【摘要】 目的借助螺旋CT和体表标志定位鱼际肌各神经入肌点(NEP)的体表位置和穿刺深度。方法 12具24侧中国成人尸体上肢,仰卧。选择经皮肤连接中环指指蹼中点与手舟骨结节顶点的曲线为纵向参考线(L);第1掌骨头桡侧缘与豌豆骨顶点的曲线为横向参考线(H)。解剖暴露鱼际肌各神经肌支NEP,涂抹硫酸钡,螺旋CT扫描并三维重建图像。NEP在手掌表面的投影点为P,P通过NEP后投射至手背表面的点为P’。经P的水平线与L线交点、垂线与H线的交点分别记为PL和PH。Syngo系统下测量和确定PL和PH在L和H线上的百分位置及NEP的深度。结果拇短展肌、拇短屈肌、拇对掌肌、拇收肌横头和拇收肌斜头神经支的PL分别位于L线的(71.61±1.50)%、(58.52±1.05)%、(77.03±1.39)%、(55.93±1.03)%和(55.91±1.07)%处,PH分别位于H线的(52.10±1.38)%、(50.93±1.04)%、(60.68±1.71)%、(59.10±0.94)%和(57.16±0.93)%处;NEP深度分别位于PP’线的(11.78±0.33)%、(18.81±0.44)%、(21.07±0.51)%、(54.05±1.12)%和(34.17±0.67)%处。结论这些神经入肌点位置和深度的确定可为提高鱼际肌痉挛化学神经溶解术的效率和疗效提供指导。更多还原

【Abstract】 Objective To localize the body surface location and puncture depth of nerve entry points(NEP) of the thenar muscles by spiral computed tomography( CT) and surface landmarks. Methods Twenty-four sides upper limb of 12 Chinese adult cadavers were dissected and exposed in the supine position. A curved line close to the skin that from the midpoint of web between the middle finger and the ring finger to the apex of scaphoid tubercle were selected as the longitudinal reference line( L). Another curved line joining the radial border of first metacarpal head to the apex of the pisiform bone were designated as the horizontal reference line( H). Those cadavers were dissected to expose the NEP of each nerve muscular branch of the thenar muscles for staining the NEP by barium sulfate. Spiral CT scanning and three-dimensional reconstruction images were performed. The projection point of the NEP on palm surface was designated as P,and P by N projecting to the dorsum of the hand was designated as P’. The intersections after the horizontal P and L line,after the vertical P and the H line were designated as PLand PH,respectively. The percentage location of PLand PHon L and H and depth of NEP were measured and determined by Syngo system. Results The PLof nerve muscular branch of the abductor pollicis brevis,flexor pollicis brevis,opponens pollicis,transverse head of adductor pollicis and oblique head of adductor pollicis muscles were located at(71. 61 ± 1. 50) %,(58. 52 ± 1. 05) %,(77. 03 ± 1. 39) %,( 55. 93 ± 1. 03) %and(55. 9 1 ± 1. 07) % of the L,respectively. The PHwas at(52. 10 ± 1. 38) %,(50. 93 ± 1. 04) %,(60. 68 ±1. 71) %,(59. 10 ± 0. 94) % and(57. 16 ± 0. 93) % of the H,respectively. The depth of NEP was located at(11. 78 ± 0. 33)%,(18. 81 ± 0. 44)%,(21. 07 ± 0. 51)%,(54. 05 ± 1. 12)% and(34. 17 ± 0. 67)%,respectively. Conclusion The location and depth of these identified nerve entry points might provide guidelines that could improve the efficacy and efficiency of the chemical neurolysis for the treatment of the thenar muscles spasticity.更多还原