前臂伸肌内神经血管分布的解剖学研究及其临床意义  

Anatomic study of neurovascular distribution of forearm extensors and its clinical significance

作　　者：陈刚[1] 江华[1] 林子豪[1] 张盈帆[1] 李文鹏[1] 党瑞山[2] 张传森[2] 熊绍虎[2] 沈辉[3] 

机构地区：[1]第二军医大学附属长征医院整形外科,上海200003 [2]第二军医大学解剖学教研室,上海200433 [3]第二军医大学附属长海医院放射科,上海200433

出　　处：《中国临床解剖学杂志》2006年第6期595-599,共5页Chinese Journal of Clinical Anatomy

基　　金：上海"市百名跨世纪学科带头人计划("076);上海市科技发展基金(024119057)

摘　　要：目的:观察前臂伸肌内神经血管解剖分布,探讨前臂肌是否可被分割为若干个功能单位,以提供新的功能性骨骼肌游离移植供区。方法:解剖10具10%甲醛固定的成人尸体共20侧前臂伸肌,观察其肌外神经血管的分布形式。5具新鲜成人尸体标本共10侧前臂伸肌,用Sihler’s染色法观察肌内神经的分布。4具新鲜成人尸体标本共8侧前臂伸肌,经30%硫酸钡、乳胶混悬液血管灌注并行X线钼靶摄片,而后对照观察各肌的神经、血管在肌内分布关系。结果:按前臂肌肌内神经的分布及其形状分为3类:I类肌肉为扁平形肌肉,主要肌内神经干垂直于肌纤维的走行方向。Ⅱ类肌肉为纺锤形肌肉,Ⅱa类肌肉,单羽肌为主,神经分支多为单干支配,神经多在其肌腹的上1/3入肌,神经入肌后多平行肌纤维纵向走行至肌远端。Ⅱb类肌肉,可分为两个部分,每个部分都有独立的神经支配,部分肌肉在其神经入肌门处还有一个返支配肌腹的上1/3。Ⅲ类肌肉,多个止点,神经在肌内呈横向穿越或纵向平行于肌纤维走行,在其肌肉起始部,有神经返支支配肌腹的上1/3。前臂伸肌血供是多源性的,以节段血管蒂型为主。结论:前臂伸肌内中Ⅱb类肌肉的第1,2种类型和Ⅲ类肌肉可将其分为不同的功能单位,供节段性游离肌肉移植。Objective： To explore intramuscular neurovascular distribution of forearm extensors and evaluate whether muscles of forearm can be divided into several functional units for transplantation. Methods： 20 cases of formaldehyde-fixed forearm extensors from 10 cadavers were used to observe the extramuscular neurovascular distribution. 10 of forearm extensors from 5 fresh cadavers were stripped and stained with the standard method of Sihler＇s nerve staining. Blood vessels of 8 forearm extensors from 4 fresh cadavers were studied with injecting a mixture of 30% barium sulfate and gelatin into brachial artery and then X-photographed. After that, intramuscular neurovascular distribution were analyzed on the resulting pictures. Results： Extensors were grouped according to their shape and neural distribution as follows： ① Class Ⅰ, with the flat shape, and its main intramuscular nerve trunk run perpendicularly to the direction of the muscle fibers; ② Class Ⅱ, with long spindle-shaped muscles, and it can be further subdivided into unipermate （Ⅱa）, with a single nerve branch supply mostly, which entered muscle belly at the proximal one third, then running parallel to the direction of the axis of the muscle to the distal tendon, and bipermate （Ⅱb）, with different two compartments, which were supplied by independent nerve. Some times, recurrent branches was given off to the proximal one third of muscle belly at the entry points （motor points）; ③ Class Ⅲ, with multiple tendons of insertion, and its intramuscular nerve branches run transversely as well as longitudinally to the muscle fibers. At the attachment of muscles, recurrent branches of nerve were given off to the proximal one third of the muscle belly. The vessels of above muscles distributed segmentally. Conclusions： According to the neurovascular distribution, the first and second kinds of Class Ⅱb muscles and class Ⅲ muscles can be divided into different compartments with independent function units for segmental muscle transpla

关 键 词：肌内神经分布 血管造影 神经肌肉室 Sihler's染色 前臂伸肌 解剖学 

分 类 号：R322.85[医药卫生—人体解剖和组织胚胎学] R323.71[医药卫生—基础医学]