足底中间群肌和足背肌肌内神经整体分布模式及意义

目的 揭示足底中间群和足背肌的肌内神经整体分布模式，探讨其意义。 方法 取下12具经福尔马林固定的成人尸体足底中间群肌和足背肌，改良的Sihler’s染色法显示肌内神经整体分布模式。 结果 接受足底内侧神经支配的趾短屈肌、第1和第2蚓状肌的神经支，分别从肌的内侧深面和浅面入肌；接受足底外侧神经支配的足底方肌、第3和第4蚓状肌的神经支从肌止端走向起端；骨间足底肌和骨间背侧肌的神经支从肌起端走向止端。趾短伸肌和母短伸肌的神经支共干。蚓状肌、第1和第2骨间足底肌、第1骨间背侧、母短伸肌和趾短伸肌仅在肌腹中部形成1个肌内神经密集区；趾短屈肌、足底方肌、第3骨间足底肌以及第2~4骨间背侧肌有2个肌内神经密集区，位于肌腹两侧，这些肌可分为2个神经肌亚部。 结论 这些结果可为外科手术免于神经损伤、肌移植的选材匹配，以及注射肉毒毒素A阻滞这些肌的痉挛提供形态学指导。     

足底肌瓣血管神经的巨微解剖

<正> 作者用手术显微镜观测了50例成人尸体足底浅层肌肉的血管和神经,并对浅层肌瓣血管蒂的选择进行了讨论。结果显示:足底浅层肌肉的血供来源于足底内、外侧动脉,神经来自足底内、外侧神经。趾短屈肌的动脉几乎均匀地来自足底内、外侧动脉,神经来自足底内侧神经。(足母)展肌的血供69％来自足底内侧动脉发出的深支动脉,该动脉出现     

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。     

足底的血管构筑与跖弓皮瓣、肌皮瓣对足跟缺损的修复

目的：用跖弓皮瓣、肌皮瓣足跟缺损、提供足底三套血管网分布特点的解剖学依据。方法：在２０例福尔马林、４例红色乳胶灌注的成人尸体标本上、观察足底内、外侧动脉的起始、行径、分支及其吻合情况。结果：足底共有三套血管网供血：１．足底内侧动脉的内、外侧支在嘴展肌深面分支分布,形成足底内侧血管网。２．足底内侧动脉外侧支与足底外侧动脉的分支在足底腱膜与趾短屈肌之间吻合形成足底浅弓。３．足底内侧动脉的内侧支与足底外     

人鱼际肌的肌内神经分支分布和肌梭密度研究

目的探索鱼际肌肌肌内神经分支和肌梭密度的分布。方法采用改良Sihler’s肌内神经染色法和HE染色法进行解剖学研究。结果鱼际肌的神经常从肌起端深面入肌,神经入肌后在拇短展肌、拇对掌肌、拇收肌横头内与肌长轴垂直走向,拇收肌斜头和拇短屈肌内沿肌长轴平行走形。80%～82.5%的拇短屈肌和拇指对掌肌接受正中神经和尺神经的双重支配。拇短屈肌浅头和深头、拇收肌横头和斜头有独立的神经支配,可分出神经肌肉亚部。4块肌内神经分支分布密集区多在肌的中部与近端,可见"Y"、"O"、"H"或"U"型等不同的神经吻合形式。鱼际肌肌梭密度高达16.19～27.14个/g,高低顺序为拇指对掌肌拇短屈肌拇短展肌拇收肌。结论鱼际肌肌内神经吻合丰富,肌梭密度高,除拇对掌肌外,其余肌块可作整肌或半肌移植的供体。     

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。     

足内侧穿支皮瓣设计的解剖基础

目的    为足内侧穿支皮瓣的临床应用提供解剖基础。  方法　对8侧乳胶灌注的成人下肢标本足内侧区进行显微解剖,观测各穿支血管的位置、数目、外径、蒂长及吻合等情况。  结果　足内侧区皮肤的血供有：足底内侧动脉、内踝前动脉、跗内侧动脉和母趾胫侧动脉。足底内侧动脉浅支穿母展肌在舟骨粗隆附近浅出,外径（1.08±0.20）mm;深支从母展肌和趾短屈肌的间隙内向足底内侧平均发出5.3支穿支,平均外径（0.63±0.25）mm,蒂长（0.93±0.31）cm;内侧深支的内侧支由舟骨粗隆前（1.92±0.61）cm处从母展肌上缘浅出至足内侧。母趾胫侧动脉从第一跖趾关节近侧（2.03±0.56）cm处穿出至足内侧。足底内侧动脉浅支、内侧深支的内侧支与内踝前动脉、跗内侧动脉吻合形成展肌上缘动脉弓,动脉弓的远端与母趾胫侧动脉相吻合。  结论　足内侧穿支皮瓣可设计以不同的穿支为蒂进行带蒂转移,修复前足、踝部及足跟周围软组织缺损,也可设计游离皮瓣修复手指掌侧软组织缺损。     

拇短屈肌形态特点及其神经支配

目的：进一步弄清拇短屈肌的神经支配，为临床有关神经损伤的诊治提供应用解剖学形态基础。方法：对３０只成人手标本拇短屈肌形态和神经支配进行了观测。结果：拇短屈肌浅头受正中神经返支支配，拇短屈肌深头受尺神经深支支配。尺神经深支的拇短屈肌深头肌支出现率占８６．７％，肌内平均支数为２．０±０．７支，有１０％的拇短屈肌深头肌支既支配拇短屈肌深头，又支配拇短屈肌浅头，并有一交通支与正中神经相连。结论：１０％的拇短屈肌具有双重性神经支配。因此，当正中神经损伤，部分病例的鱼际肌中个别肌肉可不出现瘫痪。     

足内缘动脉弓为蒂的足内侧岛状皮瓣应用解剖

目的　为足内侧岛状皮瓣修复足底外侧皮肤缺损提供解剖学依据。   方法　35侧成年尸体足标本,经动脉灌注红色乳胶,在手术显微镜下(×10)解剖观测母展肌上缘动脉弓与足底内侧动脉深支内侧支吻合的位置、外径及长度。  结果  　母展肌上缘动脉弓与足底内侧动脉深支内侧支在内侧楔骨内侧有一较恒定的吻合,并把这一吻合支暂命名为足内缘动脉弓。形成足内缘动脉弓占82.8%（29侧）,吻合处外径为(0.65±0.21)mm,长度为（2.63±0.71）mm;未发现吻合动脉弓占17.2%（6侧）。  结论　以足内缘动脉弓为蒂的足内侧岛状皮瓣可以修复足底外侧皮肤缺损。     

家兔趾深屈肌肌构筑、肌内神经和运动终板分布

目的:探讨家兔趾深屈肌的肌构筑与肌内神经和运动终板分布的关系。方法:肌构筑法、改良Sihler s染色法、乙酰胆碱酯酶染色法。结果:家兔趾深屈肌为环羽肌。肌质量为(2.30±0.02)g,肌纤维长(1.00±0.01)cm,肌生理横切面积(2.17±0.12)cm2。肌的起端,神经干于腱板上方发出内侧和外侧两条初级支,初级支在肌内发出数目不等的次级支,继而向肌的深面和边缘发出终末支。有的次级支穿越腱板到达对侧。肌表面内、外两缘有线状排列的运动终板带,两带在肌止端相接,呈“V”形。结论:家兔趾深屈肌是环羽肌,倾向力量型设计;肌内神经分支存在越边支配;肌内神经和运动终板的分布与肌纤维排列有关;趾深屈肌有划分亚部的形态学特征。     

Intramuscular nerve distribution pattern of the oblique and transverse heads of the adductor hallucis muscles in the human foot

To understand which layer of the intrinsic muscles of the foot the adductor hallucis muscle belongs to, it is essential to investigate the innervation patterns of this muscle. In the present study, we examined the innervation patterns of the adductor hallucis muscles in 17 feet of 15 Japanese cadavers. We investigated the intramuscular nerve supplies of the adductor hallucis muscles in six feet and performed nerve fiber analysis in three feet. The results indicate that: (i) the oblique head of the adductor hallucis muscle is divided into three compartments (i.e. lateral, dorsal and medial parts) or two compartments (i.e. dorsal and medial parts) based on its intramuscular nerve supplies, but we could not classify the transverse head into any parts; (ii) the communicating twig between the lateral and medial plantar nerves penetrated the oblique head of the adductor hallucis muscle in 13 of 17 feet (76.5%); (iii) the penetrating twig entered between the lateral and dorsal parts of the oblique head, passed between the lateral and medial parts of this muscle and then connected with the medial plantar nerve; and (iv) the majority of the nerve fibers of the penetrating twig derived from the lateral plantar nerve. The present study demonstrated that only the lateral part of the oblique head of the adductor hallucis muscle had a unique innervating pattern different from other parts of this muscle, suggesting that the lateral part of the oblique head has a different origin from other parts of this muscle.     

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。     

Innervation of the abductor digiti minimi muscle of the human foot: anatomical basis of the entrapment of the abductor digiti minimi nerve

The origin, relationships and innervation of the abductor digiti minimi muscle were determined in 145 human feet, from formaldehyde-fixed cadavers. The muscle arises from both processes of the calcaneal tuberosity, from the plantar aponeurosis and from the septum which separates it from the flexor digitorum brevis muscle. The nerve to the abductor digiti minimi muscle arises next to the origin of the lateral plantar nerve, close to the abductor hallucis muscle, and descends becoming closely related to the medial face of the calcaneus and the deep face of the abductor hallucis muscle. Then, it passes inferiorly through the origin of the quadratus plantae muscle and later divides into two branches for the two heads of the muscle.     

Lateromedial and dorsoplantar borders among supplying areas of the nerves innervating the intrinsic muscles of the foot

The branching patterns of nerves supplying the intrinsic muscles of the foot were analyzed as a basis to confirm the muscle layer structure. Thirty‐eight feet of 20 Japanese cadavers were examined in detail in this study. The first dorsal interosseus was innervated by a branch from the deep peroneal nerve as well as a branch of the lateral plantar nerve in 92.1%, the second dorsal interosseus in 10.5% and the third dorsal interosseus in 2.6%. In three specimens, branches from the deep peroneal nerve innervated the oblique head of the adductor hallucis or the lateral head the flexor hallucis brevis. In addition, branches from the medial and lateral plantar nerves and the deep peroneal nerve formed communication loops in three specimens. The first dorsal interosseus, the oblique head of the adductor hallucis and the lateral head of the flexor hallucis and their innervating nerve branches are closely related within the first intermetatarsal space. Since the tibial part of the first interosseus muscle primordium is occupied in the space during development, the variations of innervation patterns and formation of the communicating nerve loops may be explained by various combinations of the part and the other muscle primordia. Anat Rec 255:465–470, 1999. © 1999 Wiley‐Liss, Inc.     

Lateromedial and dorsoplantar borders among supplying areas of the nerves innervating the intrinsic muscles of the foot.

The branching patterns of nerves supplying the intrinsic muscles of the foot were analyzed as a basis to confirm the muscle layer structure. Thirty-eight feet of 20 Japanese cadavers were examined in detail in this study. The first dorsal interosseus was innervated by a branch from the deep peroneal nerve as well as a branch of the lateral plantar nerve in 92.1%, the second dorsal interosseus in 10. 5% and the third dorsal interosseus in 2.6%. In three specimens, branches from the deep peroneal nerve innervated the oblique head of the adductor hallucis or the lateral head the flexor hallucis brevis. In addition, branches from the medial and lateral plantar nerves and the deep peroneal nerve formed communication loops in three specimens. The first dorsal interosseus, the oblique head of the adductor hallucis and the lateral head of the flexor hallucis and their innervating nerve branches are closely related within the first intermetatarsal space. Since the tibial part of the first interosseus muscle primordium is occupied in the space during development, the variations of innervation patterns and formation of the communicating nerve loops may be explained by various combinations of the part and the other muscle primordia.     

Sural--lateral plantar nerve communications in Japanese macaque

It is generally accepted that the sural nerve in humans contains exclusively sensory and autonomic fibers. Recently, however, a few clinical reports have suggested that the human sural nerve contains motor fibers. On the other hand, it is known that motor fibers are present in the sural nerve of rats and dogs, and that the fibers reach intrinsic muscles of the foot via a communicating branch to the lateral plantar nerve. The author investigated the communicating branch between the sural and lateral plantar nerves in Japanese macaques, and examined both nerves by the fiber analysis method, removing the perineurium under a stereoscopic microscope. The communicating branch was found in all examined macaques. Nerve fibers which derived from the sural nerve via the branch reached the abductor digiti quinti, the flexor digiti quinti brevis, the contrahentes digitorum, the adductor hallucis, the interosseous and the lumbrical muscles. Furthermore, these fibers supplied the lateral part of the skin of the sole and the metatarsophalangeal joints. These findings in the Japanese macaques suggest that we may encounter the communicating branch between the sural and lateral plantar nerves in other primates including humans as in rats and dogs.     

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：     

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.