眉间区域表情肌的应用解剖研究

目的　探讨眉间纹形成的解剖学机制,为肉毒素注射除皱提供形态学基础。 方法　对6例成人头部标本的降眉肌、降眉间肌、皱眉肌进行解剖观测、标志点定位、肌肉称重及肌肉横截面积估算。 结果　眉间区域表情肌起点较恒定,止点为一个部位,各表情肌之间联系紧密,可称为“联合体”,其中以“降眉肌-降眉间肌”联合体最明显。眉间动力性皱纹主要由皱眉肌和降眉肌收缩时产生的水平方向力对眉间区域皮肤的协同作用所致。皱眉肌和降眉肌生理横截面积之比=6：1。皱眉肌：降眉肌水平分解力比值约为（8~10）:1。 结论　皱眉肌和降眉肌为肉毒素注射治疗眉间纹的目标肌肉,注射部位应选在皱眉肌起端1/3处和降眉肌与降眉间肌结合部位。     

眉间区表情肌的应用解剖与三维重建及其临床意义

目的　为眉间区除皱术提供表情肌解剖学形态学基础。 方法　对6例(12侧)成人头部标本的降眉肌、皱眉肌、降眉间肌进行大体解剖,测量相关表情肌构筑数,照像留存。通过人工干预后进行CT扫描,简便快捷的建立三维模型,清晰的定位表情肌。 结果　通过解剖,清晰地展示了眉间区域表情肌的形态学特点,并测量出其相关定位参数及肌重,成功地建立了眉间区域表情肌的三维可视化模型。眉间区域表情肌包括皱眉肌和眉间降肌,皱眉肌形态可分为两大类：横向型和斜向型,一般从眉毛形态即可辨识。其中,斜型按其形态又可分为：斜向单束型和斜向分束型。眉间降肌可分为降眉肌、降眉间肌,其形态及发育情况个体差异较大。 结论　眉间区表情肌为肉毒素注射治疗眉间纹的目标肌肉,通过探讨眉间区表情肌解剖位置及形态特征, 测量相关表情肌构筑数并简便快捷的建立三维模型,对个性化肉毒素除皱开展有临床指导意义。     

口周围肌的应用解剖

目的:探讨口周围肌的构筑学特征并为临床应用提供解剖学资料。方法:对10例尸体的口轮匝肌、颊肌、提上唇肌、降下唇肌、提口角肌、降口角肌、颧大肌和颧小肌进行大体解剖,横切片H-E染色、图像分析和肌构筑学研究。结果:口轮匝肌、颊肌、提上唇肌、降下唇肌、提口角肌、降口角肌、颧大肌和颧小肌的肌重分别为18.1、3.2、1.7、2.3、1.5、1.4、1.7、1.0g;肌长分别为83.1、26.3、24.5、21.3、27.8、33.3、53.5、49.5mm;生理横切面积分别为126.3、147.6、90.4、132.6、56.2、46.8、37.6、22.4mm2;8块肌的肌纤维直径在21.6~39.2μm,肌束横切面积0.89×104~3.61×104μm2。结论:口周围肌具有"速度型"设计的构筑特征,肌收缩的力量小;但颊肌更倾向于进行紧张性活动。     

眼外肌的断层解剖及其临床意义

目的:为临床眼外肌疾病及其并发症的影像学诊断提供形态学资料。方法:固定成人尸体头颅15个,经低温冷冻后,利用MJ-346B型电动带锯做眼眶连续冠状断层(层厚0.5cm,锯耗0.1cm),观测眶尖至眼球后极5个连续层面上眼外肌的宽、厚、断面面积及其与视神经、眶壁的位置关系。结果:眼外肌厚、断面面积最大值均分布于眶的第3或第4层面,眼外肌断面面积之和的最大值在第4层面,其面积和平均为128.54mm~2,而第3层面眼外肌断面面积之和占眶断面面积的比例最大,平均占29％;内直肌与上斜肌、视神经的距离最近,因而其毗邻关系最为密切:结论:内直肌的病理性肥大对视神经的压迫更为直接;当多条眼外肌同时肥大时,第3层面的影像表现更能反映眼外肌对视神经的压迫程度;还可通过眶断面影像上的几个简便测量来评估眼型Graves病人发生视神经病变的可能性。     

第三腓骨肌瓣的应用解剖

目的　为小腿下 1/3骨髓炎和其它创伤性修复提供满意的肌瓣。材料和方法　用 18具 3 6例成人尸体标本采用连续层次解剖法 ,调查了第三腓骨肌 ,用游标卡尺测量了有关数据。结果　转动第三腓骨肌瓣能覆盖胫骨前内侧下 1/3的面积为 ( 16 7± 8 1)cm2 的区域。结论　第三腓骨肌可以移植。     

眼轮匝肌蒂颞区皮瓣移位术的解剖学基础

目的 :为眼轮匝肌蒂颞侧皮瓣转位修复中颌面软组织缺损提供解剖学基础。方法 :30侧动脉内灌注红色乳胶的成人头颅标本 ,解剖观测眼轮匝肌形态及血供。结果 :①眼轮匝肌眶下部的中部、内侧部及外侧部宽分别为 (2 .5± 0 .3)cm、(0 .8± 0 .2 )cm和 (2 .6± 0 .5 )cm。②眼轮匝肌眶下部血供主要来源于内眦动脉、眶下动脉及颧眶动脉等分支 ,其外径在 0 .2～ 0 .8mm之间。这些动脉相互间形成丰富的吻合。结论 :以眼轮匝肌眶下部为蒂的颞侧皮瓣可用于转位修复中颌面软组织缺损。     

Anatomical study of the variations in innervation of the orbicularis oculi by the facial nerve

While the divisions of the facial nerve in the face are well known, the innervation of the orbicularis oculi by the different distal branches of the facial nerve is poorly described. To determine which branches of the facial nerve play a role in this innervation, the facial nerve was dissected in 30 fresh cadavers. The innervation of this muscle was in the form of two plexuses, a superior one, most often (93%) formed by the union of the temporal and superior zygomatic branches, and an inferior one, usually formed (63%) by the union of the inferior zygomatic and superior buccal branches. This new mode of innervation explains how, without damage to both plexuses, innervation of orbicularis oculi by the facial nerve remains functional. It also explains the often unsatisfactory results of treatment of primary blepharospasm, and the unusual character of palsies of this muscle in cervicofacial lifts.     

The face of effort: Frowning muscle activity reflects effort during a physical task

It is a common observation that exertion of effort is associated with a specific facial expression. However, this facial expression has never been quantified during physical tasks and its relationship with effort is unknown. The aims of the present study were to measure frowning muscle activity during a physical task with electromyography (EMG) and to investigate the relationship between facial EMG and effort. Effort was experimentally manipulated by increasing task difficulty and inducing muscle weakness. Twenty men performed leg extensions with four relative workloads. The fatigue group (n = 10) repeated the leg extensions after fatiguing eccentric exercise, and the control group repeated just the leg extensions. Facial EMG amplitude, ratings of perceived effort (RPE), and leg EMG amplitude increased significantly with increasing task difficulty and with muscle fatigue. Facial EMG, RPE, and leg EMG all correlated significantly. The results suggest that frowning muscle activity reflects effort during physical tasks.     

颈胸段脊柱周围重要神经结构及其毗邻关系

目的:为颈胸段脊柱选择合理的手术入路提供解剖学依据。方法:在30具尸体标本上,观察颈胸段脊柱周围重要神经结构及毗邻关系。结果:(1)喉返神经(RLN)进入气管食管沟的位置对应椎体水平及构成比,左:90%位于T3/4～T4水平,右:70%位于C6/7～C7上水平;67.7%的右RLN与颈总动脉的交叉点对应椎体水平在T1下～T1/2水平。(2)颈胸段交感干(CTST)与椎体前正中线(PVM)距离在T1椎体中点水平较C6～C7和T2～T5水平大,且男女之间差异有统计学意义(P<0.05)。(3)膈神经(PN)入胸腔后,左PN于主动脉弓前方、右PN于上腔静脉前外侧经心包与纵隔胸膜之间在肺根前方下行。结论:熟悉喉返神经、交感干和膈神经的相关解剖有助于在颈胸段脊柱手术中选择合理的手术入路。     

The anatomy of the hip abductor muscles

The anatomy of the hip abductors has not been comprehensively examined, yet is important to understanding function and pathology in the gluteal region. For example, pathology of the hip abductor muscle‐tendon complexes can cause greater trochanteric pain syndrome, and may be associated with gluteal atrophy and fatty infiltration. The purpose of this study was to investigate the detailed morphology of gluteus medius (GMed), gluteus minimus (GMin), and tensor fascia lata (TFL), and determine whether the muscles comprised anatomical compartments. The gluteal region from 12 cadavers was dissected and data collected on attachment sites, volume, fascicular and tendinous anatomy, and innervation. Three sites of GMed origin were identified (gluteal fossa, gluteal aponeurosis, and posteroinferior edge of the iliac crest) and the distal tendon had lateral and posterior parts. GMed was the largest in volume (27.6 ± 11.6 cm³; GMin 14.1 ± 11.1 cm³; TFL 1.8 ± 0.8 cm³). Fascicles of GMin originated from the gluteal fossa, inserting onto the deep surface of its distal tendon and the hip joint capsule. TFL was encapsulated in the fascia lata, having no bony attachment. Primary innervation patterns varied for GMed, with three or four branches supplying different regions of muscle. Distinct secondary nerve branches entered four regions of GMin; no differential innervation was observed for TFL. On the basis of architectural parameters and innervation, GMed, and GMin each comprise of four compartments but TFL is a homogenous muscle. It is anticipated that these data will be useful for future clinical and functional studies of the hip abductors. Clin. Anat. 27:241–253, 2014. © 2013 Wiley Periodicals, Inc.