本文關(guān)鍵詞：指淺屈肌神經(jīng)阻滯精確區(qū)域定位與尺、橈側(cè)腕屈肌肌肉神經(jīng)構(gòu)筑學(xué)臨床應(yīng)用研究　出處：《吉林大學(xué)》2011年博士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 指淺屈肌 尺側(cè)腕屈肌 橈側(cè)腕屈肌 肌腱移位 神經(jīng)移位 肌肉構(gòu)筑學(xué)

【摘要】：腦外傷病、大腦性癱瘓、血管性偏癱的病人,很多都伴隨有去功能化的上肢痙攣,這一并發(fā)癥,經(jīng)常影響到上肢前臂的屈肌肌肉群。在眾多上肢肌肉痙攣性殘疾中,尤其以手指屈肌痙攣,因為其限制了手腕的活動幅度和手指的精細(xì)運(yùn)動,最影響日常的生活。在通過神經(jīng)肌肉阻滯降低手指屈肌痙攣的治療實踐中,指淺屈肌是個重要的目的肌肉。指淺屈肌的神經(jīng)入肌點(diǎn)和肌肉內(nèi)神經(jīng)末梢的準(zhǔn)確定位對于用肉毒毒素治療手指屈肌痙攣是必不可少的,但目前尚無報道實現(xiàn)對指淺屈肌的上述解剖位置的準(zhǔn)確定位。我們的研究闡明指淺屈肌的肌肉外的支配神經(jīng)的分支特征、精準(zhǔn)的神經(jīng)入肌點(diǎn)分布以及肌肉內(nèi)神經(jīng)末梢的分布特點(diǎn)及分布區(qū)域,以此為肉毒毒素以及其他去神經(jīng)阻滯劑對指淺屈肌的注射提供一個準(zhǔn)確的指導(dǎo)區(qū)域,在研究中,我們還論述了指淺屈肌近端神經(jīng)分支作為神經(jīng)移位供體重建旋前圓肌旋前功能的可能性。 隨著臨床上應(yīng)用帶血管神經(jīng)的肌瓣游離移植以及原位的肌腱神經(jīng)移位功能重建開展,以及神經(jīng)肌肉功能獨(dú)立亞部(Neuromuscular compartment, NMCs)概念的提出,學(xué)者們提出是否可以將肌肉分割成若干亞部進(jìn)行游離移植或者原位移位功能重建,使得在不過于損傷供體肌肉功能的前提下,充分利用前臂肌肉的動力資源,實現(xiàn)多重的功能重建。我們的實驗重點(diǎn)研究了尺側(cè)腕屈肌和橈側(cè)腕屈肌的肌肉構(gòu)筑學(xué)特征,以及顯微視野下的神經(jīng)斷面構(gòu)筑學(xué)特征,對尺橈側(cè)腕屈肌的神經(jīng)肌肉分布特征臨床應(yīng)用前景給予了的深入研究,闡明了肌肉形態(tài)與功能的一致性,為肌腱、神經(jīng)移位的臨床設(shè)計提供了重要思路,為深入研究肌肉的形態(tài)特征和生理功能提供可靠的臨床應(yīng)用解剖學(xué)依據(jù),為臨床實踐中,更理想供體肌肉的選擇,提供了理論基礎(chǔ)。
[Abstract]:Many patients with brain trauma, cerebral palsy, and hemiplegia are accompanied by disabling upper limb spasms, a complication. The flexor muscle group of the forearm of the upper limb is often affected. In many upper limb muscle spastic disabilities, especially the finger flexor spasm, it limits the range of wrist movement and the fine movement of the finger. Most affect daily life. In the treatment of reducing finger flexor spasm through neuromuscular block. Flexor digitorum superficial muscle is an important target muscle. The exact location of nerve entry point and nerve endings of flexor digitorum muscle is essential for the treatment of finger flexor spasm with botulinum toxin. However, there is no report on the exact location of the above anatomical position of flexor digitorum. Our study elucidates the branching characteristics of the innervated nerve outside the flexor digitorum digitorum muscle. The accurate distribution of nerve entry points and the distribution of nerve endings in muscle provides an accurate guidance area for the injection of botulinum toxin and other denervating agents to flexor digitorum. In our study, we also discussed the possibility of reconstructing the supinator function of the flexor digitorum muscle proximal nerve branch as a nerve transfer donor. With the clinical application of vascularized muscle flap free transplantation and orthotopic tendon nerve transfer function reconstruction. And the concept of Neuromusculus compartmentalization (NMCs), an independent subunit of neuromuscular function. Scholars have proposed whether muscle can be divided into several subparts for free transplantation or orthotopic transposition to make full use of the power resources of the forearm muscles without too much damage to the muscle function of the donor. Our experiments focused on the muscular architecture of flexor Carpi ulnaris and flexor Carpi radialis, as well as the characteristics of nerve sectional architecture in microscopic view. The clinical application prospect of neuromuscular distribution of flexor Carpi ulnaris was studied, and the consistency of muscle morphology and function was elucidated, which provided an important idea for the clinical design of tendon and nerve transposition. It provides a reliable anatomical basis for the study of morphologic features and physiological functions of muscles, and provides a theoretical basis for the better choice of donor muscles in clinical practice.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2011
【分類號】：R322

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