本文選題：骨骼肌 + 肌亞部��； 參考：《第二軍醫(yī)大學(xué)》2007年碩士論文

【摘要】： [目的] ①觀察并測量臨床常用肌瓣,即足拇展肌、背闊肌、股薄肌、胸小肌、腹直肌和縫匠肌,及小腿各肌肉的形態(tài)和肌肉起止點(diǎn)。明確支配各肌肉的神經(jīng)來源、肌外神經(jīng)走行,測定各神經(jīng)分支的入肌點(diǎn)。觀察肌肉解剖肌亞部的劃分。 ②通過Sihler’s肌內(nèi)神經(jīng)染色,觀察神經(jīng)入肌后的走行、分布及神經(jīng)肌亞部的劃分。 ③根據(jù)大體解剖及肌內(nèi)神經(jīng)染色的結(jié)果對肌肉進(jìn)行綜合分類。 ④探討臨床常用肌瓣及小腿諸肌能否被分割為若干個肌亞部,填補(bǔ)解剖學(xué)的空白,為臨床切取部分肌肉用于移植和指導(dǎo)手術(shù)入路提供解剖學(xué)依據(jù)。 [方法] 1大體解剖學(xué)研究: 解剖15側(cè)經(jīng)10%甲醛固定的成年尸體小腿及8側(cè)成年尸體的臨床常用肌瓣,觀測肌肉的形態(tài)和肌束排列走行方向;研究支配肌肉的神經(jīng)來源及走行,記錄肌外神經(jīng)分支。以腓骨頭水平為基準(zhǔn)測定肌肉起點(diǎn)和各神經(jīng)分支的入肌點(diǎn),將肌肉做矢狀切和水平切,觀察肌肉內(nèi)部肌束的排列和肌內(nèi)腱板走行情況。 2肌內(nèi)神經(jīng)染色: 切取新鮮成年尸體的92塊小腿肌和24塊臨床常用肌瓣共116塊骨骼肌。采用Sihler’s肌內(nèi)神經(jīng)染色方法,經(jīng)過取材、固定、浸軟、除色素、脫鈣、染色、脫色、中和以及透明等一系列過程,達(dá)到透明肌肉,著色神經(jīng)的目的,觀察神經(jīng)在肌內(nèi)的走行及分布。 3肌肉分類的方法: 根據(jù)Lim等人對上肢肌的分類方法,再結(jié)合本實(shí)驗(yàn)大體解剖和肌內(nèi)神經(jīng)染色的結(jié)果,對本實(shí)驗(yàn)中的肌肉進(jìn)行分類,提出肌肉的亞部化觀點(diǎn)。 [結(jié)果] 1大體解剖學(xué)結(jié)果剖肌亞部劃分,這些肌肉包括扁肌(乆肌、胸小肌、背闊肌)、雙羽肌(腓骨長肌、比目魚肌、部分趾長屈肌)、多頭肌(腓腸肌)、環(huán)羽肌(脛骨前肌、脛骨后肌)和多腹肌(腹直肌)。 2肌內(nèi)神經(jīng)染色結(jié)果 Sihler’s染色后,肌肉呈透明或半透明狀,外形完整,肌束的走行方向肉眼可見,肌肉內(nèi)的神經(jīng)各級分支被染成紫藍(lán)色,在肌肉內(nèi)的分支及走行清晰可見。 最適合臨床上進(jìn)行亞部移植的小腿肌肉有腓腸肌、比目魚肌、脛骨前肌、脛骨后肌和腓骨長肌。 臨床常用肌瓣的神經(jīng)亞部劃分:①足拇展肌可以分為前中后三個亞部;②背闊肌可以按肌纖維走行方向?qū)⑵浞譃?～4個亞部;③股薄肌可以分為上中下三個亞部;④腹直肌可以取其中一個節(jié)段作為移植供體,也可以縱行劈開一個或者幾個節(jié)段進(jìn)行移植;⑤胸小肌可以將其分為上下兩個肌亞部;⑥縫匠肌可以取下亞部的內(nèi)側(cè)或者外側(cè)次亞部進(jìn)行移植。 3肌肉綜合分類結(jié)果 4肌內(nèi)神經(jīng)分布規(guī)律 ①當(dāng)神經(jīng)在肌肉的起點(diǎn)入肌,且方向與肌肉長軸平行時,神經(jīng)將沿肌肉方向向前延伸,分支呈平行或放射狀排列(如拇長伸肌、背闊肌)。當(dāng)肌肉被肌內(nèi)腱膜延伸分成幾部分時,神經(jīng)分支也將分為幾組,分別支配被分割的幾部分(如腓骨長肌、脛骨前肌)。 ②當(dāng)神經(jīng)的入肌點(diǎn)在距離肌肉起點(diǎn)一定距離,且和肌肉的長軸呈一定夾角時,神經(jīng)將發(fā)出兩支以上分支,其中一支向肌肉起點(diǎn)方向回返,支配肌肉近端亞部,其余分支向前行,支配遠(yuǎn)側(cè)肌肉(如股薄肌、縫匠肌)。 ③當(dāng)神經(jīng)入肌點(diǎn)在肌肉的中部,且和肌肉長軸垂直或近乎垂直時,神經(jīng)將發(fā)出兩側(cè)分支和前方分支,支配肌肉的三個部分(如足拇展肌、乆肌) [結(jié)論] ①對臨床常用肌瓣及小腿肌肉的大體解剖測定及神經(jīng)入肌點(diǎn)的測定具有重要的臨床意義,能夠指導(dǎo)臨床避免神經(jīng)損傷及對肌肉進(jìn)行亞部移植。 ②Sihler’s肌內(nèi)神經(jīng)染色方法結(jié)合大體解剖及顯微解剖方法是研究肌內(nèi)神經(jīng)分布及走行的理想方法。 ③骨骼肌可以根據(jù)大體解剖及肌內(nèi)神經(jīng)染色結(jié)果進(jìn)行綜合分類,其中除單羽肌中第一型外均能進(jìn)行亞部移植。 ④神經(jīng)在肌肉內(nèi)的分布及走行是有規(guī)律可循的。
[Abstract]:Purpose of the project






( 1 ) To observe and measure the clinical commonly used muscle flap , namely the foot abductor muscle , the dorsomus dorsi muscle , the thigh thin muscle , the pectus minimus , the rectus abdominis muscle and the sartorius muscle , and the shape and the muscle starting point of each muscle of the calf .






( 2 ) Through the Sihler ' s intramuscular nerve staining , we observed the running , distribution and division of the neuromuscular sub - division after the nerve was entered into the muscle .






( 3 ) performing comprehensive classification on muscles according to the gross anatomy and the result of intramuscular nerve staining .






Objective To study whether the muscles of common muscle flap and small leg can be divided into several sub - parts , fill the blank of anatomy , and provide anatomical basis for clinical cutting of partial muscles for transplantation and guidance of surgical approach .






Methodology






1 Gross anatomical study :






The muscle flap of adult corpses fixed by 10 % formaldehyde on 15 sides of anatomy was dissected , the morphology of muscle was observed and the direction of muscle bundle arrangement was observed .






2 Intramuscular nerve staining :






A total of 116 skeletal muscles were obtained from 92 small leg muscles and 24 pieces of clinically common muscle flap from fresh adult corpses . Using the method of Sihler ' s intramuscular nerve staining , a series of processes such as material selection , fixation , softening , depigmenting , calcium removal , staining , decolouring , neutralization and transparency were used to achieve the purpose of transparent muscle and colored nerve to observe the running and distribution of nerve in the muscle .






3 Method of muscle classification :






According to the classification method of the upper limb muscles by Lim et al . , the muscle in the experiment was classified according to the gross anatomy of the experiment and the results of intramuscular nerve staining .






The result is not valid .






1 General anatomical results are divided into sub - division , these muscles include flat muscle ( musculus rectus muscle , pectus minimus , dorsi mus dorsi muscle ) , bifeather muscle ( long muscle of fibula , soleus muscle , partial toe long flexor muscle ) , multi - head muscle ( fibula muscle ) , ring feather muscle ( tibialis anterior muscle , posterior tibial muscle ) , and multi - abdominal muscle ( rectus abdominis muscle ) .






2 Intramuscular nerve staining results






After Sihler ' s staining , the muscle is transparent or translucent , the appearance is intact , the walking direction of the muscle bundle is visible to the naked eye , and the branches of the nerves at all levels in the muscle are dyed into purple blue , and branches and walking lines in the muscle are clearly visible .






The most suitable calf muscle that is most suitable for clinical sub - transplantation is muscle of fibula , soleus muscle , anterior tibial muscle , posterior tibial muscle and long muscle of fibula .






It is divided into three sub - parts : 鈶，

本文編號：1764336