小趾展肌神经与跟痛症的关系及治疗

临床治疗30例跟痛症的实践证明,“小趾展肌神经”与跟痛症有明确的关系。5例手术切取神经段的病理证明,该病可能是“小趾展肌神经”卡压综合症的结果。     

跟外侧神经与神经源性跟痛症关系的解剖学基础

目的　探讨跟外侧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,解剖观察跟外侧神经的起源、分支、走行和分布特点。 结果　跟外侧神经均起自于腓肠神经,9.38%以单干的形式出现,28.13%为双干,43.75%为3干,18.75%为4干。神经分布于足跟外侧及跟底外侧1/3的皮肤和跟垫组织以及骨膜。 结论　跟外侧神经在跟管内和覆盖于小趾展肌表面的足底腱膜外侧部的锐利缘处均有可能被卡压而引发神经源性跟痛症。     

跟内侧神经与神经源性跟痛症关系的解剖学基础

目的　探讨跟内侧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,解剖观察跟内侧神经的起源、分支、走行和分布特点。 结果　跟内侧神经41.42%起源于胫神经,28.57%起源于胫神经分叉处,18.57%起源于足底内侧神经,11.42%起源于足底外侧神经。起点距O点（内踝尖最下缘与跟骨结节内侧突连线中点）(30.22±15.34)mm。跟内侧神经穿出屈肌支持带后分布于足跟内侧及跟底的皮肤和跟垫组织。 结论　跟内侧神经在踝管内,浅出屈肌支持带处及跟管内可能被卡压;神经卡压或病变可能与足底腱膜炎发生及疼痛有关。     

“点线角距离法”在小趾展肌神经卡压综合征中的体表定位诊断研究

目的 探究小趾展肌神经卡压综合征的简易体表定位诊断方法。方法 对10具尸体标本20侧足踝在踝关节90°功能位,以内踝尖的最下缘为A点,以跟骨结节的内侧突为B点,以第一跖骨头内侧的最突点为C点,以小趾展肌神经穿出踇展肌深筋膜腱弓处为D点,测量小趾展肌神经在穿过踇展肌深筋膜腱弓处D点的直径,测量D点与B点的距离L1、A点与BC点连线的垂直距离L2,测量AB点连线与BD点连线所成角度、BC点连线与BD点连线所成角度,得到D点与体表标志的相对关系,分析不同性别标本D点的体表投影简易定位。结果 20侧足踝尸体标本中,18侧小趾展肌神经来自跖外侧神经,2侧直接发源于胫神经。小趾展肌神经在穿过踇展肌深筋膜腱弓处D点的直径成年男性平均为(1.87±0.30)mm,成年女性平均为(1.85±0.25)mm。小趾展肌神经通过跟骨前方时与跟骨垂直距离成年男性平均为(20.86±1.38)mm,成年女性平均为(20.06±1.16)mm。A点与BC点连线的垂直距离L2成年男性平均为(71.10±2.17)mm,成年女性平均为(67.31±2.93)mm。AB点连线与BD点连线所成角度为(43.71±2.96)...     

跟骨骨刺的解剖学观测及其临床意义

目的探讨跟骨骨刺的解剖学形态特点,为跟痛症的诊疗提供解剖学依据。方法在589例成人干燥的跟骨骨性标本上,仔细观察跟骨骨刺的形态结构,观测跟骨骨刺的长度和宽度。结果①跟骨骨刺生长在趾短屈肌起点,并非趾筋膜止点处;②趾筋膜止点是一个区域,并非一个点或线;③骨刺除位于内侧突外,还位于内外侧突之间、足底长韧带起点处。结论骨刺并非只位于趾筋膜的起止点,趾筋膜起止点处劳损时的压痛点不能等同于骨刺尖部。     

跟痛症的病因及相关应用解剖研究进展

跟痛症（Painful heel syndrome，PHS）是足跟周围疼痛性疾病的总称，是指多种慢性疾患所引起的跟部包括跟后、跟跖、跟内和跟外侧急、慢性疼痛。多发生于40-70岁的中老年人，男性多于女性，男女比约2：1，特别是男性肥胖者及运动员，可一侧或两侧同时发病。     

神经源性肌萎缩与肌源性肌萎缩肌电图表现

一、神经源性肌萎缩 (1)多发性周围神经病(感染、炎性及免疫性神经病,遗传性周围神经病,代谢性神经病,中毒性神经病以及其他的周围神经病)通过神经传导的检测,主要表现为周围神经二条以上神经表现为脱髓鞘或轴索损害的诊断指标。相应神经支配的肌肉表现为神经原性异常。     

跟痛症病因的研究进展

跟痛症是一种临床上常见多发疾病,中老年患者多见。其病因及发病机制比较复杂,一直以来争议较多。通过总结临床工作和国内外文献对跟痛症病因及其发病机制加以阐述。     

An accessory belly of the abductor digiti minimi muscle: a case report and embryologic aspects

Accessory fasciculi of the hypothenar muscles have been involved in vascular and nerve compressions. During a routine dissection an accessory belly of the abductor digiti minimi muscle arising from the tendon of the palmaris longus muscle was found in the lower third of the forearm. The accessory fasciculus ran through Guyon’s canal enclosing the ulnar nerve and vessels. It was attached by means of two tendons where the fibres of the abductor digiti minimi muscle ended in a single pennate form. This anatomic variation was associated with a marked reduction of the caliber of the fourth tendon of the flexor digitorum superficialis muscle and a split of the median nerve. The nerve supply arose from the ulnar nerve. A fibrous band originating from this accessory muscular belly was found covering the median nerve. Based on the development of muscles and fibrous structures within the hand and forearm, as well as on our results, we consider the present anomalies as an unusual persistence of an undifferentiated group of mesenchymal cells. These belong to the superficial muscular anlagen layer of the hand, just between the flexor digitorum superficialis muscle blastema (which has the capacity of migration) and that for the abductor digiti minimi muscle.     

Anatomic variation of the 5th extensor tendon compartment and extensor digiti minimi tendon

Anatomic variation within the 5th extensor compartment may contribute to the development of tenosynovitis and limit the usefulness of the extensor digiti minimi (EDM) for tendon transfer. The purpose of this study was to assess the anatomic variation of the EDM tendon and its surrounding retinaculum, with particular attention to anatomical variation between specimens. Forty-one fresh cadaver hands were dissected. The length of the 5th compartment retinaculum was noted. The incidence of an intercompartmental septum was noted in each specimen as well as the type of tendinous attachments present between the EDM and extensor digitorum communis (EDC) tendons. The presence and length of any accessory retinacular bands distal to the edge of proper extensor retinaculum was also noted. Only one specimen contained a single EDM tendon, while 71% (n = 29) of specimens contained two slips and 23% (n = 9) had three slips; 24% (n = 10) of EDC tendons had no slip to the small finger, while 61% (n = 25) of specimens had a single slip to the small finger. The EDC's contribution to the small finger was found to be an independent tendon in 42% of cases (n = 17), while 34% (n = 14) of specimens were found to have a common EDC slip, which branched to both the ring and small finger. Three EDM tendons divided distal to the extensor retinaculum, while the remaining EDM tendons divided beneath or proximal to the extensor retinaculum. Seventy-three percent (n = 30) of the specimens had an accessory retinacular band surrounding the EDM tendon identified at the base of the 5th metacarpal. Eighty-eight percent (n = 36) of hands had a septum between the EDM slips. The surgeon should be aware of variability within the 5th dorsal compartment in cases of trauma and in cases of tendon transfer. In our series 30 of 41 specimens were noted to contain an accessory dorsal retinacular band surrounding the EDM and 36 specimens were noted to contain a septum within the 5th compartment. The presence of an accessory retinacular band surrounding the EDM at the level of the 5th metacarpal base is an anatomic finding that requires further investigation.     

面神经颞、颧、颊支与SMAS关系的解剖学研究

目的 明确面神经颞支、颧支、颊支的走行及其与SMAS的关系,为面中部除皱术提供形态学资料.方法 10具(20侧)成人头部标本,逐层解剖观测,数据描记于以眼外眦点与耳屏上切迹点连线所在水平面为X轴(横坐标),耳屏上切迹点为原点建立的坐标系上.结果 ①面神经颞支以3支型为多,各支由腮腺上缘出腮腺,而后向前上越过颧弓中外1...     

Muscle variations and abnormal branching and course of the ulnar nerve in the forearm and hand

During dissection of the right forearm of a 27-year-old female cadaver, variations in the form and insertion of the palmaris longus muscle were observed. The tendon of the palmaris longus muscle, which demonstrated a centrally placed belly, split into two tendons: one inserted into the palmar aponeurosis and the other into the proximal part of the flexor retinaculum. Additionally, we found an accessory muscle extending between the flexor retinaculum and the tendon of the abductor digiti minimi muscle. This accessory muscle was located deep to the ulnar artery but superficial to the superficial and deep branches of the ulnar nerve at the wrist. Finally, an aberrant branch of the ulnar nerve was identified in the forearm; it traveled distally alongside the ulnar artery and in the palm demonstrated communications with common palmar digital nerves from the ulnar and the median nerves. No variations were observed in the contralateral upper limb.     

桡神经浅支皮下段的解剖学特点及临床意义

目的报道桡神经浅支皮下段的解剖学特点及临床意义。方法选用福尔马林固定的成人上肢标本42例,解剖观察桡神经浅支的走行及分支分布特点。结果桡神经浅支距桡骨茎突(8.33±1.16)cm处自肱桡肌深层浅出,沿肱桡肌和桡侧腕屈肌之间于皮下前行,在桡骨茎突近端(4.58±1.06)cm处分为内、外侧支。外侧支在桡骨茎突掌侧面前行至拇指桡背侧成为拇指的感觉神经,内侧支则在桡骨茎突的近侧段绕向背侧,于桡骨茎突远侧(1.32±0.26)cm处在1、2掌骨中段水平分为第1、2掌背皮神经,进而成为手背桡侧半的感觉神经。桡神经浅支浅出处和肱桡肌的夹角为(20.7±3.16)°,桡神经浅支分为内、外两侧支间的夹角为(18.0±4.4)°,桡骨茎突水平内、外侧支的间距为(1.4±0.23)cm。结论(1)根据桡神经浅支的解剖学特点,在不同的损伤平面进行修复,以最大限度的恢复手部的感觉;(2)在应用含有桡神经浅支的皮瓣修复创面时,尽可能以神经为轴线,将神经置于皮瓣中央位置,以提高皮瓣的成活率和手术的质量。     

针刀治疗枕大神经卡压综合征的应用解剖研究

目的 力针刀治疗枕大神经卡压综合征提供形态学依据.方法在20侧成人尸体头颈标本上,对枕大神经的行径、穿斜方肌腱膜和深筋膜以及易发生卡压的部位进行了解剖、观察和测量.结果①枕大神经在枕外隆凸的下方2.8cm±0.2cm,旁开2.6cm±0.1cm处穿斜方肌健膜和深筋膜至皮下;③穿斜方肌腱膜和深筋膜的部位约位于枕外隆凸到乳突尖连线中、上1/3交界点;③穿出点有大量腱纤维和筋膜束缠绕枕大神经及枕动静脉,是发生卡压的部位.结论 用针刀在枕神经穿腱膜和筋膜点的稍内侧进针,从外上向内下作分离松解,便可解除其卡压.     

颈神经后支的解剖及其临床意义

目的为临床诊治椎孔外颈神经后支卡压提供解剖学基础。方法对20具(40侧)成人尸体的颈神经后支起源、走行、分支、分布及其与颈椎周围组织的解剖关系进行观测。结果C