腹前外侧群肌的肌内神经分布模式

目的 揭示腹前外侧群肌的肌内神经分布模式，探讨其临床意义。 方法 取经甲醛固定的12具24侧中国成年尸体的腹前外侧群肌，行改良的Sihler染色。 结果 腹前外侧群肌的神经绝大多数源于节段性分布的胸神经。腹外斜肌各肌齿有独立的神经支配，在髂前上棘和髂结节之间的髂嵴上方有一纵向神经密集带。腹内斜肌腹股沟韧带中点上方有一纵向神经密集带，髂嵴上方有一横向神经密集带。腹横肌髂前上棘与第8、9肋软骨连结处之间有一弧形的神经密集带。腹直肌各肌腹中部有一横向神经密集带，上3个肌腹有独立神经支配。 结论 腹外斜肌和腹直肌可分出神经肌肉亚部；各肌内的神经密集带应被考虑为肉毒毒素A注射和局部麻醉的最佳靶点部位，不宜设为腹壁手术的切口部位。

Intramuscular nerve distribution pattern of anterolateral abdominal wall muscles

Objective To investigate the intramuscular nerve distribution pattern of anterolateral abdominal wall muscles and to explore its clinical significance. Methods Twenty-four anterolateral abdominal wall muscles from twelve Chinese adult cadavers that were fixed with formaldehyde were removed for modified Sihler’s staining. Results Most of the innervation of the anterolateral abdominal wall muscles originated from the segmental distribution of the intercostal nerve. Each muscular serration of the obliquus externus abdominis muscle had an independent innervation and there was a single longitudinal nerve dense band above the iliac crest between the anterior superior iliac spine and iliac tubercle. In the obliquus internus abdominis muscle, there was a longitudinal nerve dense band above the midpoint of the inguinal ligament and a transverse nerve dense band above the iliac crest. In the transversus abdominis muscle, there was an arched nerve dense band between the anterior superior iliac spine and the junction of the ninth and eighth costal cartilage. The rectus abdominis muscle had one transverse nerve dense band in the middle of each muscle belly and the upper 3 muscle bellies had independent innervation. Conclusion The obliquus externus abdominis and rectus abdominis muscle can be divided into neuromuscular subdivisions. The nerve dense zone in each muscle should be considered as the optimal target site for botulinum toxin A injections and local anesthesia, and it should not be designed as the incision site for abdominal wall surgery.