舌骨下肌群神经肌带的解剖学基础

在手术显微镜下解剖了30例成人舌骨下肌群的神经和血管,并用一具成年新鲜女尸(死后约30小时)及一只狗对舌骨下肌群神经肌蒂的运动终板进行了氯化金染色。舌骨下肌群神经肌蒂的神经主要来自颈袢上根。肩胛舌骨肌上腹,胸骨舌骨肌和胸骨甲状肌的神经在它们进入这些肌肉时,有甲状腺上动脉的第二或第三级分支伴行。神经和血管大都可以包含在神经肌蒂内。柱新鲜尸体和狗的神经肌蒂内,明显地存在有典型运动终板。本文还对舌骨下肌群各肌的大小进行了测量,并对舌骨下肌群神经肌蒂的临床应用,进行了讨论。     

舌下神经肌蒂移位治疗面瘫的解剖学基础

解剖了46侧成尸颈部和28侧面部标本,针对面神经损伤后的有关问题观察了舌下神经袢前降支及面神经下颌缘支。认为神经肌蒂移位时应选择肩胛舌骨肌上腹肌支和胸骨舌骨肌上肌支。受区选择在口角外侧1.5cm 处的面肌为宜。当不适宜作神经肌蒂移位时,可用前降支与下颌缘支缝合。     

环甲肌的解剖形态和生理功能的再认识

目的：为了重新认识环甲肌的形态和功能。方法：用６０个经福尔马林固定的成人尸体喉，在手术显微镜下对环甲肌进行解剖观测；用８条中国犬在手术麻醉下对环甲肌进行电生理实验。结果：电刺激单侧和双侧环甲肌，甲状软骨都固定不动，环状软骨运动；切断一侧喉上神经喉外支，使该侧环甲肌瘫痪，用直接喉镜观察声门，可见声门后端向患侧偏斜。结论：环甲肌属于二头肌，起于甲状软骨，止于环状软骨；环甲肌收缩时，甲状软骨固定，环状软骨活动；一侧环甲肌瘫痪时，环状软骨弓向健侧偏转，声门后端向患侧偏斜。     

环杓后肌神经的显微外科解剖

本文借助SXP-Ⅰ型手术显微镜观察了30例成人喉返神经终末支支配环杓后肌的分支,并用改良的karnovsky-Roots AchE染色方法鉴定了喉返神经终末分支的性质。结果表明,喉返神经以前、后二终支入喉,前支是运动支,后支为感觉支;环杓后肌神经来自前支和前支的分支——杓间肌支,支数多,长度短。组织学研究表明,前支内,环杓后肌神经纤维和其它神经纤维随机分布在一起,未形成一个独立的神经束。     

实验犬环杓后肌功能重建的组织化学研究及图像分析

为了确定并比较犬两种不同术式：Ⅰ。颈袢胸骨舌骨肌支蒂移植术；Ⅱ．副神经胸锁乳突肌支肌蒂移植术，治疗声带麻痹的效果。建立单侧联合性声带麻痹动模型，分别用Ⅰ、Ⅱ两种术式移植神经肌蒂于失神经的环杓后肌。术后４个月取各组ＰＣＡＭ做同结构检查，并做光镜组织化学：乙酰胆碱酯酶、琥珀酸脱氢酶、三磷酸苷酶、糖原反应。用图像定量并测示肌纤维直径。结果发现两种术式都能使ＰＣＡＭ恢复功能，第Ⅱ种术式组织化学结构优于第Ⅰ     

恢复环甲肌功能的实验研究

<正> 本文通过对狗颈部诸喉外肌与环甲肌肌电的对照研究证明,胸骨舌骨肌和环甲肌在发音、呼吸时基本呈同步放电,为用神经肌蒂移位恢复环甲肌功能的手术提供了理论依据。同时介绍带舌下神经袢分支的胸骨舌骨肌肌蒂移植恢复环甲肌功能的治     

人冈上肌肌形态、肌内神经和肌梭分布的研究

目的为进一步探讨冈上肌的生理功能和临床应用提供形态学依据。方法大体解剖法、改良的Sihler＇s肌内神经染色法、HE染色法。结果（1）肌中部有一白色腱板,肌束呈辐凑状排列于腱板周围,似环羽肌。（2）肌内有三支初级神经支,其中肌中支最粗大,支配范围最广。在肌中部多形成交通支。（3）冈上肌的平均肌梭密度为63．94±4．73个／cm^3。结论（1）冈上肌是环羽肌,倾向力量型设计。（2）神经分支主要分布在肌内腱板的深面,在肌中部多形成神经交通支。（3）冈上肌与三角肌可构成“平行肌组”。     

左颈袢变异1例

颈袢是由第1～3颈神经前支的纤维组成,其上、下根通常在肩胛舌骨肌中间腱上,适平环状软骨弓处,颈动脉鞘浅面合成颈袢,自袢发支支配肩胛舌骨肌、胸骨舌骨肌及胸骨甲状肌.作者在解剖1例成年男性标本时,发现其左侧颈袢不形成袢的结构,而直接汇合成1个干(图1).现报道如下:     

双侧肩胛舌骨肌合并肌皮神经变异一例

笔者在解剖一具老年男尸时,发现其两侧肩胛舌骨肌发出副肌与胸骨舌骨肌或胸骨甲状肌的肌纤维融合.同时两侧的肌皮神经与正中神经之间存在交通支变异.检索文献发现此种变异十分少见,为积累国人解剖学资料并为临床手术提供参考,现报道如下. 左侧的肩胛舌骨副肌位于肩胛舌骨肌的内侧,两者共同肌起自肩胛切迹内侧的肩胛骨上缘.该肌由外下向前...     

阔筋膜张肌肌构筑和肌内神经的研究

目的通过对阔筋膜张肌构筑学和肌内神经分支分布的研究,为阔筋膜张肌的临床应用提供解剖学资料。方法大体解剖法、肌构筑法、改良Sihler′s肌内神经染色法。结果(1)阔筋膜张肌肌重(46.25±4.8)g,肌长(16.42±0.6)cm,肌纤维长(4.54±0.5)cm,羽状角0°,肌生理横切面积(9.65±0.74)cm2;(2)支配阔筋膜张肌的神经来自臀上神经下支,从肌的后上部入肌,入肌后向肌下部走行,分成前后两大支,前支主要支配肌前半部,后支主要支配肌后半部。结论 (1)阔筋膜张肌是扁肌,倾向于速度型构筑特征;(2)阔筋膜张肌肌内神经主要分布在肌中部。     

人喉环甲肌运动神经终末的形态特点

本文取新鲜人喉标本,对环甲肌进行冰冻纵切片,采用镀银法染片,光镜下观察,研究其运动神经终末的形态特点。发现环甲肌与四肢肌不同,除肌纤维较细,排列不甚紧密外,运动终板数目较多,形态多姿,在肌腹的中1/3处排成终板带。     

Laryngeal muscle fibre types

The internal laryngeal muscles have evolved to subserve the highly specialized functions of airways protection, respiration, and phonation. Their contractile properties, histochemistry, biochemical properties, myosin heavy chain (MyHC) expression and their regulation by nerves and hormones are reviewed and compared with limb muscle fibres. Cricothyroid, the vocal cord tensor, is limb‐like in MyHC composition and fibre type properties, while the vocal fold abductor and adductors are allotypically different, with capacity for expressing an isoform of MyHC that is kinetically faster than the fastest limb MyHC. In rats and rabbits the faster isoform is the extraocular (EO) MyHC, while in carnivores, it is the IIB MyHC. These adaptations enable the abductor and adductor muscles to remain always faster than the cricothyroid as the latter changes in speed during evolution to match changing metabolic and respiratory rates in relation to scaling with body mass. Such phylogenetic plasticity is vital to the airways protection and respiratory functions of these muscles. The posterior cricoarythenoid, the abductor muscle, is tonically driven during expiration, and consequently has a slower fibre type profile than the principal adductor, the thyroarythenoid. The human thyroarythenoid appears not to express EO or IIB MyHC significantly, but is unique in expressing the slow‐tonic MyHC. The concepts of allotype and phylogenetic plasticity help to explain differences in fibre type between limb and laryngeal muscles and between homologous laryngeal muscles in different species. Laryngeal muscle fibres exhibit physiological plasticity as do limb muscles, being subject to neural and hormonal modulation.     

应用Sihler氏染色研究人喉神经分支分布类型

采用Sihler氏染色,经过染色后,在立体显微解剖镜下、可清晰地观察到喉内肌肌肉神经支配类型及神经间的联系,结果:(1)喉返神经支配除环甲肌以外的所有喉内肌,环甲肌由喉上神经外支支配.(2)喉上神经内支不仅支配声门上粘膜,也支配杓间肌(包括的横肌和杓斜肌)和声门下粘膜.(3)在每侧杓间肌肉.喉返神经和喉上神经内支之间百多个吻合支.(4)喉返神经的杓间肌神经和环杓后肌神经之间常有交通支.     

运动神经元病的神经电生理诊断方法探讨

目的：探讨运动神经元病（MND）诊断中神经电生理检测方法及特点。方法：对22例MND病人常规进行运动神经、感觉神经传导检测（NCS）,侧重肌电图（EMG）检测四肢肌肉（特别是远端肌）及舌肌、胸锁乳突肌、T10椎旁肌,观察所检肌肉静息、轻收缩、重收缩时的变化。结果：NCS检测运动神经102条,感觉神经90条均在正常范围。EMG检测肌肉243块均表现为广泛性神经原性损害,其中：186块（22例）可见失神经电位（纤颤电位、正尖波）,162块（15例）见束颤电位,144块（18例）见高波幅（≥5mV）、宽时限的巨大电位,128块（17例）重收缩时见募集电位减弱为高波幅的单纯相。EMG舌肌检测阳性率为82％;胸锁乳突肌检测阳性率为52％;T10椎旁肌检测阳性率为75％。结论：神经电生理检测指标在MND诊断中十分必要,其中EMG是诊断MND最重要的检测手段,EMG广泛性神经原性损害是MND特征性改变。束颤电位、巨大电位是诊断MND的常用指标。舌肌、胸锁乳突肌和椎旁肌在MND的诊断中具有特异性,是有价值的检查方法,舌肌和胸锁乳突肌作为必选检测肌肉可以提高诊断阳性率。舌肌与胸锁乳突肌EMG的结合诊断价值更高。     

Positional relationships between the masticatory muscles and their innervating nerves with special reference to the lateral pterygoid and the midmedial and discotemporal muscle bundles of temporalis

For an accurate assessment of jaw movement, it is crucial to understand the comprehensive formation of the masticatory muscles with special reference to the relationship to the disc of the temporomandibular joint. Detailed dissection was performed on 26 head halves of 14 Japanese cadavers in order to obtain precise anatomical information of the positional relationships between the masticatory muscles and the branches of the mandibular nerve. After complete removal of the bony elements, the midmedial muscle bundle in all specimens and the discotemporal muscle bundle in 6 specimens, derivatives of the temporalis, which insert into the disc were observed. On the anterior area of the articular capsule and the disc of the temporomandibular joint, the upper head of the lateral pterygoid, the midmedial muscle bundle of temporalis and the discotemporal bundle of temporalis were attached mediolaterally, and in 3 specimens the posterosuperior margin of the zygomaticomandibularis was attached to the anterolateral area of the disc. It is suggested that these muscles and muscle bundles contribute to various mandibular movements. Although various patterns of the positional relationships between the muscles and muscle bundles and the their innervating nerves are observed in the present study, relative positional relationships of the muscles and muscle bundles and of nerves of the mandibular nerve are consistent. A possible scheme of the developmental formation of the masticatory muscles based on the findings of the positional relationships between the muscles and the nerves is presented.     

咀嚼肌的应用解剖学研究Ⅱ.颞肌的动脉与神经

在30具(男23,女7)共60例成人尸体上观察与测量了颞肌的营养动脉与神经的起源、分支以及肌内配布.颞肌的营养动脉来自于上颌动脉发出的颞深前与颞深后动脉,以及颞浅动脉发出的颞中动脉.三者在肌内有丰富的吻合,但各有其供血优势区域.颞肌的神经支配来自于下颌神经前干发出的颞深前与颞深后神经,其起源分为三种类型.就结果探讨了有关的临床应用问题.     

The dimensions and vascular anatomy of the cricothyroid membrane: Relevance to emergent surgical airway access

Following traumatic injury, rapid surgical access to the airway may be required, with surgical cricothyroidostomy the procedure of choice. Immediate complications of cricothyroidostomy include unsuccessful or incorrect site of tube placement and hemorrhage. Subglottic stenosis is the most common late complication. This project was undertaken to better define the dimensions and vasculature of the cricothyroid region. In 15 cadaveric specimens, cervical dissection revealed the average width of the cricothyroid membrane visible between cricothyroid muscles to be 8.2 mm, and the average height 10.4 mm. Latex injection of the carotid artery demonstrated a transverse cricothyroid artery arising from the superior thyroid artery in 93% of cases. The cricothyroid artery crossed the upper one-half of the cricothyroid membrane in all but one specimen. Branches of the cricothyroid artery penetrated the membrane and ascended along the undersurface of the thyroid cartilage. Unilateral superior thyroid artery injection demonstrated anastomoses between right and left cricothyroid arteries. In 54% of specimens, the superior thyroid artery coursed anterior to the sternothyroid muscle and then the lateral edge of the cricothyroid membrane. The membrane was also crossed by venous tributaries to the superior and inferior thyroid veins. To lessen the possibility of complications following cricothyroidostomy, a knowledge of the dimensions, relations, and vasculature of the cricothyroid membrane is of inestimable value. © 1996 Wiley-Liss, Inc.     

Expression of extraocular myosin heavy chain in rabbit laryngeal muscle

Summary The intrinsic laryngeal muscles of mammals are functionally heterogeneous, some of these muscles (e.g. the thyroarytenoid) contract extremely rapidly, like extraocular muscle, whilst others (e.g. the cricothyroid) contract as fast as limb fast muscle. The extraordinarily rapid contraction speed of extraocular muscles is associated with a fast myosin not found in limb muscles. In this work we explored the possibility that the thyroarytenoid muscle may also express this extraocular-specific fast myosin by raising a monoclonal antibody (mab 4A6) against its heavy chain. Electrophoretic separation of native isomyosins revealed that both the extraocular and the thyroarytenoid have two similar bands migrating ahead of bands found in limb fast or cricothyroid myosins. These two bands bound mab 4A6. The thyroarytenoid muscle can be divided into two divisions, a vocalis division which is important in phonation and an external division which functions in closing the glottis. Fibres in the vocalis are heterogeneous, some stain with mab 4A6, whilst others stain with mabs against limb myosin heavy chains. Fibres in the external division stain almost homogeneous with mab 4A6. The immunohistochemical staining pattern in the cricothyroid muscle resembled that of fast limb muscle: no fibres stained with mab 4A6. Thus, the high speed of contraction of the thyroarytenoid is associated with the same myosin heavy chain found in extraocular muscles, this characteristic is presumably an evolutionary adaptation for rapid closure of the glottis to enhance airway defense mechanisms.     

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...