameters are the ones more reliable for clinical application.     

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。     

Long Abductor Digiti Minimi Muscle: Variation of the Hypothenar Muscles and Clinical Consequences

Variations in the hypothenar muscles influence the susceptibility of Guyon's canal and surgical procedures in this region. The hypothenar regions of both hands of 38 human donors were dissected and the single muscles identified. A semiquantitative evaluation included 19 donors. The opponens digiti minimi and the abductor digiti minimi were constantly present. The flexor digiti minimi showed various appearances: in 58% it formed one belly, in 21% two bellies, and in 21% it was missing. Rare unilateral supernumerary muscles (2.5% in this study) were associated to the abductor digiti minimi. The variation of the flexor digiti minimi and the possible appearance of additional muscles should be recognized for hypothenar region pathologies. Clin. Anat., 33:643–645, 2020. © 2019 Wiley Periodicals, Inc.     

Insertion of the abductor hallucis muscle in feet with and without hallux valgus

Textbooks of human anatomy present different opinions on the insertion of the abductor hallucis muscle which is concerned in etiology as well as in therapy of hallux valgus. In plastic and reconstructive surgery the muscle is taken as a graft for flap-surgery. In this study 109 feet (58 right, 51 left) were examined, 18 of these with clinical hallux valgus. The tendon of the muscle may attach to the tendon of the medial head of the short flexor hallucis muscle where a subtendineous bursa can be found. At the head of the first metatarsal bone the joint capsule is reinforced by fibres arising from the medial sesamoid bone which may be called "medial sesamoidal ligament." The tendon passes the first metatarsophalangeal joint plantarily to its transverse axis. Three types of insertion could be distinguished: type A, insertion at the proximal phalanx (N = 42); type B, insertion at the medial sesamoid ligament and at the medial sesamoid bone (N = 65); type C, insertion at the medial sesamoid bone (N = 2). In all types superficial fibres of the tendon extended to the medial and plantar sides of the base of the proximal phalanx, running in a plantar to dorsal direction. Statistical analysis exposed neither significant differences between both sides nor significant difference between normal feet and feet with hallux valgus. Therefore, a specific pattern of insertion of the abductor hallucis muscle in hallux valgus cannot be stated.