肱三头肌恶性周围神经鞘瘤1例

恶性周围神经鞘瘸(malignant peripheral nerve sheath tumor,MPNST)是临床上一种较少见的软组织恶性肿瘤,占全身软组织恶性肿瘤的5%～10%,原发于肱三头肌的MPNST极罕见,Miura等[1]曾于1986年报道过1例.我科于2007年2月收治了复发性肱三头肌恶性周围神经鞘瘤1例.现报告如下.     

肱二头肌额外头的形态学观察及其应用解剖

目的为肱二头肌短头转位治疗肩锁关节脱位手术入路提供解剖学基础。方法观察52具成人尸体(104侧)的肱二头肌额外头的形态、神经支配和动脉供应。结果52具尸体中14具有肱二头肌额外头,出现率为26.9%±1.6%,其中1具为双侧性。15侧肱二头肌额外头均由肌皮神经支配。由肱动脉分支供血。结论本地区人群中,肱二头肌额外头的出现率为26.9%,根据其起止点可分为4种类型。肱二头肌额外头的存在原因可从种系发生与个体发生两方面来解释。在肱骨骨折时考虑是否有肱二头肌额外头的存在来进行生物力学分析,取肱二头短头转位治疗肩锁关节脱位手术入路时应注意肱二头肌额外头的动脉分支。     

Effect of position of electrodes relative to the innervation zone onsurface EMG

We investigated the effect of the position of electrodes relative to the innervation zone (IZ) of the biceps brachii muscle during isometric elbow flexion using eight-channel surface array electrodes. We estimated the location of the IZ near the centre of the muscle in 20 male subjects. The pulse peaks from electromyogram (EMG) waveforms were detected for each channel and averaged, the triphasic pulse was determined, and the peak values of the first and third phases were compared. The results showed significantly greater pulse values for the first phase when the electrode placement was proximal to the estimated IZ, and for the third phase when the electrode placement was distal to the estimated IZ. Using this method, the positional relationship between electrodes and IZ can be determined using a surface EMG waveform recorded with a pair of bipolar electrodes. This method may be clinically useful in confirming the reliability of a recorded surface EMG.     

TRICEPS TO BICEPS TRANSFER TO RESTORE ELBOW FLEXION IN THREE PATIENTS WITH BRACHIAL PLEXUS PALSY

Between April 1994 and April 1998, triceps to biceps transfers were done for three men with posttraumatic lesions of the brachial plexus and consequent loss of elbow flexion. Their mean age at the time of their accidents was 33 years (range 19-41) and at the time of muscle transfer 40 years (28-46), with a mean observation period of 21 months (12-31). The transfer resulted in active elbow flexion in all patients with a mean of 113° (90°-130°) and a degree of strength 4-5 (contraction against resistance) with no remaining deficit of passive extension. Two patients were satisfied with the result of the operation and the other was content. No complications were noted. The transfer of the triceps muscle to the tendon of the biceps muscle on loss of elbow flexion resulted in adequate movement and degree of strength. The triceps to biceps transfer involves operating close to the elbow joint and minimal complications, is cosmetically satisfactory, and is particularly suitable for co-contraction of triceps and biceps.     

The MR arthrographic anatomy of the biceps labral insertion and its morphological significance with labral tears in patients with shoulder instability

Introduction

Most of the fibres of the long head of biceps tendon attach on the superior labrum just posterior to the supraglenoid tubercle.

Aim

Our hypothesis was that posteriorly attached biceps tendons predispose to posterior superior labral tears and SLAP lesions.

Methods and materials

A prospective analysis of all MR shoulder arthrograms for shoulder instability referred from the shoulder specialist clinics, performed during a one year period were reviewed by two independent observers who were blinded to clinical history. The biceps attachment was classified into four groups according to the method described in an earlier cadaveric study into four groups; posterior-type 1, predominantly posterior-type 2, equal contributions to both anterior and posterior labrum-type 3 and predominantly anterior labral attachment-type 4. Data was analysed using Kappa statistics and Fischer's exact test.

Results

48 patients (33 males and 15 females) were included in this study with a mean age of 32 years. Majority, 22 patients (46%) had a type 1 attachment of the biceps on the superior labrum. There was moderate intra-observer and good interobserver agreement with a Kappa of 0.58 and 0.63 respectively. There was a significant association between a type 2 attachment and posterior tears (p ≤ 0.04) and also between a type 2 attachment and SLAP tears (p ≤ 0.04).

Conclusion

Our results suggest that variation in anatomy of biceps origin influences the type of labral tears that occur in patients with shoulder instability. The importance of these findings could influence selection of individuals in throwing sports like cricket and baseball.     

The proximal hamstring muscle-tendon-bone unit: A review of the normal anatomy, biomechanics, and pathophysiology

Proximal hamstring injuries occur during eccentric contraction with the hip and the knee on extension; hence they are relatively frequent lesions in specific sports such as water skiing and hurdle jumping. Additionally, the trend toward increasing activity and fitness training in the general population has resulted in similar injuries. Myotendinous strains are more frequent than avulsion injuries. Discrimination between the two types of lesions is relevant for patient management, since the former is treated conservatively and the latter surgically. MRI and Ultrasonography are both well suited techniques for the diagnosis and evaluation of hamstring tendon injuries. Each one has its advantages and disadvantages. The purpose of this article is to provide a comprehensive review of the anatomy and biomechanics of the proximal hamstring muscle-tendon-bone unit and the varied imaging appearances of hamstring injury, which is vital for optimizing patient care. This will enable the musculoskeletal radiologist to contribute accurate and useful information in the treatment of athletes at all levels of participation.     

超声引导下注药治疗老年急性肱二头肌长头腱腱鞘炎

目的：探讨超声引导下经皮注药治疗老年肱二头肌长头肌腱（LHBB）腱鞘炎的疗效。方法：48例老年LHBB腱鞘炎伴肩痛患者,在超声引导下于结节间沟处LHBB旁、腱鞘内注药治疗,注射药物为地塞米松棕榈酸酯注射液4 mg和1%盐酸利多卡因注射液4 ml。双侧病变者,一侧治疗后间隔1周后再治疗另一侧。于治疗后4周行超声检查,并做疼痛评分测定,以评价超声引导注药治疗效果。结果：48例老年患者52根LHBB鞘炎在超声引导下经皮注药前抽出积液（0.23±0.17）ml。注药4周后,肩疼评分明显减低（6.33±1.34 vs 1.01±0.82,P〈0.01）,超声显示结节间沟处腱鞘积液明显减少（0.27±0.16）mm：（0.04±0.06）mm,P〈0.01,该处肌腱横径与治疗前无明显差异（6.61±2.1）mm：（6.33±2.0）mm。结论：老年人LHBB腱鞘炎痛苦大,影响睡眠,超声引导下经结节间沟肌腱旁腱鞘内注药治疗可将药物准确注入靶部位,通过抽取腱鞘积液后注药治疗能有效缓解肩痛症状。