副神经的临床应用解剖学研究

目的 :通过尸体解剖 ,观察副神经的行程及其分支支配 ,为更合理的利用副神经移位治疗臂丛神经损伤提供解剖学依据。方法 :显微解剖 30侧颈肩部人体标本 ,观测副神经在颈后三角区以及斜方肌深面的主干行程、分支部位及其毗邻和肌支支配情况。结果 :副神经在胸锁乳突肌后缘乳突下方 (5 .2± 1.8)cm处穿出 ,向后、外、下斜行跨过颈后三角区 ,在锁骨中点后方 (5 .0± 1.6 )cm处进入斜方肌深面筋膜内 ,在斜方肌的深面副神经仍呈单干向下走行 ,沿途发出 3～ 6个分支支配斜方肌 ,在肩胛冈下方 (5 .0± 1.5 )cm副神经不同平面分出的终支水平进入斜方肌。结论 :在肩胛冈下方不同平面选择性的切断副神经移位治疗臂丛损伤而保留斜方肌上部的神经支配和部分功能是可行的。     

副神经的叠加定位

通过84侧胸锁乳突肌与斜方肌之间副神经行程的叠加处理,发现副神经在胸锁乳突肌后缘的穿出点位于乳突最突出点与锁骨胸骨端连线的上29.4～50％之间;副神经在斜方肌前缘的穿入点位于乳突最突出点至斜方肌前缘与锁骨上缘交点连线的下69.5～94.2％之间。并经对总体均数可信区间的分析,提出此段副神经行程的体表投影。     

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。     

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…     

颈后三角的应用解剖学

在20具(男10女10)共40侧成人尸体上解剖了颈后三角,观测了支配斜方肌的诸神经的走行、定位,分支分布情况和该区内淋巴结的数目、排列情况。38侧(95%)斜方肌主要由副神经支配,掩盖段长78.01±12.98mm,显露段长50.04±13.00mm,其中36侧(90%)同时有C_3、C_4前支加入副神经成直接进入斜方肌;2侧(5%)仅由C_3、C_4前支支配斜方肌。副神经在出胸锁乳突肌后缘和入斜方肌前缘两处距乳突尖分别为63.11±13.82mm和83.35±17.56mm。颈深上淋巴结多位于副神经显露段上1/3附近,有较大淋巴结2.2±1.6个,其余细小,可呈链状排列于副神经两侧,而c_3前支也常在该段加入副神经。锁骨上淋巴结位于锁骨上窝,距离c_4前支入肌处较近。本文认为,斜方肌是由多条神经共同支配的,在淋巴结活检时都易受损而造成斜方肌的瘫痪,由此可知,斜方肌瘫痪并不仅见于副神经受损,也可能是C_3、C_4前支受损造成的,须引起重视。     

胸锁乳突肌亚部肌构筑、肌梭和神经入肌点定位

目的:为胸锁乳突肌亚部的临床应用提供形态学依据。方法:肌构筑法,组织学HE染色和体视学法。结果:(1)胸骨头亚部的肌重与生理横切面积分别是锁骨头两亚部之和的1.39倍与1.33倍;锁骨头深亚部的肌纤维长仅为胸骨头亚部肌纤维长的82%。(2)胸骨头亚部和锁骨头浅亚部的肌梭密度显著小于锁骨头深亚部。(3)副神经胸锁乳突肌支绕锁骨头深亚部后缘(占65%)入肌时距乳突尖(4.39±0.42)cm,而穿锁骨头深亚部(占35%)入肌时距乳突尖(3.96±0.34)cm。结论:胸骨头亚部是胸锁乳突肌肌力的主要提供者。锁骨头深亚部更多参与维持头部姿势。     

寰枢关节错位与胸锁乳突肌和斜方肌疼痛的解剖关系的初步研究

目的　观察寰枢椎与副神经及第2颈神经的解剖关系,以及观察胸锁乳突肌和斜方肌的神经支配特点,为寰枢关节错位致胸锁乳突肌和斜方肌疼痛提供解剖学依据。 方法　对3具共6侧成年人颈部尸体标本进行解剖,观察寰椎横突与副神经、寰枢外侧关节与第2颈神经前支、寰枢椎椎间孔外韧带的解剖结构,以及观察胸锁乳突肌和斜方肌的神经支配特点,测量副神经与寰椎横突尖的最短距离。 结果 (1)胸锁乳突肌和斜方肌均受副神经和颈丛（第2~4）神经支配,并且副神经与颈丛神经存在交通支联系。(2)副神经走行在寰椎横突前方,二者关系密切,副神经与寰椎横突尖的距离为4.84~7.60 mm(左侧)和3.22~6.80 mm（右侧）。(3)寰枢椎存在椎间孔外韧带,该韧带与第2神经相连,并附着在寰椎横突。(4)第2颈神经前支贴着寰枢外侧小关节向前走行。 结论 寰枢关节错位可能会刺激副神经及第2颈神经或其前支,从而引起胸锁乳突和斜方肌紧张、疼痛。     

斜方肌各亚部神经分布和神经入肌点定位

目的为斜方肌各亚部的临床应用提供形态学基础。方法①观察30具成尸斜方肌各亚部的神经来源,并定位神经入肌点。②用6具尸体的斜方肌行Sihler’s肌内神经染色,观察肌内神经分布。结果①斜方肌降部入肌点约在斜方肌前缘的上3/4与下1/4交界处,水平部入肌点在锁骨肩峰端外侧缘中点与第7颈椎棘突上缘连线的中点,升部入肌点在肩胛冈内侧端结节与第4胸椎棘突上缘连线的中点。②斜方肌受副神经和颈丛(C2-4)斜方肌支支配,副神经主干在颈后三角和斜方肌降部深面发出1～3支一级分支到斜方肌降部,颈丛斜方肌支加入副神经主干一起在斜方肌水平部深面发出4～6支一级分支到斜方肌水平部,在斜方肌升部深面发出2～5支一级分支到斜方肌升部。斜方肌各亚部的肌腹中部均有一终未神经分支密集区,它们连成一条连续的约呈"S"形的神经分支带。结论斜方肌的降部仅由副神经支配,斜方肌的水平部和升部由副神经与颈神经双重支配。     

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.     

The human temporalis muscle: Superficial,deep, and zygomatic parts comprise one structural unit

The structure of the temporalis muscle was examined in detail from cadaveric specimens (32 specimens from 16 subjects: 5 males, average age 80.6 years; 11 females, average age 88.6 years) and Computerized Tomography (CT) and T1‐weighted Magnetic Resonance (MR) images from normal clinical patients (10 females: average age 45.0 years). Three parts of the muscle were clearly delineated in all cadaveric specimens: (1) the classically recognized superficial part, (2) a zygomatic part, and (3) a complex deep part. In one female specimen, the superficial temporalis demonstrated extensive insertions into the zygomatic process and temporomandibular joint. The zygomatic temporalis originates from the zygomatic arch to insert into the superficial part of the temporalis as it inserts into the lateral surface of the coronoid process. In all specimens, the deep temporalis contained muscle bundles that originated from various crests along the anterior surface of the temporal fossa and inserted into the internal aspect of the coronoid process and retromolar triangle, interdigitating with the buccinator, mylohyoid, and superior constrictor muscles. The confluence of muscle fibers into the buccinator muscle was confirmed in all CT/MRI images. The deep and zygomatic parts described were regarded as accessory muscle bellies previously, but are demonstrably part of the temporalis muscle as a whole. Clin. Anat. 22:655–664, 2009. © 2009 Wiley‐Liss, Inc.     

妊娠及分娩对盆底肌力的影响

目的比较妊娠及分娩后妇女和正常妇女的盆底肌力,了解妊娠及分娩对盆底肌力的短期影响。方法将183例在本院就诊的孕产妇分为顺产组和剖宫产组,使用盆底肌电生理仪分别检测其产前及产后盆底肌肌力,并与166例正常妇女进行评估及比较。结果妊娠组盆底肌力与正常组比较明显降低,差异有统计学意义（P〈0.05）;妊娠组和正常组中的Ⅰ类与Ⅱ类肌纤维肌力均降低,但差异无统计学意义（P〉0.05）;产后6～8周顺产组盆底肌力较剖宫产组肌力明显降低,差异有统计学意义（P〈0.05）;产后12～14周顺产组盆底肌力与剖宫产组盆底肌力均降低,差异无统计学意义（P〉0.05）。结论顺产及选择性剖宫产对盆底肌肌力的影响在产后3个月无明显差异。     

Effect of single and periodic contusion on the rat soleus muscle at different stages of regeneration

This work analyzed the rat soleus muscle after single and recurrent contusions at different stages of regeneration. A noninvasive contusion was produced by a type of drop‐mass equipment. The posterior region of the right hind limb received a trauma and both right and left soleus muscles were analyzed 1, 4, and 6 days after a single contusion (1×), and 6 and 30 days after periodic contusions (10×, one trauma per week for 10 weeks). Single contusion: there was no significant difference between right and left soleus muscle weight. All animals showed abundant signs of acute damage in the right soleus. AChE activity was identified in regeneration segments of the right soleus. Periodic contusions: there was an increase in the right soleus muscle weight (α = 5%) only in the animals evaluated 6 days after periodic contusions. The right soleus muscle showed a high incidence of chronic signs of damage, such as split fibers and a centralized nucleus, which predominated when compared with the acute signs. Right soleus muscles showed split fibers with AChE activity in both the proximal and middle regions. There was no difference in the incidence of muscle fiber types (I, II, and IIC) between right and left soleus muscles after periodic contusions. Skeletal muscle contusion is common in humans, especially in sport activities, where repetitive traumas are also frequent. The results of this work indicate that despite the regeneration process there is an important change in the morphological aspect of regenerated muscle fibers, which possibly affect muscle performance. Anat Rec 254:281–287, 1999. © 1999 Wiley‐Liss, Inc.     

Long‐term regeneration of fast and slow murine skeletal muscles after induced injury by ACL myotoxin isolated from Agkistrodon contortrix laticinctus (broad‐banded copperhead) venom

The aim of the present work was to analyze the regenerated muscle types I and II fibers of the soleus and gastrocnemius muscles of mice, 8 months after damage induced by ACL myotoxin (ACLMT). Animals received 5 mg/kg of ACLMT into the subcutaneous lateral region of the right hind limb, near the Achilles tendon; contralateral muscles received saline. Longitudinal and cross sections (10 μm) of frozen muscle tissue were evaluated. Eight months after ACLMT injection, both muscle types I and II fibers of soleus and gastrocnemius muscles still showed centralized nuclei and small regenerated fibers. Compared with the left muscle, the incidence of type I fibers increased in the right muscle (21% ± 03% versus 12% ± 06%, P = 0.009), whereas type II fibers decreased (78% ± 02% versus 88% ± 06%, P = 0.01). The incidence of type IIC fibers was normal. These results confirm that ACLMT induced muscle type fiber transformation from type II to type I, through type IIC. The area analysis of types I and II fibers of the gastrocnemius revealed that injured right muscles have a higher percentage of small fibers in both types I and II fibers (0–1,500 μm²) than left muscles, which have larger normal type I and II fibers (1,500–3,500 μm²). These results indicate that ACLMT can be used as an excellent model to study the rearrangement of motor units and the transformation of muscle fiber types during regeneration. Anat Rec 254:521–533, 1999. © 1999 Wiley‐Liss, Inc.     

Muscle fibre types in the suprahyoid muscles of the rat

Five muscle fibre types (I, IIc, IIa, IIx and IIb) were found in the suprahyoid muscles (mylohyoid, geniohyoid, and the anterior and posterior bellies of the digastric) of the rat using immuno and enzyme histochemical techniques. More than 90% of fibres in the muscles examined were fast contracting fibres (types IIa, IIx and IIb). The geniohyoid and the anterior belly of the digastric had the greatest number of IIb fibres, whilst the mylohyoid was almost exclusively formed by aerobic fibres. The posterior belly of the digastric contained a greater percentage of aerobic fibres (83.4%) than the anterior belly (67.8%). With the exception of the geniohyoid, the percentage of type I and IIc fibres, which have slow myosin heavy chain (MHCβ), was relatively high and greater than has been previously reported in the jaw‐closing muscles of the rat, such as the superficial masseter. The geniohyoid and mylohyoid exhibited a mosaic fibre type distribution, without any apparent regionalisation, although in the later MHCβ‐containing fibres (types I and IIc) were primarily located in the rostral 2/3 region. In contrast, the anterior and posterior bellies of the digastric revealed a clear regionalisation. In the anterior belly of the digastric 2 regions were observed: both a central region, which was almost exclusively formed by aerobic fibres and where all of the type I and IIc fibres were located, and a peripheral region, where type IIb fibres predominated. The posterior belly of the digastric showed a deep aerobic region which was greater in size and where type I and IIc fibres were confined, and a superficial region, where primarily type IIx and IIb fibres were observed.     

人小腿肌的构筑学研究

对１６侧人小腿肌用肌构筑学方法进行了研究。结果表明，虽然小腿前群肌的肌重超于小腿后群深层肌，但由于二者的构筑不同，小腿后群深层肌的生理横切面积是小腿前群肌的１．７５倍，参与维持足弓和内、外翻足心的胫骨前，后肌和腓骨长，短肌的生理横面积达４９．１ｃｍ＾２。小腿肌多是羽肌，其中胫骨前、后肌属于环羽肌。根据肌构筑研究，认为羽肌是静力性功能和力量型设计的产物。     

Muscle fibre types in the suprahyoid muscles of the rat

Five muscle fibre types (I, IIc, IIa, IIx and IIb) were found in the suprahyoid muscles (mylohyoid, geniohyoid, and the anterior and posterior bellies of the digastric) of the rat using immuno and enzyme histochemical techniques. More than 90% of fibres in the muscles examined were fast contracting fibres (types IIa, IIx and IIb). The geniohyoid and the anterior belly of the digastric had the greatest number of IIb fibres, whilst the mylohyoid was almost exclusively formed by aerobic fibres. The posterior belly of the digastric contained a greater percentage of aerobic fibres (83.4%) than the anterior belly (67.8%). With the exception of the geniohyoid, the percentage of type I and IIc fibres, which have slow myosin heavy chain (MHCβ), was relatively high and greater than has been previously reported in the jaw-closing muscles of the rat, such as the superficial masseter. The geniohyoid and mylohyoid exhibited a mosaic fibre type distribution, without any apparent regionalisation, although in the later MHCβ-containing fibres (types I and IIc) were primarily located in the rostral 2/3 region. In contrast, the anterior and posterior bellies of the digastric revealed a clear regionalisation. In the anterior belly of the digastric 2 regions were observed: both a central region, which was almost exclusively formed by aerobic fibres and where all of the type I and IIc fibres were located, and a peripheral region, where type IIb fibres predominated. The posterior belly of the digastric showed a deep aerobic region which was greater in size and where type I and IIc fibres were confined, and a superficial region, where primarily type IIx and IIb fibres were observed.     

Electrogenesis of muscle fibers of the rat masseter muscle

It was shown by intracellular recording of resting membrane potentials (RMP) and action potentials that the superficial layers of the rat masseter muscle contain chiefly fibers with a high MPP and small overshoot, whereas the deep layers contain mainly fibers with a low MPP but a high overshoot. The excitability of the cytoplasmic membrane of muscle fibers with different MPP levels was found to be similar with respect to its electrical parameters. It is suggested that the rat masseter muscle contains a high proportion of fast phasic fibers in its superficial layers and slow phasic fibers in its deep layers.Department of Pathological Physiology, N. A. Semashko Moscow Medical Stomatologic Institute. (Presented by A. D. Ado.) Translated from Byulleten' Éksperimental'noi Biologii i Meditsiny, Vol. 88, No. 9, pp. 265–267, September, 1979.     

Possible effects of fatigue on muscle efficiency

The efficiency of energy transduction is defined as the ratio of the work done by a muscle to the free energy change of the chemical processes driving contraction. Two examples of the experimental measurement of muscle efficiency are: (1) the classical method of Hill which measures the value during a steady state of shortening, (2) measuring the overall efficiency during a complete cycle of a sinusoidal process, which comes closer to the situation during natural locomotion. The reasons why fatigue might lower efficiency are the following. (1) The reduction in PCr concentration and increase in Pi and Cr concentration which are characteristic of fatigued muscle, reduce the free energy of PCr splitting. This will reduce the efficiency of the recovery process. It is not known whether the efficiency of the initial process is increased to compensate. (2) There is a general conflict between efficiency and power output when motor units are chosen for a task or when the timing of activation is decided. During fatigue more powerful units have to be used to achieve a task which is no longer within the scope of less powerful units. (3) The slowing of relaxation that is sometimes found with fatigue may make it impossible to achieve the short periods of activity required for optimum efficiency during rapid cyclical movements. A reason why fatigue might increase efficiency is that muscles are thought to be more efficient energy converters when not fully activated than when fully active. Full activation is often not achieved in muscle which is considerably fatigued. Available observations do not allow us to find where the balance between these factors lies. The conclusion is thus that experiments of both the types discussed here should be performed.