先天性马蹄内翻足小腿肌肉运动神经支配的组织学观察

Histological Observation of Motor Nerve Inner-Vatinnervation of the Iower Ieg Muscles in CongenitalClubfoot

作者采用镀银染色法对２３例先天性马蹄内翻足患者小腿肌肉的运动神经支配进行了观察，发现被选择的三组肌肉胫前肌、腓肠肌和腓骨肌运动神经支配均有异常改变，主要表现为神经轴突和运动终板退变和再生。退变轴突局部增粗或变细，着色不均，退变终板变小，分枝不全，形状不规整，染色不均。再生包括轴突侧方分枝和终板发芽。在全部４２个标本中，有１３个标本ＴＩＲ轴突终末支配比率增高，三组肌肉间异常运动终板差异不显著（Ｐ＞０．０５）。本研究表明马蹄内翻足可能是一种神经原性疾病。患肢小腿肌肉萎缩可能与退变终板和再生幼稚终板功能低下有关。

Abstract Motor nerve innervation of the lower leg muscles in23 cases of clubfeet was studied histologically. Of 42musuler specimens obtained, 12 were tibialis anterior,13gastrocnemius,17 peroneal muscles. The patient’s ageaverage 9 months. Abnormalities of nerveinnervation coexisted with re-gressive and regenerative changes were revealed in all ofthe 42 specimens. The regressive nervs axons shewed lo-calized swelling,small,motor end-plate poorly ramifiedand irTegular shapcd. The regeneration process includedcollateral reinneration and end-plate sprouting. WithPremature appearance.The terminal innervation ratio(TIR)was increasedin 13 of 42 specimens. The percentage of abnormal end-plates among the 3 groups of museles showed no statisfit-cal difference(P>0.05). This results suggested that congenital clubfoot is aneurogenic lesion and the atropyh of the muscles of thelower leg in clubfoot is related to the regressive and pre-mature end-plates.when the ech of the blcod-stream expanded toabout 1/2 of the length of the flap,then the flap rotationcould be performed. The authors considered that, Ultra-sonic Doppler may provide valuable huidance in separ-tion dclayed flap rotation.