大圆肌的神经入肌点定位及其临床意义

doi:10.13418/j.issn.1001-165x.2017.05.002

中国临床解剖学杂志 ›› 2017, Vol. 35 ›› Issue (5): 486-489.doi: 10.13418/j.issn.1001-165x.2017.05.002

大圆肌的神经入肌点定位及其临床意义

王猛¹，　王国亚²，　杨胜波¹

1.遵义医学院解剖学教研室，贵州遵义 563000；　2.习水县公安局司法鉴定中心，贵州遵义 564600

收稿日期:2017-06-21 出版日期:2017-09-25 发布日期:2017-10-30
通讯作者: 杨胜波，教授，硕士生导师，E-mail: yangshengbo　8205486@163.com
作者简介:王猛（1987-），男，河南南阳人，助教，从事骨骼肌与周围神经损伤研究，Tel：13518528095，E-mail: 932051454@qq.com
基金资助:
国家自然科学基金（31540031）；贵州省科技厅联合基金(LH-2015-7528)

Localization and clinical significance of the nerve entry point of the teres major muscle

WANG Meng¹, WANG Guo-ya², YANG Sheng-bo¹

1. Department of Anatomy of Zunyi Medical College, Zunyi, Guizhou 563000, China; 2. Centre of Forensic Expertise of Xishui country, Zunyi, Guizhou 564600, China

Received:2017-06-21 Online:2017-09-25 Published:2017-10-30

摘要/Abstract

摘要：

目的　准确定位大圆肌神经入肌点（NEP）的体表位置和穿刺深度。方法　12具中国成年人尸体。设计紧贴皮肤连接颈静脉切迹最低点至肩峰尖为横向参考线（H线）、颈静脉切迹最低点至剑胸结合处为纵向参考线（L线）。解剖暴露大圆肌NEP，涂抹硫酸钡，逐层复位缝合，CT扫描与三维重建。Syngo系统下确定大圆肌NEP的体表投影点（P）；P通过NEP投影至背部皮肤上的点为P'点；经P的垂线与H线的交点记为PH，经P的水平线与L线的交点记为PL；分别测量PH和PL在H和L线上的百分位置及NEP的百分深度。结果　大圆肌NEP的PH位于H线的（9.59±1.24）%处，PL位于L线的（39.37±2.45）%处；NEP深度位于PP'线的（41.83±2.98）%处。结论　这些参数可为提高大圆肌痉挛的神经阻滞效率和疗效提供指导。

关键词: 大圆肌, 　肌痉挛, 　神经入肌点, 　定位, 　螺旋CT

Abstract:

Objective This study aimed to localize the body location of nerve entry point (NEP) of the teres major muscle accurately.　Methods　Twelve Chinese adult cadavers in the supine position were used. The lineclose to the skin that connecting the most inferior point of the jugular notch to the apex of the acromion was the horizontal reference H line and the line from the most inferior point of the jugular notch to the junction of sterna body and xiphoid process were designated as the L line longitudinal reference line L. Those cadavers were dissected to expose the NEPs of teres major muscle for marking the NEPs by barium sulfate. CT scanning and three-dimensional reconstruction were performed. The body surface projection points (P) of the NEPs were determined under Syngo system, P projected to the back skin was designated as P' point by NEP. The intersections between the vertical P and the H line, and between the horizontal P and L line were designated as PH and PL, respectively. The percentage location of PH and PL points on H line and L line and the percentage depth of NEPs were measured respectively. Results The points PH and PL of the NEP of teres major muscle were located at (9.59±1.24)% of the H line and (39.37±2.45)% of the L line, respectively. The percentage depth of NEP was located at (41.83±2.98)%. Conclusion These parameters can provide guidance for improving the efficiency and efficacy of the treatment of teres major muscle spasticity with shoulder pain after hemiplegia.

Key words: Teres major muscle, 　Spasticity, 　Nerve entry point, 　Localization, 　Spiral computed tomography

王猛,王国亚,杨胜波. 大圆肌的神经入肌点定位及其临床意义[J]. 中国临床解剖学杂志, 2017, 35(5): 486-489.

WANG Meng1, WANG Guo-ya2, YANG Sheng-bo1. Localization and clinical significance of the nerve entry point of the teres major muscle[J]. Chinese Journal Of Clinical Anatomy, 2017, 35(5): 486-489.

参考文献

[1] 中国康复医学会．肉毒毒素治疗成人肢体肌痉挛中国指南[J]．中国康复医学杂志，2015，25(6)：595-620．
[2] Coskun Benlidayi, Basaran S. Hemiplegic shoulder pain: a common clinical consequence of stroke [J]. Pract Neurol, 2014, 14(2):88-91.
[3] Yelnik AP, Colle FM, Bonan IV. Treatment of pain and limited movement of the shoulder in hemiplegic patients with botulinum toxin a in the subscapular muscle [J]. Eur Neurol, 2003, 50(2):91-93.
[4] Chae J, Mascarenhas D, Yu D, et al. Post stroke shoulder pain: its relationship to motor impairment, activity limitation and quality of life [J]. Arch Phys Med Rehabil，2007, 88:298-301.
[5] Mall V, Heinen F, Linder M, et al. Treatment of cerebral palsy with botulinum toxin A: functional benefit and reduction of disability. Three case reports [J]. Pediatr Rehabil, 1997, 1(4):235-237.
[6] Lam K, Wong D, Tam CK, et al. Ultrasound and electrical stimulator-guided Obturator nerve block with phenol in the treatment of hip adductor spasticity in long-term care patients: a randomized, triple blind, placebo controlled study [J]. Am Med Dir Assoc, 2015, 16(3):238-246.
[7] 胡帅宇, 卓立凡, 杨胜波. 利用神经入肌点定位小腿三头肌痉挛的神经阻滞靶点[J]. 中国临床解剖学杂志, 2017, 35(1): 15-18.
[8] Lee DG, Jang SH. Ultrasound guided alcohol neurolysis of musculocutaneous nerve to relieve elbow spasticity in hemiparetic stroke patients [J]. Neuro Rehabilitation, 2012, 31 ( 4) : 373-377．
[9] Boudarham J, Hameau S, Pradon D, et al. Changes in electromyographic activity after botulinum toxin injection of the rectus femoris in patients with hemiparesis walking with a stiff-knee gait [J]. J Electromyogr Kinesiol, 2013, 23( 5) : 1036-1043．
[10] Kawashima N, Popovic MR, Zivanovic V. Effect of intensive functional electrical stimulation therapy on upper-limb motor recovery after stroke: case study of a patient with chronic stroke [J]. Physiother Can, 2013, 65( 1) : 20-28．
[11] Marciniak C M, Harvey R L, Gagnon C M, et al. Does botulinum toxin type A decrease pain and lessen disability in hemiplegic survivors of stroke with shoulder pain and spasticity?: a randomized, double-blind, placebo-controlled trial [J]. American journal of physical medicine & rehabilitation, 2012, 91(12): 1007-1019.
[12]唐少华，胡勇，杨胜波．臂前群肌神经入肌点的定位[J]．解剖学杂志，2017,40（2）：181-185.
[13]Dancker M, Lambert S, Brenner E. The neurovascular anatomy of the teres major muscle [J]. Journal of Shoulder and Elbow Surgery, 2015, 24(3): e57-e67.
[14]Hu X, Suresh NL, Chardon MK, et al. Contributions of motoneuron hyperexcitability to clinical spasticity in hemispheric stroke survivors [J]. Clin Neurophysiol, 2015, 126(8): 1599-1606.
[15]胡双江，张永，田旭峰，等．大腿肌内侧群痉挛肌外神经阻滞靶点的定位[J]．解剖学报，2015，46(4)：532-537．
[16]Horimoto Y, Inagaki A, Yoshikawa M, et al. Therapeutic outcome of onabotulinum toxin type A in patients with upper limb spasticity [J]. Rinsho Shinkeigaku, 2015,55(8):544-549.

大圆肌的神经入肌点定位及其临床意义

Localization and clinical significance of the nerve entry point of the teres major muscle

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 9

Metrics

本文评价

推荐阅读 0

[1]	周家宇, 杨胜波. 前臂前群肌痉挛神经阻滞靶点定位的研究进展[J]. 中国临床解剖学杂志, 2023, 41(4): 496-498.
[2]	熊伟, 王捷, 舒红燕, 杨胜波. 枕下肌的神经入肌点定位[J]. 中国临床解剖学杂志, 2023, 41(4): 377-381.
[3]	周家宇, 周国燕, 杨胜波. 成人前臂前群肌的神经入肌点定位及意义[J]. 中国临床解剖学杂志, 2022, 40(2): 126-131.
[4]	罗怀香, 季松岭, 杨胜波. 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[J]. 中国临床解剖学杂志, 2021, 39(4): 392-395.
[5]	李澜哲, 牟珂霖, 何美楠, 刘伟豪, 张慧, 陈伟. 320排螺旋CT三维重建大脑前动脉的临床影像解剖学研究[J]. 中国临床解剖学杂志, 2021, 39(3): 292-298.
[6]	胡向楠, 胡帅宇, 杨胜波. 小腿前群肌神经入肌点定位及在阻滞肌痉挛中的意义[J]. 中国临床解剖学杂志, 2021, 39(3): 247-251.
[7]	李琨, 李志军, 张少杰, 王星, 李筱贺, 高尚, 陈杰, 和雨洁. 1~6岁儿童枢椎经椎板螺钉内固定的可行性研究[J]. 中国临床解剖学杂志, 2020, 38(2): 166-170.
[8]	朱光琼,李寿田,何斌,杨方玖. 腹外斜肌的神经入肌点定位与肌内神经分布研究[J]. 中国临床解剖学杂志, 2018, 36(3): 241-244.
[9]	卓立凡,胡帅宇,潘艳梅,柯志腾,杨胜波. 小腿外侧群肌神经入肌点和肌梭丰度最高区中心的定位及其意义[J]. 中国临床解剖学杂志, 2018, 36(2): 121-126.