Mechanical advantage of the human parasternal intercostal and triangularis sterni muscles

摘要

class="enumerated" style="list-style-type:decimal">Previous studies in dogs have demonstrated that the maximum change in airway pressure (ΔPao) produced by a particular respiratory muscle is the product of three factors, namely the mass of the muscle, the maximal active muscle tension per unit cross-sectional area (∼3.0 kg cm⁻²), and the fractional change in muscle length per unit volume increase of the relaxed chest wall (i.e. the muscle's mechanical advantage). In the present studies, we have used this principle to infer the ΔPao values generated by the parasternal intercostal and triangularis sterni muscles in man.The mass of the muscles and the direction of the muscle fibres relative to the sternum were first assessed in six cadavers. Seven healthy individuals were then placed in a computed tomographic scanner to determine the orientation of the costal cartilages relative to the sternum and their rotation during passive inflation to total lung capacity. The fractional changes in length of the muscles during inflation, their mechanical advantages, and their ΔPao values were then calculated.Passive inflation induced shortening of the parasternal intercostals in all interspaces and lengthening of the triangularis sterni. The fractional shortening of the parasternal intercostals decreased gradually from 7.7% in the second interspace to 2.0% in the fifth, whereas the fractional lengthening of the triangularis sterni increased progressively from 5.9 to 13.8%. These rostrocaudal gradients were well accounted for by the more caudal orientation of the cartilages of the lower ribs.Since these fractional changes in length corresponded to a maximal inflation, the inspiratory mechanical advantage of the parasternal intercostals was only 2.2–0.6% l⁻¹, and the expiratory mechanical advantage of the triangularis sterni was only 1.6–3.8% l⁻¹. In addition, whatever the interspace, parasternal and triangularis muscle mass was 3–5 and 1–3 g, respectively. As a result, the magnitude of the ΔPao values generated by a maximal contraction of the parasternal intercostals or triangularis sterni in all interspaces would be only 1–3 cmH2O.These studies therefore confirm that the parasternal intercostals in man have an inspiratory action on the lung whereas the triangularis sterni has an expiratory action. However, these studies also establish the important fact that the pressure-generating ability of both muscles is substantially smaller than in the dog.