儿童小腿外侧群肌肌内神经分布模式及意义  

Intramuscular nerve distribution pattern in the peroneus longus and peroneus brevis of children

作　　者：唐谦 徐燕 李寿田 谢鹏 Tang Qian;Xu Yan;Li Shoutian;Xie Peng(Experimental Teaching Management Center,Zunyi Medical University,Zunyi Guizhou 563099,China;Department of Anatomy,School of Preclinical Medicine,Zunyi Medical University,Zunyi Guizhou 563099,China;College of Forensic Medicine,Zunyi Medical University,Zunyi Guizhou 563099,China;Department of Critical Care Medicine,The Third Affiliated Hospital of Zunyi Medical University,Zunyi Guizhou 563000,China)

机构地区：[1]遵义医科大学实验教学管理中心,贵州遵义563099 [2]遵义医科大学基础医学院人体解剖学教研室,贵州遵义563099 [3]遵义医科大学法医学院,贵州遵义563099 [4]遵义医科大学第三附属医院重症医学科,贵州遵义563000

出　　处：《遵义医科大学学报》2022年第5期576-580,共5页Journal of Zunyi Medical University

基　　金：国家自然科学基金资助项目(NO:82060359);贵州省自然科学基金重点项目(NO:黔科合基础-ZK[2022]重点049);贵州省科技人才建设计划项目(NO:黔科合平台人才[2021]5648)。

摘　　要：目的探索儿童小腿外侧群腓骨长肌、腓骨短肌肌内神经密集区域的分布范围,为临床注射肉毒毒素A治疗脑瘫患儿小腿外侧群肌痉挛提供解剖学阻滞位点。方法使用改良的Sihler’s肌内神经染色法显示儿童腓骨长肌和腓骨短肌的肌内神经分支密集区。结果来自腓浅神经的腓骨长肌支从肌上端入肌,入肌后发出前、中、后和深支4条分支,分别分布于腓骨长肌肌腹的前、中、后部,其中前支最长、其细小分支可达肌肉下部和肌腱。在肌内的树枝状分支形成“O”型和“Y”吻合,主要密集地分布于肌腹上部。来自腓浅神经的腓骨短肌支从起点交叉入肌,入肌后发出浅、深两支,这两支沿途分出的树枝样分支间构成许多“O”型和“Y”型交通,密集地分布于肌腹中部。结论本研究结果提示,在使用肉毒毒素A(BTX-A)治疗脑瘫患儿腓骨长肌和腓骨短肌痉挛时,建议将药物注入腓骨长肌肌腹上部和腓骨短肌肌腹中部。Objective To explore the distribution of nerve-intensive areas of peroneus longus and peroneus brevis in children’s lateral calf group,and to provide anatomical blocking sites for clinical injection of botulinum toxin A for the treatment of spasticity in children with cerebral palsy.Methods The improved Sihler’s intramuscular nerve staining method was used to show the dense areas of intramuscular nerve branches of peroneus longus and peroneus brevis in children.Results The peroneus longus branch from the superficial peroneal nerve entered the muscle from the upper end of the muscle.After entering the muscle,four branches,anterior,middle,posterior and deep branches,were distributed in the anterior,middle and posterior parts of the peroneus longus muscle belly,respectively.The anterior branch was the longest,and its tiny branches could reach the lower part of the muscle and tendon.Dendritic branches in muscle form"O"and"Y"anastomoses,mainly distributed densely in the upper part of muscle belly.The peronealbrevis branch from the superficial peroneal nerve crosses into the muscle from the starting point,and after entering into the muscle,it sends out the superficial and deep branches.Many"O"and"Y"types of traffic are formed between these branches,which are densely distributed in the belly of the muscle.Conclusion The results of this study suggest that when botulinum toxin A(BTX-A)is used to treat spasticity of peroneus longus and peroneus brevis in children with cerebral palsy,it is recommended to inject drugs into the ventral part of peroneus longus and peroneus brevis.

关 键 词：腓骨长肌 腓骨短肌 肌痉挛 肌内神经 BTX-A 

分 类 号：R322.71[医药卫生—人体解剖和组织胚胎学]