旋后肌管的外科解剖学

于９２侧成尸上肢观察，旋后肌管为一肌性管道，上口主要由旋后肌弓围成，下口由旋后肌下口围成。自肘前外侧面由内上斜向外下绕桡骨体上部至前臂后面，管长３５．７±８．１ｍｍ，旋后肌管与肱骨外上髁至桡骨茎突连线的夹角３０°±７°。骨后后神经穿经此管。探讨了旋后肌管的体表投影，讨论了骨间后神经受压综合征的解剖学机制。     

骨间后神经受压的解剖学基础

目的阐明骨间后神经(PIN)卡压的原因及其手术治疗提供解剖基础。方法30侧尸体上肢标本,将PIN分为3段(即桡管段、旋后肌管段和旋后肌管后段)观察其肌支的分支情况;用卡尺对桡管(RT)、旋后肌管(ST)和桡侧腕短伸肌腱弓(AECRM)的形态和大小进行了观测,并对ST入口和出口的体表投影定位。结果ST入口和出口的宽度分别为(14.1±2.1)mm和(6.2±1.7)mm,长度为(35.0±6.9)mm。PIN从桡骨头至旋后肌腱弓(AF)和PIN从旋后肌穿出处的长度分别为(19.3±4.4)mm和(53.4±5.2)mm。AF的53.3%由肌性加腱性组织构成,23.3%由腱性组织构成,23.3%由肌组织构成。70%旋后肌远侧缘由腱性组织构成,所有AECRM均是腱性。桡骨背侧桡骨头下方1示指宽和3示指宽分别为ST的入口和出口的体表投影。结论本文提供的RT、ST和AECRM详细形态资料,对于PIN卡压的诊断和手术治疗具有指导意义。     

骨间后神经与桡骨上端关系的解剖学观测及临床意义

目的:探讨桡骨头颈部手术的安全区域。方法:在30侧上肢标本上显露骨间后神经,观察其走行及其与桡骨上端的关系。结果:骨间后神经越过桡骨头上缘前方中线稍偏外斜向外下方走行,距桡骨头上缘(13.8±4.2)mm、桡骨前方中线外侧(3.2±1.1)mm处经旋后肌腱弓深方入旋后肌管,走行于旋后肌深浅两层之间,在桡骨头上缘下方(42.6±6.5)mm越过桡骨外侧中线,在桡骨头上缘下方(63.4±7.6)mm越过桡骨后平面。结论:桡骨上端后外侧3.5cm范围内为手术安全区域。     

骨间背神经卡压综合征压痛点定位规律及其解剖学基础

目的探讨骨间背神经卡压综合征常见压痛点的体表定位规律及临床解剖学基础。方法对30例骨间背神经综合征患者进行压痛点体表定位观测与统计分析,并针对压痛区域进行解剖学观测。结果常见骨间背神经卡压综合征体表压痛处距髁间连线为(47.80±7.72)mm;与前臂正中线的垂直距离为(34.99±6.59)mm。围绕此痛点的解剖标本上可看到骨间背神经行至旋后肌处,穿过一弧形结构,即Frohse弓。前臂被动旋前时,旋后肌管变窄,骨间背神经被拉紧,在Frohse弓处被压;前臂被动旋后时,旋后肌管变宽,骨间背神经松弛,无Frohse弓卡压骨间背神经现象。结论明确骨间背神经卡压综合征的准确体表定位及临床解剖学特点,有利于骨间背神经卡压综合征的准确诊断及针对痛点的各种治疗手段的精确实施。     

骨间后神经及其拇示指肌支的解剖学特征

目的　观察前臂骨间后神经及其拇示指肌支的解剖学特征。 方法　解剖43具尸体的86侧上肢部桡神经深支及其分支到腕背部,观测骨间后神经的行程与投影及其拇示指肌支起始部位横径、长度和骨性标志线与神经干间夹角关系等参数。 结果　骨间后神经及其各分支均呈扁薄的窄带状神经束,其主干和多数肌支都走行在前臂后面中2/4段浅、深层肌之间,终末支止于腕背侧的梭形膨大部;主干起始处横径为（3.79±0.64）mm,各分支在起始部的平均横径（除指伸肌支约2.0 mm外）均小于1.0 mm;在旋后位,它呈向桡侧开放的弓形线段投影在肱骨外上髁至尺骨茎突连线的尺侧,半旋前位时则投影于该连线上或其桡侧。 结论　前臂后面中2/4段是骨间后神经主干及其大多数拇示指肌支在临床上易被损伤、误伤发生的高风险区域。     

骨间后神经穿桡管远端处的解剖特点及其临床意义

目的：了解骨间后神经穿旋后肌后可能的卡压位置及临床意义,方法：在2倍放大镜下解剖骨间后神经穿旋后肌后的行程,分支,可能卡压位置以及前臂活动对其影响。结果：骨间后神经穿旋后肌后恒定地分尺仙支和桡侧支;旋后肌远侧缘和拇短伸肌,拇长展肌浅面的腱性肌纤维结构可能是致卡压的解剖结构,前臂伸肌群的活动可 诱发上述结构卡压骨间后神经,结论：在桡管远端同样存在卡坟骨间后神经的解剖结构,必要时应手术探查,松解。     

骨间前动脉背侧支为蒂前臂背侧岛状瓣的应用解剖

本文观测了２８例红色乳胶染料灌注的上肢，骨间前动脉在旋前方肌上缘发出背侧支，其穿过骨间膜后即发出一皮支，该皮支沿拇短伸肌与指总伸肌之肌隙穿出并入皮，在入皮前该皮支发出一骨膜支，分布到桡骨远端背侧骨膜，该皮支解剖恒定，长２．２６±０．２４ｃｍ，可作为血管蒂的一部分连同背侧支主干一起向远端逆转，可形成岛状皮瓣、骨膜瓣、分别用于修复手背此肢软组织缺损、腕骨骨折不愈合及缺血坏死。     

桡骨远端骨折掌侧手术入路改进的解剖及临床研究

目的:探讨桡骨远端骨折LCP内固定术掌侧入路改进的解剖基础.方法:常规尸体解剖观察旋前方肌的形态、神经血管束的走行及毗邻关系,测量肌肉相关形态学指标.设计保留旋前方肌的桡骨远端骨折掌侧手术入路并进行临床验证.结果:旋前方肌的桡尺侧以腱膜与骨膜相移行,肌腹深面直接与桡尺骨骨面和骨间膜结合,支配肌肉的血管神经束来自骨间前血管和神经,于肌肉上缘穿入,行于其深而,腕背支血管穿过骨间膜,与骨间后动脉交通.在旋前方肌上缘的平面,血管神经束距桡骨尺侧缘的距离为(6.10±0.86)mm;肌肉下缘与桡腕关节面的距离为(9.30±2.11)mm.临床采用保留旋前方肌掌侧入路桡骨远端骨折LCP内固定术5例,方法可行.结论:在桡骨远端骨折LCP内固定术掌侧人路中保留旋前方肌是完全可行的,符合现代微创手术的观点.     

骨间背侧神经的解剖学特征及其临床意义

目的　研究前臂骨间背侧神经及其肌支的解剖学特征,为体表定位提供形态学基础。 方法　解剖 30具成人防腐尸体的60侧上肢骨间背侧神经及其肌支,观察骨间背侧神经的行程与神经分叉点,测量分叉点分别至肱骨外上髁（LHE）、桡骨Lister结节（LTR）、尺骨茎突（SPU）的距离等参数,通过三圆交汇法及神经分段法来确定神经的体表位置。 结果　骨间背侧神经在发出指伸肌支、小指伸肌支及尺侧腕伸肌支后,主干有4个主要分叉点（O、O1、 O2、 O3）;以分叉点分别至LHE 、LTR 、SPU 的平均距离为半径,LHE 、LTR 、SPU为圆心,绘制3个圆,三圆交汇的点或区域可作为神经的体表定位;4个分叉点又可将骨间背侧神经分为7段（O点上段、OO1段、O1点下段、OO2段、O2点下段、O2O3段、O3点下段）。 结论　骨间背侧神经分叉点结合三圆交汇定位及神经分段法,根据神经损伤的临床表现,可明确神经损伤的位置。     

骨间前神经综合征解剖学基础

目的 :探讨骨间前神经综合征发病解剖基础。方法 :48侧 (左右各 2 4侧 )成人防腐固定标本在肉眼或双目放大镜下解剖观察可能构成对骨间前神经卡压的解剖结构。结果 :有 6 6 .6 %的拇长屈肌副头由内上至外下斜过骨间前神经主干前方。横过骨间前神经的结构还有 :尺侧副血管 (48.3% ) ,指浅屈肌发出至拇长屈肌的小肌束或纤维束 (10 .4% )。骨间前神经与桡、尺骨的关系 :77%骨间前神经走在桡骨颈前方下行一段 ,长为 3.9cm(37侧 ,) ;16 .7%骨间前神经在桡、尺骨之间走行 ;6 .3%隔指深屈肌走在尺骨的前方。结论 :拇长屈肌副头、横过骨间前神经的肌束和纤维等结构可能是致骨间前神经综合征的解剖基础。     

Anatomic basis of dorsoradial approach for radioulnar synostosis

The object of this study was to identify the best approach for exposing the radioulnar interosseous membrane while protecting the posterior interosseous n. (PIN). Twenty paired upper limbs were used to obtain measurements of the PIN and expose the distal two-thirds of the interosseous membrane in the forearm through a dorsoradial approach. The length of the PIN from the radial head to the arcade of Frohse (AF) was 26.5 ± 1.6 mm in males and 25.3 ± 1.1 mm in females. The length of the PIN between the radial head and the point where the PIN exits from the supinator was 66.7 ± 4.7 mm in males and 64.0 ± 2.5 mm in females. The length of the PIN covered by the supinator was 44.0 ± 0.5 mm in males and 37.0 ± 0.5 mm in females. The distance between the point where the PIN exits from the supinator and the lateral margin of the radius was 15.0 ± 0.9 mm in males and 14.5 ± 0.9 mm in females. The distance between the exit point of the PIN from the supinator and the lateral margin of the ulna was 18.2 ± 0.6 mm in males and 17.9 ± 0.7 mm in females. The distance from the point where the most lateral branch of the PIN entered the abductor pollicis longus (APL) to the lateral margin of the radius was 3.5 ± 0.5 mm. In 20 cadaveric upper limbe, the middle and distal portions of the interosseous membrane were exposed through the interval between the extensor carpi radialis brevis (ECRB) and extensor digitorum communis (EDC) m., after the origine of the extensor pollicis brevis (EPB), and extensor pollicis longus (EPL) mm. had been elevated from the lateral margin of the radius. The present study suggests that usina dorsoradial approach facilitates exposure of the middle and distal portions of the interosseous membrane.     

An uncommon form of the rare extensor carpi radialis accessorius.

Two accessory muscles were found in the lateral compartment of the forearm while dissecting a 92-year-old female cadaver. One of these originated from the extensor carpi radialis brevis, became tendinous and travelled between the two radial extensor tendons. It inserted independently into the second metacarpal bone, and may be regarded as an extensor carpi radialis intermedius. The other accessory muscle originated from the extensor carpi radialis longus, passed superficially over the parent tendon and inserted into the abductor pollicis brevis. This variation appeared to be a rare extensor carpi radialis accessorius, an additional muscle, which usually arises from below the extensor carpi radialis longus and inserts into the first metacarpal bone. Various forms of the accessorius have been described previously, including one that inserts into the abductor pollicis brevis. The tendon of the accessory muscle described in this study passed through its own dorsal tunnel under the extensor retinaculum, making it an uncommon form of the rare accessorius.     

The innervation of deep muscles of the human forearm extensors]

The innervation of four deep muscles of the human forearm extensors (the abductor pollicis longus, the extensor pollicis brevis, the extensor pollicis longus, and the extensor indicis muscles) were investigated in 24 bodies (48 sides) from those used in the 1989 and 1990 student courses in gross anatomy dissection at the Iwate Medical University School of Medicine. The forearm extensor muscles and the deep branch of the radial nerve were dissected intensively in the student courses in gross anatomy and were removed afterwards. The four deep muscles of the human forearm extensors and the nerves innervating the muscles were observed while they were immersed in the water and with use of a stereomicroscope--with the assistance of which they were drawn. In six sides the intramuscular nerve supply was also examined carefully and drawn. The results were as follows. 1. The nerves to the four deep muscles of the forearm extensors arose usually from the deep branch of the radial nerve after emerging the supinator muscle and sending branches to superficial forearm extensors. In some cases a nerve or nerves to the superficial forearm extensors were observed arising from the deep branch of the radial nerve after sending one or more branches to the deep forearm extensor muscles, or from the branches to the deep muscles themselves. However they were split easily from the deep branch of the radial nerve and from the branches to the four deep forearm extensors proximally near to the emerging of the deep branch from the supinator muscle. Therefore, it was considered to be constant that the nerves to the four deep forearm extensors arose from the deep branch of the radial nerve after branching to the superficial forearm extensors. 2. The radial group of the deep forearm extensors (the abductor pollicis longus and the extensor pollicis brevis muscles) was innervated usually by one branch that arose from the deep branch of the radial nerve just after emerging from the supinator and giving off branches to the superficial forearm extensors. This branch ran on the dorsal (extensor) surface of the abductor pollicis longus muscle distally, sending many twigs to this muscle, and entered into the muscle at various distances from the origin (Figs. 1-6). The abductor pollicis brevis muscle was innervated by some twigs that ran usually inside but occasionally outside of the abductor pollicis longus muscle (Figs. 7-10).(ABSTRACT TRUNCATED AT 400 WORDS)     

Bilateral abductor pollicis longus muscle variation. Case report and review of the literature

An abnormal abductor pollicis longus muscle was encountered bilaterally during the dissection of the upper limb of a 26-year-old male cadaver. In the left side, the abductor pollicis longus had seven tendon slips. The medial two inserted into the abductor pollicis brevis, the other five inserted into the base of the first metacarpal bone. In the right side of the case, the abductor pollicis longus was consisted of three bellies. The lateral belly's tendon was the main abductor pollicis longus tendon and inserted into the base of the first metacarpal bone. The medial belly inserted into the abductor pollicis brevis. Between these muscle bellies, there was an intermediate belly. Its tendon was split into two thin slips and inserted into both the abductor pollicis brevis and the opponens pollicis muscles. The number of such accessory tendons has a functional significance in the development of de Quervain's stenosing tendovaginitis and possibly also has a practical significance. This paper is the first to describe seven tendons of the abductor pollicis longus and extensor pollicis brevis in the same compartment.     

足部相关肌肉、肌腱组织材料弹性模量的测定

背景：目前,几乎所有足部三维有限元模型的材料参数均来自国外研究,尚未见有关国人组织材料参数的测量与报道。 目的：对国人足部的相关肌肉、肌腱材料做测量,获得初步的参数数据。 方法：解剖成年女性左小腿足新鲜标本拇长屈肌及其肌腱、拇短屈肌内外侧头、拇长伸肌及其肌腱、拇收肌横头及斜头、拇展肌,分别测量和计算各试样的截面积和位于夹具之间的长度并记录数值,将标本加载载荷,1个测样反复测量4次,采集强度极限、最大载荷等数据,以及载荷-位移曲线。根据胡克定律,计算各标本的弹性模量。 结果与结论：共得到了包括拇长伸肌、拇长屈肌、拇收肌、拇展肌横头和斜头、拇短屈肌内外侧头、拇长屈肌腱、拇长伸肌腱9个样本的相关测量数据,主要包括长度、宽度、厚度、横截面积、最大载荷、强度极限和弹性模量。中国组织工程研究杂志出版内容重点：生物材料;骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性;组织工程全文链接：     

A variation in the organization of abductor pollicis longus

The abductor pollicis longus (APL) muscle has been studied bilaterally in 50 cadavers. A variation in the organization of the muscle was found bilaterally in 15 of the 50 specimens. The novel muscular arrangement gives the appearance of being an additional muscle belly arising from the lateral aspect of the distal portion of the typical abductor pollicis longus muscle belly. This variation in the arrangement also creates a retinacular-like tunnel which encases the tendons of the extensor carpi radialis longus and the extensor carpi radialis brevis muscles. To the authors' knowledge, this arrangement has not been cited in the recent medical literature. An understanding of this unusual finding may be clinically relevant in describing the dorso-lateral compartment of the distal forearm. © 1996 Wiley-Liss, Inc.     

骨间掌侧神经受压综合征的解剖学研究

在32具成人尸体的64侧上肢中解剖了骨间掌侧神经及其发出的肌支共510支,对其分支平面,分支数目,长度及其走行过程中的受压因素进行了观察和测量,旋前圆肌尺骨头的纤维弓,指浅屈肌腱弓,拇长屈肌的异常肌束和骨间掌侧血管的分支血管束是造成骨间掌侧神经受压的主要因素.     

Multiple variations in the region of Mm. extensores carpi radialis longus and brevis.

While dissecting the body of an 80-year-old female we observed multiple variations in the right region of Mm. extensores carpi radialis longus and brevis. The M. extensor carpi radialis longus gave origin to an accessory head. The tendon of this accessory head passed through a separate tunnel in the extensor retinaculum and inserted in the middle of the first metacarpal bone. Concerning its function, this accessory head of the M. extensor carpi radialis longus could be regarded as an additional abductor pollicis. The M. extensor carpi radialis brevis had an accessory tendon lying underneath the main tendon of this muscle. The accessory tendon joined with the main tendon just when undercrossing Mm. abductor pollicis longus and extensor pollicis brevis. Afterwards the tendon lay in the second tunnel of the extensor retinaculum and inserted in the base of the third metacarpal. In her lifetime the individual's tabatière probably must have been conspicuously pronounced at its radial margin.