成人大圆肌肌内神经密集区中心的定位及在肌痉挛阻滞中的意义

目的　确定大圆肌肌内神经密集区中心（centers of intramuscular nerve dense regions，CINDR）的位置和标记方法。 方法　选取24具成人尸体。设计紧贴皮肤连接肩胛上角和肩峰及肩胛下角的曲线分别为横向（H）和纵向（L）参考线。改良的Sihler’s染色法显示一侧大圆肌肌内神经密集区，解剖暴露另一侧肌的肌内神经密集区相应位置，硫酸钡标记其CINDR，螺旋CT扫描确定CINDR在背部和胸部的体表投影点（P和P'点）。Syngo系统确定通过P点的垂线分别与H和L线的交点（PH和PL点）的位置和CINDR的深度。 结果　大圆肌内仅有1个肌内神经密集区，其CINDR的PH位于H线的（86.71±0.85）%处，PL位于L线的（72.07±1.08）%处。CINDR的深度位于P-P'线的（40.06±2.44）%处。 结论　这些结果可作为肌内注射肉毒毒素A阻滞大圆肌痉挛的指导依据。

Localization of the centers of intramuscular nerve dense regions of the adult teres major muscle and its significance in blocking spasticity

Objective　To localize the centers of intramuscular nerve dense region (CINDR) of teres major muscle accurately. 　Methods　Twenty-four adult cadavers were collected. The curved lines close to skin surface connecting the superior angle of scapula and the acromion, and the inferior angle of scapula were designed as the horizontal (H) and longitudinal (L) reference lines, respectively. A modified Sihler's staining was used to show the intramuscular nerve dense region of one side teres major muscle. The corresponding position of the intramuscular nerve dense region of the other side muscle was anatomically exposed. And the CINDR was labeled with barium sulfate, and its body surface projection points（P and P'） of CINDR on the back and chest were determined by spiral computed tomography. The position of intersections（PH and PL） of point P vertical with H and L lines, and the depth of CINDR were determined by the Syngo system. 　Results　There was only one intramuscular nerve dense region in teres major muscle. The PH of CINDR was located at (86.71±0.85) % of line H and the PL was at (72.07±1.08) % of line L. The depth of CINDR was at (40.06±2.44) % of line P-P'. 　Conclusions　These results should be used as a guidance for intramuscular injection of botulinum toxin A to block the spasticity of teres major muscle.