胸锁乳突肌变异一例报告

在尸体解剖中,发现一例左胸锁乳突肌变异.本例为女性尸体70岁左右,左侧胸锁乳突肌起始部有三个头,一个起自胸骨柄即胸骨头;一个起自锁骨胸骨端即锁骨头;第三个头起自锁骨中、内1/3交界处,根据其位置、起止认定为“锁骨乳突肌”.为人类体质变异积累资料,现报告如下:胸骨头和锁骨头发起后即在锁骨上方汇合为一个肌腹(胸骨头纤维居锁骨头的浅面),两头与锁骨间形成锁骨上小窝.“锁骨乳突肌”第三头呈长带状,被颈阔肌覆盖,深面紧贴肩胛舌骨肌,颈横动、静脉,外测缘与颈外静脉相邻.以肌纤维起自锁骨,起始部肌宽2.0 cm,其前缘距锁骨     

胸锁乳突肌锁骨头的血供及应用解剖

目的:为临床应用胸锁乳突肌锁骨头复合瓣提供应用解剖学基础。方法:在40侧成人尸体标本上,解剖观察胸锁乳突肌的形态,血供来源及其动脉在胸锁乳突肌内的分布、构筑特点。结果:胸锁乳突肌血供丰富。其锁骨头主要血供为甲状腺上动脉胸锁乳突肌肌支。该支出现率占82.5%,距甲状腺上动脉起点(1.72±0.76)cm处发出,起始外径(1.52±0.10)mm,肌外长度为(22.07±0.4)mm;胸锁乳突肌由副神经支配,其体表投影位于乳突尖下方(4.01±0.39)cm,距肌前缘的距离为(2.14±0.46)cm处。结论:胸锁乳突肌锁骨头血供丰富为多源性,血管粗、蒂长,可以制成胸锁乳突肌锁骨头带半片锁骨瓣修复骨组织缺损。     

胸锁乳突肌锁骨头锁骨瓣修复下颌骨缺损的应用解剖

目的:为带胸锁乳突肌锁骨头为蒂锁骨瓣移位术提供解剖学基础。方法:在40侧成人尸体标本上,解剖观察胸锁乳突肌的形态,血供来源,分布特点及其与锁骨的关系;2例新鲜标本上作模拟术式。结果:胸锁乳突肌血供丰富,其锁骨头的主要血供为甲状腺上动脉胸锁乳突肌支,外径1.52±0.1mm,其入肌点相当于胸锁乳突肌前缘中下1/3交界处;锁骨内侧端主要血供由甲状腺上动脉胸锁乳突肌支(82.5%)的骨膜支及其与颈横动脉(10%)或肩胛上动脉的锁骨支(2.5%)构成的丰富吻合支供血。结论:以胸锁乳突肌锁骨头带半片锁骨瓣转位修复下颌骨缺损是可行的。     

斜方肌锁骨部抵止异常伴有关神经走行变异1例

在一例约 60岁女性尸体标本上 ,见其左侧的斜方肌锁骨部抵止异常 ,伴枕小神经、锁骨上神经和副神经走行变异 ,报道如下 :斜方肌前外侧部的肌纤维向前下走行 ,覆盖了颈后三角的大部分 ,其上、中部前缘距胸锁乳突肌后缘约1.5ｃｍ ,而下部抵止于锁骨上面的大部 ,其抵止处前缘距胸锁乳突肌锁骨头后缘仅 0 .6ｃｍ。枕小神经自胸锁乳突肌后缘中点上方 0 .8ｃｍ处浅出 ,主干长 5.9ｃｍ ,横径 2 .0ｍｍ ,厚 0 .6ｍｍ ,向后上斜行一段后 ,进入斜方肌深面 ,在距其前缘 1.0ｃｍ处穿过该肌后垂直上行 ,至乳突尖水平分支分布于枕部皮肤。锁骨上神经自胸锁…     

三角肌神经入肌点定位及肌内神经分布的研究

目的　揭示三角肌神经入肌点和肌内神经分支分布 ,为其临床应用提供较为详尽的形态学资料。方法　①用经甲醛固定 2年以上的成人尸体 (2 0～ 5 0岁 ) 12具 (男 9,女 3)共 2 4侧。以肩峰后角为骨性标志 ,测量三角肌各亚部神经支入肌点的位置。②用经甲醛固定 1年以内的童尸 3具 (3～ 10岁 )及成人尸体 2具 (2 0、4 0岁 )完整取下三角肌 ,采用Sihler′s肌内神经染色法观察肌内神经分支分布。结果　①三角肌各亚部神经入肌点的体表投影 :三角肌前亚部、中亚部、后亚部的神经入肌点分别在距肩峰后角下方 (5 7± 0 7)cm、(5 9± 0 8)cm、(4 8± 0 5 )cm处的水平线上 ,距三角肌前缘外后方 (3 6± 0 4 )cm处及距三角肌后缘外前方 (3 5± 0 6 )cm、(2 3± 0 3)cm处 ,上述三点均在肌的中 1/3部。②肌内神经分布 :三角肌前、后亚部的肌内神经支在肌内为直接横过肌纤维中部 ,沿途再发出分支与肌纤维并行走行 ;而中亚部肌内神经支在各个羽内 ,与肌纤维相交 ,行向短肌纤维的起止端。结论　①三角肌的神经入肌部位及入肌形式与该肌的形态和功能有关联 ;②三角肌的肌内神经分支分布可能与该肌的肌纤维长度及肌纤维型有关 ;③三角肌中亚部的肌内神经吻合网较宽而致密 ,推测有着更精细的神经调节。     

双侧胸骨肌与胸锁乳突肌相连变异一例

正笔者在局部解剖学实验操作中发现1例成年男性尸体上出现双侧胸骨肌且与双侧胸锁乳突肌相连变异,现报道如下。依次切开皮肤、浅筋膜和深筋膜后,胸骨肌位于双侧胸大肌的前面和胸骨两侧,呈"八"字形,上窄下宽,右侧较粗大,左侧细小。右侧胸骨肌长24.5 cm,其上、中、下三部肌腹的宽分别为1.1 cm、3.5cm、2.8 cm;左侧胸骨肌长17.9 cm,其上、中、下三部肌腹的宽分别为0.6cm、1.5cm、1.7 cm。右侧胸骨肌以腱膜起于第7肋软骨、腹直肌鞘前层及腹外斜肌腱膜,肌纤维行向内上方,在胸骨角处移行为肌腱,末端与胸锁乳突肌胸骨头移行在     

胸锁乳突肌瓣转位修复晚期面瘫的解剖与临床

目的:为应用胸锁乳突肌瓣转位修复晚期面瘫提供解剖依据。方法:利用新鲜尸体和活体头颈部共计26侧,解剖观测胸锁乳突肌的起止、长度、血供及其神经的分支类型和入肌部位。结果:胸锁乳突肌全长为17.0～19.0cm,枕动脉与副神经伴行支于乳突尖部下方4.0～5.0cm入肌肉上段;副神经分叉点至胸锁乳突肌胸骨端起点的长度为14.0～15.7cm,大于分叉点至口轮匝肌外上缘的距离11.0～14.3cm。结论:胸锁乳突肌瓣转位修复面瘫的长度足以满足治疗需要,并且不论肌外、肌内分叉均可以顺利转位,肌肉血供也没有影响。。     

胸锁乳突肌瓣转位修复晚期面瘫的解剖与临床

目的:为应用胸锁乳突肌瓣转位修复晚期面瘫提供解剖依据.方法:利用新鲜尸体和活体头颈部共计26侧,解剖观测胸锁乳突肌的起止、长度、血供及其神经的分支类型和入肌部位.结果:胸锁乳突肌全长为17.0～19.0cm,枕动脉与副神经伴行支于乳突尖部下方4.0～5.0cm入肌肉上段;副神经分叉点至胸锁乳突肌胸骨端起点的长度为14.0～15.7cm,大于分叉点至口轮匝肌外上缘的距离11.0～14.3cm.结论:胸锁乳突肌瓣转位修复面瘫的长度足以满足治疗需要,并且不论肌外、肌内分叉均可以顺利转位,肌肉血供也没有影响.     

甲状腺上动脉胸锁乳突肌支为蒂锁骨瓣转位术的解剖及其应用

目的为甲状腺上动脉胸锁乳突肌支为蒂的锁骨瓣转位修复下颌骨缺损提供解剖学依据。方法在36侧成人尸体标本上,观察甲状腺上动脉胸锁乳突肌支的走行、分支、分布及吻合。结果甲状腺上动脉胸锁乳突肌支起源恒定,距锁骨上方(7.9±0.8)cm处分为升支和降支,降支主干外径(1.0±0.2)mm。72.2%的降支直达锁骨,27.8%的降支与颈横动脉或肩胛上动脉锁骨支吻合分布锁骨。结论以甲状腺上动脉胸锁乳突肌支为蒂半片锁骨瓣转位可修复下颌骨小面积缺损。临床应用1例取得成功。     

单侧副胸锁乳突肌与胸骨肌相连1例

在解剖一成年男性尸体标本时 ,发现其右侧副胸锁乳突肌与胸骨肌相连的变异 ,较为罕见 ,报道如下 :(1)副胸锁乳突肌上端连于胸锁关节处 ,向左下方连于左侧胸骨角下缘 ,位于体壁肌肉浅层 ,长 2 .0ｃｍ ,宽 1.0ｃｍ。(2 )胸骨肌上端在胸锁关节处 ,分别与胸锁乳突肌和副胸锁乳突肌相连 ,下端与右侧腹直肌鞘前层相续 ,位于肌肉浅层 (即浅筋膜下方 )最宽处 4 .0ｃｍ ,长 9.0ｃｍ ,与副胸锁乳突肌呈 4 5°夹角。(3)左侧未见异常 ,分析变异原因 :副胸锁乳突肌的发生可能于腮弓间充质演化异常有关 ;而胸骨肌变【收稿日期】2 0 0 1 - 0 4 - 2 3异则可…     

人三角肌的肌内神经分布与亚部划分及其临床意义

目的：研究三角肌肌内神经分支分布为三角肌的肌肉移植提供详尽的解剖学基础。方法：用经甲醛固定1年以内的童尸3具(3～10岁)及成人尸体2具，完整取下三角肌，采用Sihler’s肌内神经染色法观察肌内神经分支分布。结果：三角肌前、中、后亚部内的肌内神经分支分布相互独立，彼此间未见明显的神经吻合。中亚部内的肌内神经吻合较前、后亚部为密集。结论：根据肌内神经分支分布，进一步证实三角肌可分为前、中、后3个亚部。前、后亚部可单独取材用于肌移植。三角肌中亚部内的神经吻合较致密，在三角肌活动中起着重要作用，不能单独用于肌移植。     

多血管神经蒂腹内斜肌瓣修复面瘫的解剖学基础

目的：为多血管神经蒂腹内斜肌瓣修复晚期面瘫提供解剖学基础。方法：在３６侧成尸标本上,对腹内斜肌的形态、血供及神经支配进行解剖观测。结果：腹内斜肌中部上１／２肌腹主要由第１１肋间神经支配,下１／２肌腹主要由肋下神经支配。上１／２肌腹的血供６６．７％来自第１１肋间后动脉,３３．３％来自旋髂深动脉的髂嵴支;下１／２肌腹的血供主要来自旋髂深动脉的腹壁肌支。第１１肋间神经、肋下神经在腋后线横径分别为２．２ｍｍ和２．４ｍｍ,入肌点距腋后线长分别为１３．３ｃｍ和１３．８ｃｍ。第１１肋间后动脉在腋后线外径为１．７ｍｍ,入肌点距腋后线长为１３．１ｃｍ;旋髂深动脉腹壁肌支和髂嵴支的起始外径分别为１．３ｍｍ和１．８ｍｍ,入肌点至起点长分别为５．１ｃｍ和８．６ｃｍ。结论：吻合多血管神经腹内斜肌瓣移植可全面修复晚期面瘫     

Architectural properties of the neuromuscular compartments in selected forearm skeletal muscles

The purposes f this study were to (i) explore the possibility of splitting the selected forearm muscles into separate compartments in human subjects; (ii) quantify the architectural properties of each neuromuscular compartment; and (iii) discuss the implication of these properties in split tendon transfer procedures. Twenty upper limbs from 10 fresh human cadavers were used in this study. Ten limbs of five cadavers were used for intramuscular nerve study by modified Sihler''s staining technique, which confirmed the neuromuscular compartments. The other 10 limbs were included for architectural analysis of neuromuscular compartments. The architectural features of the compartments including muscle weight, muscle length, fiber length, pennation angle, and sarcomere length were determined. Physiological cross-sectional area and fiber length/muscle length ratio were calculated. Five of the selected forearm muscles were ideal candidates for splitting, including flexor carpi ulnaris, flexor carpi radials, extensor carpi radialis brevis, extensor carpi ulnaris and pronator teres. The humeral head of pronator teres contained the longest fiber length (6.23 ± 0.31 cm), and the radial compartment of extensor carpi ulnaris contained the shortest (2.90 ± 0.28 cm). The ulnar compartment of flexor carpi ulnaris had the largest physiological cross-sectional area (5.17 ± 0.59 cm²), and the ulnar head of pronator teres had the smallest (0.67 ± 0.06 cm²). Fiber length/muscle length ratios of the neuromuscular compartments were relatively low (average 0.27 ± 0.09, range 0.18–0.39) except for the ulnar head of pronator teres, which had the highest one (0.72 ± 0.05). Using modified Sihler''s technique, this research demonstrated that each compartment of these selected forearm muscles has its own neurovascular supply after being split along its central tendon. Data of the architectural properties of each neuromuscular compartment provide insight into the ‘design’ of their functional capability. In addition to improving our understanding of muscle anatomy and function, elucidation of forearm neuromuscular compartments architecture may ultimately provide information useful for selection of muscle subdivisions used in tendon transfer.     

Bilateral accessory flexor digitorum longus muscle in man

An accessory muscle (flexor digitorum longus accessorius) was encountered in the deep posterior compartment of both legs of a 57-year-old male cadaver. The muscle originated with two heads from the medial margin of the tibia, lateral margin of the fibula, posterior intermuscular septum and the deep fascia at the distal part of the leg. Both heads came together just posterior and superficial to the tibial nerve, and converged into a slender tendon which traversed the tarsal tunnel in the vicinity of the neurovascular bundle to reach the sole of the foot. It terminated by merging into the tendon of the quadratus plantae muscle. The potential of such an anomalous muscle to lead to misinterpretations of the radio-diagnostic examinations and the fact that it can be one of the causes of tarsal tunnel syndrome should be borne in mind.     

Anatomic landmarks for localization of the spinal accessory nerve

This anatomical study examines the anatomic topography and landmarks for localization of the spinal accessory nerve (SAN) during surgical dissections in 40 fresh human cadavers (2 females and 38 males; ages from 22 to 89 years with a mean of 60 years). In the submandibular region, the SAN was found anteriorly to the transverse process of the atlas in 77.5% of the dissections. When the SAN crossed the posterior belly of the digastric muscle, the mean distance from the point of crossing to the tendon of the muscle was 1.75 ± 0.54 cm. Distally, the SAN crossed between the two heads of the SCM muscle in 45% of the dissections and deep to the muscle in 55%. The SAN exited the posterior border of the sternocleidomastoid muscle in a point superior to the nerve point with a mean distance between these two anatomic parameters of 0.97 ± 0.46 cm. The mean overall extracranial length of the SAN was 12.02 ± 2.32 cm, whereas the mean length of the SAN in the posterior triangle was 5.27 ± 1.52 cm. There were 2–10 lymph nodes in the SAN chain. In conclusion, the nerve point is one of the most reliable anatomic landmarks for localization of the SAN in surgical neck dissections. Although other anatomic parameters including the transverse process of the atlas and the digastric muscle can also be used to localize the SAN, the surgeon should be aware of the possibility of anatomic variations of those parameters. Similar to previous investigations, our results suggest that the number of lymph nodes of the SAN chain greatly varies. Clin. Anat. 22:471–475, 2009. © 2009 Wiley‐Liss, Inc.     

Physiological characteristics of two extreme muscle compartments in gastrocnemius medialis of the anaesthetized rat

Rat medial gastrocnemius (GM) muscle is a compartmentalized muscle. The functional properties and fibre type composition of the most proximal and most distal compartment were studied in in situ preparations. The proximal compartment contained predominantly fast twitch oxidative fibres. The distal compartment was mainly composed of fast twitch glycolytic fibres. With the use of two small electrodes placed around the primary nerve branches, both compartments could be separately stimulated within the same muscle. The length-force relationship was less broad and maximal twitch and tetanic forces were obtained at lower muscle lengths for the proximal compartment. The differences (mm) were 0.9 ± 0.2 and 1.2 ± 0.2 for maximal twitch and tetanic force (120 Hz) production, respectively (P < 0.001). The shortening velocity for maximal power production was lower (P < 0.001) for the proximal compartment (proximal: 57.1 ± 2.7 mm s^-1, distal: 73.1 ± 3.0 mm s^-1). During a standard fatigue test the fatiguability was significantly lower for the proximal compared with the distal fibres. Our findings suggest that the proximal compartment is likely to be activated in vivo during activities requiring relatively low power outputs for longer time periods. In contrast the distal compartment is probably recruited only during high power demanding short lasting activities. The presented model makes it possible to study fatigue related changes in power production of the ‘red’ and ‘white’ areas of the GM separately in a way that is probably meaningful with respect to in vivo function.     

肩胛上神经及其冈上肌干支入肌点的应用解剖

目的探讨肩胛上神经的行程和冈上肌干支入肌点,为肩部疾病的诊治提供解剖形态学基础。方法对15具(30侧)成人上肢标本,观察肩胛上神经及其分支冈上肌支的走行、分段、体表定位和冈上肌支入肌点进行研究。结果肩胛上横韧带前段的肩胛上神经主干长4.03～5.23(4.36±0.60)cm,外径2.21～4.45(4.22±0.63)mm;骨纤维管内肩胛上神经外径与入管前一样;出管后肩胛上神经的分支冈上肌干支长1.24～0.90(3.78±0.23)cm,外径为0.54～2.01(1.82±0.20)mm。冈上肌干支入肌点距孔后为1.15～2.01(8.22±5.20)mm。结论①肩胛上神经行程较长,穿越骨纤维管位置恒定,易发生卡压,其体表定位位于距离肩峰最外端约6 cm处。②冈上肌干支伴血管行走,距孔后约1 cm入肌体,位置相对恒定,其体表定位相当于锁骨锥状结节的后方约3 cm处,入肌内分有前、中、后三支。     

Effective botulinum toxin injection guide for treatment of cervical dystonia

The aim of this study was to elucidate the distribution of the accessory nerve within the sternocleidomastoid muscle (SCM) to aid identifying the optimum sites for botulinum neurotoxin (BoNT) injections and applying chemical neurolysis. Thirty SCM specimens from 15 Korean cadavers were used in this study. Sihler's staining was applied to 10 of the SCM specimens. Transverse lines were drawn in 20 sections to divide the SCM into 10 divisions vertically, and a vertical line was drawn into the medial and lateral halves from the mastoid process to the sternoclavicular joint. The most densely innervated areas were 5/10–6/10 and 6/10–7/10 along the lateral and medial parts of the muscle, respectively. We suggest injecting BoNT in the medial region 6/10–7/10 along the SCM prior to injecting in the lateral region 5/10–6/10 along the muscle to ensure safe and effective treatment. Clin. Anat. 33:192–198, 2020. © 2019 Wiley Periodicals, Inc.     

A histochemical analysis of identified compartments of cat lateral gastrocnemius muscle

The lateral gastrocnemius muscle of cats can be divided into four discrete subvolumes or compartments which are supplied by the primary branches of its muscle nerve. The histochemical profile of each compartment was determined from the reaction for myosin ATPase after acid preincubation. Fibers were classified as fast-twitch glycolytic (FG), fast-twitch oxidative-glycolytic (FOG), or slow-twitch oxidative (SO). Each compartment in each cat examined was found to contain a relatively uniform distribution of different types of fibers. The most proximal LG compartment contains mainly type FG fibers, with relatively few type SO fibers; the most distal compartment, while still predominated by type FG fibers, contains a significantly larger proportion of type SO fibers. The histochemical profile of the intermediate compartments indicates that they contain fibers which lie intermediate in composition between these two. These results are consistent with the notion that LG compartments consist of aggregations of motor units, arranged such that muscle fibers comprising a single motor unit are contained within a single compartment.