《筋膜学》简介

正《筋膜学》通用教科书是南方医科大学、深圳大学医学院原林教授带领课题组在国家863数字人研究、国家973筋膜学项目研究的支持下对人体结缔组织(筋膜)进行宏观研究的阶段性成果总结。本书主要提出了人体结构的两系统理论:人体是由未分化的结缔组织,主要是疏松结缔组织和脂肪所形成的遍布全身的筋膜支架所构成的支持与储备系统和被该支架支持和包绕的由已分化的功能细胞所构成的     

人体筋膜重建经线与经典经线走行路线对比

目的:探讨经络与人体筋膜重建经线的解剖学位置关系。方法:首先在数字人研究的基础上利用计算机三维重建人体全身的筋膜网状支架,并对人体肢体和躯干的肌间隙结缔组织进行标记和三维重建,构成与古代文献记载经络走行相似的串珠状连线,应用计算机三维图像处理软件结合数学分析方法,在重建的虚拟人体上对筋膜重建经线与经典经线体表走行路线进行对比研究。结果:人体筋膜重建经线与中医古代文献记载的经脉体表走行路线基本相似。结论:人体筋膜三维重建经线与中医经络线在形态上相似,两者之间存在密切的解剖学位置关系。     

人体四肢经穴筋膜基础的医学影像学研究

目的:本研究尝试采用医学影像学方法,对人体四肢经穴的解剖结构加以观察,结合计算机三维重建技术,重点探索经络走行与筋膜分布密切相关的规律,为揭示经络的解剖学实质提供新的依据。方法:通过超声影像学观察、采用CT、MRI手段和把CT、MRI与三维重建技术相结合引进经络研究领域,为揭示经络与穴位的解剖学实质进行方法学上的创新性研究。结果:与传统中医记载的经络机理和走行线进行对比分析,发现有相似性。结论:中医经络的解剖学基础可能是分布于全身的筋膜结缔组织。     

腰骶部骨筋膜室的外科解剖

对２５具成尸的腰背筋膜，骶棘肌及腰神经后支进行了观测。腰椎，骶骨及周围韧带与腰背筋膜浅，深层构成腰骶部骨膜室，是产生腰骶部骨筋膜室综合征的解剖学基础。腰背筋膜有约束骶棘肌，加强脊柱稳定的作用，腰背筋膜下的疏松结缔组织及脂肪有缓冲，减少腰背筋与棘肌摩擦的作用。腰神经后支穿经骶棘肌，手术时应保护之。     

人体筋膜组织的神经支配及神经内分泌调控

<正>筋膜是结缔组织形成的解剖学结构,遍布全身,相互连结,参与构成人体各个组织器官,形成这些组织器官的被膜、隔膜和内部支架等结构。传统观点认为筋膜仅仅具有充填、支持和连结作用,而对其深层复杂的生物学意义还缺乏足够的认识和研究。近十年来,国际医学界对筋膜的研究逐步兴起,研究的领域     

数字人体下肢筋膜重建经线与经络线形态学相似性的计算机化研究

目的利用计算机自动标识与三维重建技术,探索人体下肢筋膜类间隙结缔组织与经络经线形态位置相似性的证据及规律。方法获取虚拟中国人男1号(VCH-M1)数据集,截取左腿区域,利用计算机软件,首先提取肌肉信号,完成去噪处理;然后通过边缘检测,求出肌肉轮廓点的凸包;最后完成对间隙结缔组织的标记,并对标记的间隙结缔组织利用3D-Doctor软件进行三维重建。结果通过对虚拟人体下肢间隙结缔组织计算机自动识别标记,并对标记的间隙结缔组织进行三维重建,得到了与传统中医经络图谱描述相似的重建虚拟经线。结论本实验结果说明,南方医科大学人体解剖学教研室和中山大学科学计算与计算机应用研究所合作开发的将虚拟人体数据集应用于经络研究的计算机工具,可对虚拟人体下肢间隙结缔组织进行自动识别标记,并三维重建出虚拟筋膜经线,在一定程度上避免了筋膜重建手工识别过程中产生的人为因素误差,对于研究人体筋膜类间隙结缔组织与经络是否存在形态位置相关性有重要意义。     

大转子区筋膜骨膜血管分布及其临床意义

目的：为股方肌蒂大转子筋膜骨膜骨瓣移位术提供解剖学基础。方法：在３４侧下肢标本上对大转子区筋膜和骨膜的形态特点及其血供进行了解剖学观察。结果：大转子区筋膜较厚,分浅、深两层,与臀大肌筋膜和大转子骨膜通过疏松结缔组织相连。筋膜和骨膜的动脉来源为多源性,来自旋股内侧动脉深支、臀下动脉大转子支、第１穿动脉升支、旋股外侧动脉升支和横支。它们在大转子形成广泛的吻合。旋股内侧动脉深支管径为１．７±０．５ｍｍ,长３．３±０．７ｃｍ,其筋膜支和骨膜支是大转子的主要营养血管。臀下动脉大转子支管径１．４±０．５ｍｍ,长５．２±０．８ｃｍ,常与旋股内侧动脉深支吻合。结论：带筋膜血管的骨膜骨瓣比不带筋膜的骨膜骨瓣血供丰富。根据大转子区筋膜和骨膜的血管分布特点,可设计带筋膜血管的股方肌蒂大转子骨膜骨瓣。     

针推班解剖学成绩分析与教学改革探讨

针灸推拿学是我校医学与生命科学学院中医系本科专业新开设的一门学科。我教研室共承担了人体解剖学和穴位解剖学两门课程的教学任务。其中人体解剖学作为一门非常重要的基础课，是每一个刚踏进医学院校门的大学生都必修的；而穴位解剖学则是我室根据针灸推拿专业的特殊要求而新开的一门课。     

人体应建立防卫系统

皮肤、筋膜包被全身 ,构成人体与外环境间的保护屏障。免疫器官组织发挥免疫功能。屏障作用和免疫功能看似互不相关 ,其实是有机联系的 ,均是执行对人体的保护和防御功能 ,即防卫功能。从这个角度讲 ,它们构成了人体独特的器官功能系统———防卫系统。传统医学把它们视为零散的 ,互不相关的 ,无系统性的人体“构件” ,使得防卫系统在描述正常人体形态结构的解剖学中无一席之地。或者仅对免疫器官组织轻描淡写 ,并造成皮肤、筋膜的系统归属混乱。如此等等 ,无形中形成这些器官组织是其它系统的附属部分 ,功能上无关紧要的模糊认识。为了解决…     

人体皮肤微循环的观察与临床应用(上)

<正> 皮皮(Skin)复盖于全身表面,约占体垂的16%,是人体最大的器官。活体皮肤微循环观察,不论对全身疾病或局部病变都有独特的临床诊断价值,这一点在我们的临床观察中得以证实。 1 皮肤的组织结构皮肤主要可分为上皮性的表层及结缔组织构成的真皮。皮肤的厚度依部位不同在1～4mm左右,真皮下方有疏松     

Preliminary embryological study of the radiological concept of retroperitoneal interfascial planes: what are the interfascial planes?

Purpose

Recently, the radiological concept of retroperitoneal interfascial planes has been widely accepted to explain the extension of retroperitoneal pathologies. This study aimed to explore embryologically based corroborative evidence, which remains to be elucidated, for this concept.

Methods

Using serial or semi-serial transverse sections from 29 human fetuses at the 5th–25th week of fetal age, we microscopically observed the development of the retroperitoneal fasciae and other structures in the retroperitoneal connective tissue. A hypothesis for the formation of the interfascial planes was generated from the developmental study and analysis of retroperitoneal fasciae in computed tomography images from 224 patients.

Results

Whereas the loose connective tissue was uniformly distributed in the retroperitoneum by the 9th week, the primitive renal and transversalis fasciae appeared at the 10th–12th week, as previous research has noted. By the 23rd week, the renal fascia, transversalis fascia, and primitive adipose tissue of the flank pad emerged. In addition, the primitive lateroconal fascia, which runs parallel to and close to the posterior renal fascia, emerged between the renal fascia and the adipose tissue of the flank pad. Conversely, pre-existing loose connective tissue was sandwiched between the opposing fasciae and was compressed and narrowed by the developing organs and fatty tissues.

Conclusion

Through this developmental study, we provided the hypothesis that the compressed loose connective tissue and both opposed fasciae compose the interfascial planes. Analysis of the thickened retroperitoneal fasciae in computed tomography images supported this hypothesis. Further developmental or histological studies are required to verify our hypothesis.     

Hyaluronan within fascia in the etiology of myofascial pain

The layers of loose connective tissue within deep fasciae were studied with particular emphasis on the histochemical distribution of hyaluronan (HA). Samples of deep fascia together with the underlying muscles were taken from neck, abdomen and thigh from three fresh non-embalmed cadavers. Samples were stained with hematoxylin–eosin, Azan-Mallory, Alcian blue and a biotinylated HA-binding protein specific for HA. An ultrasound study was also performed on 22 voluntary subjects to analyze the thickness of these deep fasciae and their sublayers. The deep fascia presented a layer of HA between fascia and the muscle and within the loose connective tissue that divided different fibrous sublayers of the deep fascia. A layer of fibroblast-like cells that stained prominently with Alcian blue stain was observed. It was postulated that these are cells specialized for the biosynthesis of the HA-rich matrix. These cells we have termed “fasciacytes”, and may represent a new class of cells not previously recognized. The ultrasound study highlighted a mean thickness of 1.88 mm of the fascia lata, 1.68 mm of the rectus sheath, and 1.73 mm of the sternocleidomastoid fascia. The HA within the deep fascia facilitates the free sliding of two adjacent fibrous fascial layers, thus promoting the normal function associated with the deep fascia. If the HA assumes a more packed conformation, or more generally, if the loose connective tissue inside the fascia alters its density, the behavior of the entire deep fascia and the underlying muscle would be compromised. This, we predict, may be the basis of the common phenomenon known as “myofascial pain.”     

The deep fascia and retinacula of the equine forelimb – structure and innervation

Recent advances in human fascia research have shed new light on the role of the fascial network in movement perception and coordination, transmission of muscle force, and integrative function in body biomechanics. Evolutionary adaptations of equine musculoskeletal apparatus that assure effective terrestrial locomotion are employed in equestrianism, resulting in the wide variety of movements in performing horses, from sophisticated dressage to jumping and high‐speed racing. The high importance of horse motion efficiency in the present‐day equine industry indicates the significance of scientific knowledge of the structure and physiology of equine fasciae. In this study, we investigated the structure and innervation of the deep fascia of the equine forelimb by means of anatomical dissection, histology and immunohistochemistry. Macroscopically, the deep fascia appears as a dense, glossy and whitish lamina of connective tissue continuous with its fibrous reinforcements represented by extensor and flexor retinacula. According to the results of our histological examination, the general structure of the equine forelimb fascia corresponds to the characteristics of the human deep fasciae of the limbs. Although we did find specific features in all sample types, the general composition of all examined fascial tissues follows roughly the same scheme. It is composed of dense, closely packed collagen fibers organized in layers of thick fibrous bundles with sparse elastic fibers. This compact tissue is covered from both internal and external sides by loosely woven laminae of areolar connective tissue where elastic fibers are mixed with collagen. Numerous blood vessels running within the loose connective tissue contribute to the formation of regular vascular network throughout the compact layer of the deep fascia and retinacula. We found nerve fibers of different calibers in all samples analyzed. The fibers are numerous in the areolar connective tissue and near the blood vessels but scarce in the compact layers of collagen. We did not observe any Ruffini, Pacini or Golgi‐Mazzoni corpuscles. In conclusion, the multilayered composition of compact bundles of collagen, sparse elastic fibers in the deep fascia and continuous transition into retinacula probably facilitate resistance to gravitational forces and volume changes during muscle contraction as well as transmission of muscle force during movement. However, further research focused on innervation is needed to clarify whether the deep fascia of the equine forelimb plays a role in proprioception and movement coordination.     

Ultrasonography in myofascial neck pain: randomized clinical trial for diagnosis and follow-up

Objective

A definitive diagnosis of chronic neck pain (CNP) is sometimes not possible. The aim of this study was to understand the possible role of the deep fasciae in CNP and the utility of the ultrasonography in the diagnosis of myofascial neck pain.

Methods

The morphometric and clinical data of 25 healthy subjects and 28 patients with CNP were compared. For all subjects, the active and passive cervical range of motion (ROM) was analyzed and the neck pain disability questionnaire (NDPQ) was administered. The fascial thickness of the sternal ending of the sternocleidomastoid and medial scalene muscles was also analyzed by ultrasonography.

Results

There were significant differences between healthy subjects and patients with CNP in the thickness of the upper side of the sternocleidomastoid fascia and the lower and upper sides of the right scalene fascia both at the end of treatment as during follow-up. A significant decrease in pain and thickness of the fasciae were found. Analysis of the thickness of the sub-layers showed a significant decrease in loose connective tissue, both at the end of treatment and during follow-up.

Conclusions

The data support the hypothesis that the loose connective tissue inside the fasciae may plays a significant role in the pathogenesis of CNP. In particular, the value of 0.15 cm of the SCM fascia was considered as a cut-off value which allows the clinician to make a diagnosis of myofascial disease in a subject with CNP. The variation of thickness of the fascia correlated with the increase in quantity of the loose connective tissue but not with dense connective tissue.     

Relationship of acupuncture points and meridians to connective tissue planes

Acupuncture meridians traditionally are believed to constitute channels connecting the surface of the body to internal organs. We hypothesize that the network of acupuncture points and meridians can be viewed as a representation of the network formed by interstitial connective tissue. This hypothesis is supported by ultrasound images showing connective tissue cleavage planes at acupuncture points in normal human subjects. To test this hypothesis, we mapped acupuncture points in serial gross anatomical sections through the human arm. We found an 80% correspondence between the sites of acupuncture points and the location of intermuscular or intramuscular connective tissue planes in postmortem tissue sections. We propose that the anatomical relationship of acupuncture points and meridians to connective tissue planes is relevant to acupuncture's mechanism of action and suggests a potentially important integrative role for interstitial connective tissue.     

The glycosaminoglycans of Dupuytren's disease

The total and individual glycosaminoglycan (GAG) content at various stages of the Dupuytren disease process and in samples of normal palmar connective tissue (palmar dermis, palmar fascia and digital flexor tendon) from the hands of uninvolved age-matched controls have been assayed and compared. Morphological comparisons between the different tissues were made by histological examination of sections stained to demonstrate collagen fiber patterns and glycosaminoglycan distribution. Significant differences in the type and amount of GAG were found between the various manifestations of the disease process, i.e., nodules, cellular and fibrous bands, and between these and the normal palmar connective tissues. In the most actively proliferating cellular regions chondroitin sulfate levels were 11 times greater than those of the normal palmar connective tissues, whereas dermatan sulfate tissue levels showed a fourfold increase. On the other hand, tissue concentrations of hyaluronate were similar to those of normal palmar connective tissue. The relationship of these differences in GAG levels to the development and maturation of the normal palmar connective tissues and the Dupuytren's process is discussed.     

Nonclostridial anaerobic soft tissue infections

Fourteen cases of nonclostridial anaerobic infections of soft tissues caused by peptococci, peptostreptococci, bacteroids or their combinations with E. coli, Proteus, and Staphylococcus aureus were studied. They are characterized by a rapid spread of serous-suppurative inflammation and the causative agents in loose fibrous connective tissue of subcutaneous adipose tissue (cellutitis), surface fascia (fasciitis), or skeletal muscles (myositis). Dissolution of intercellular structures of the connective tissue, extensive necroses, mild leukocyte reaction, and a wide peripheral zone of toxic edema are observed in the focus of inflammation. This is due to a high toxicity and enzymatic activity of the causative agents. Gas formation is observed when anaerobes are combined with E. coli.     

Streptococcal necrotizing fasciitis: development of an animal model to study its pathogenesis.

Necrotizing fasciitis is a serious and increasingly common human disease which can be caused by an infection with beta-haemolytic streptococci (BHS) of Lancefield groups A, C or G, spreading rapidly in the loose connective tissue over the muscle fascia. To facilitate study of its pathogenesis, we have developed an animal model for the production of a spreading infection with BHS in the loose connective tissue over the muscle layer in the skin of New Zealand White rabbits. Intradermal injection of group A BHS alone into the flank was unsatisfactory in that a spreading lesion occurred on only 12% of occasions. When the group A BHS were co-injected with cultures of Staphylococcus aureus, the results depended on the strain of S. aureus used: an abscess-producing strain isolated from pigs gave rise to a spreading lesion on 50% of occasions. When BHS were injected with the alpha-lysin of S. aureus at a titre which produced inflammation without necrosis, spreading lesions occurred on 75% of occasions. However, both inoculated and uninoculated broth acted synergistically with the alpha-lysin in potentiating the spread of the streptococci. This demonstration of synergy between BHS and alpha-lysin of S. aureus may reflect the clinical situation in the human, as both organisms have been found to occur together at sites where spreading streptococcal infections have originated.