人髂腰肌神经的显微解剖和大鼠髂腰肌的复合动作电位研究

Microanatomy and electrophysiology of iliopsoas innervation

目的 :了解髂腰肌的神经支配及电生理学特征。 方法 :在 30侧经甲醛溶液固定的成人尸体标本上进行显微解剖观察与测量 ,于手术显微镜下操作 ,剥离神经外膜 ,分离出神经束 ,研究髂腰肌神经的走行、分布及其神经纤维的来源 ,通过逆行追踪观察各分支的神经纤维在神经干内的分布定位的特征 ;对大鼠髂腰肌神经进行电生理学测定 ,依次刺激 L2 ～ L5神经根 ,于髂腰肌记录其复合肌肉动作电位 (CMAP) ,观察并计算其运动潜伏期 (motor latency)、动作电位的波幅及波幅下面积以判定神经功能的状况 ,研究各腰神经根对髂腰肌支配的不同效应。结果 :支配腰大肌的神经纤维主要来源于 L2 ,其次是 L3,肌支纤维在 L2 神经干的外上侧束走行 ,部位较恒定。髂肌肌支则在股神经起始处发出 ,其神经纤维主要来源于 L4 ,其次为 L3及L2 ,一部分集中于 L4 神经根近侧端 (靠近脊神经节 )的下内象限 ,来源于 L2 、L3的神经纤维在股神经起始处断面的内上象限集中。电生理检测运动传导中复合肌肉动作电位发现对 L2 、L4 神经根刺激后测得波幅下面积分别为 (7.4 6± 2 .2 3)、(2 1.4 8± 1.87) m V· ms,与其他神经根所测相比有明显差异 (P<0 .0 5 )。 结论 :腰大肌的神经纤维来源主要是 L2 ,肌支纤维在 L2 神经干的外上部走行 。

Objective:To study the electrophysiology of iliopsoas and the microsurgical anatomy of its nerve supply. Methods: The source, course, and distribution of the nerve supply of iliopsoas were observed on 30 sides of adult cadavers under operative microscope after striping the perineurium and separating the nerve bundles. The position of the nerve fibers of the muscular branches in the nerve trunk was detected by the method of retrograde tracing. The lumbar roots (L 2-L 5) were stimulated by turns and the amplitude of wave and area of amplitude in iliopsoas were recorded by CMAP. Results: It was found that the nerve fibers to psoas major are originated chiefly from L 2 and then from L 3, and run constantly in the superiolateral part of L 2 root. The nerve fibers to iliacus are derived from L 4 and then from L 3 and L 2, and concentrate in the inferior medial quadrant of proximal part of L 4 root and the superior medial quadrant at the beginning of femoral nerve. The area of amplitude of compound muscle action potential in L 2 and L 4 group were respectively (7.46±2.23) mV·ms and (21.48± 1.87) mV·ms, showing significant difference when compared with other lumbar roots (P<0.05). Conclusion: The nerve fibers to psoas major are originated chiefly from L 2 and run constantly in the superiolateral part of L 2 root; the nerve fibers to iliacus are derived from L 4 and L 3 and mainly concentrate at the beginning of femoral nerve; the innervation effect of different lumbar roots to iliopsoas is different.