臂前群肌神经入肌点的定位

摘要

目的:借骨性标志确定肌皮神经肌支神经入肌点(N点)的位置.方法:成年尸体上肢,肩峰至颈静脉切迹连线为喙肱肌支N点的横向参考线(H1),肱骨外上髁至内上髁连线为肱二头肌和肱肌支N点的横向参考线(H2);肩峰至肱骨外上髁连线为纵向参考线(L).解剖暴露N点,涂抹硫酸钡,CT扫描.N点在臂前体表上的投影点为P,P点通过N点后投射至臂后体表上的点为P'.经P的垂线与H线、水平线与L线的交点分别记为PH和PL.Syngo系统下确定PH和PL在H和L线上的位置及N点的深度.结果:喙肱肌支、肱二头肌短头、肱二头肌长头及肱肌支的PH分别位于H1的18.38％、H2的56.85％、52.81％和57.52％处;PL位于L的24.86％、50.20％、55.91％和64.31％处;经过P点的N点深度分别位于PP'线的23.16％、24.68％、26.32％和38.19％处.结论:这些神经入肌点的定位可提高臂前群肌痉挛神经溶解术的疗效和效率.%Objective:To identify the location of nerve entry points(N points) of musculocutaneous nerve muscle branches in relation to bony landmarks.Methods:Chinese adult cadavers were used.A line joining the acromion and the jugular notch was defined as a horizontal reference line(H1) of the N point of coracobrachialis muscle branch,and another line joining the lateral epicondyle and the medial epicondyle of humerus was defined as the horizontal reference line(H2) of N point of the of biceps brachii and brachiis muscle branch.A line joining the acromion to the lateral epicondyle of humerus was defined as the longitudinal reference line(L).Following dissection of N points,the N points were labeled with barium sulfate,and spiral computed tomography scanning was performed.The projection point of the N points on anterior surface of upper arm was designated as P.P by N projecting on posterior surface of upper arm was designated as P'.The intersection points through P of the parallel to arm axis line and the H and through P of the horizontal line and the L were designated as PH and PL,respectively.The location of PH and PL on the H and L and the depth of N points were determined by Syngo system.Results:The PH of coracobrachialis muscle branch,biceps brachii short head branch,biceps brachii long head branch and brachiis muscle branch were located at 18.38％ of H1,56.85％,52.81％ and 57.52％ of H2,respectively;PL were at 24.86％,50.20％,55.91％ and 64.31％ of the L,respectively.The depth of N points past P points were located at 23.16％,24.68％,26.32％ and 38.19％ of the PP'line,respectively.Conclusion:The localization of these nerve entry points can improve the efficacy and efficiency of the neurolysis for the treatment of spasticity of upper arm anterior compartment muscles.