胸锁乳突肌乳突部形态学特征及其临床意义

Anatomical observation and clinical significance of the sternocleidomastoid muscle

目的为胸锁乳突肌乳突部扳机点疼痛的体表定位及诊治提供形态学依据。方法选取新鲜成人尸体头颈部标本15例,防腐成人尸体头颈部标本1例,对胸锁乳突肌乳突部的解剖结构及神经血管毗邻关系进行测量,包括乳突尖部肌肉、筋膜结构的宽度、厚度及乳突尖至耳垂、颈动脉鞘等之间的垂直距离。结果乳突水平肌肉前缘厚度(9.63±0.05)mm、肌肉中部厚度(10.36±0.07)mm、肌肉后缘厚度3.74±0.01mm,乳突止点部肌肉前缘至耳垂距离(17.42±2.53)mm、肌肉后缘至耳垂距离(62.74±12.53)mm,皮肤点至颈动脉鞘的(3.74±0.01)平均深度为(35.52±6.31)mm。结论从胸锁乳突肌乳突部的解剖特征来看,乳突后部行扳机点注射或针刺较为安全,乳突下及乳突前行扳机点注射时垂直进针、深度不宜超过20.00mm。

Objective To provide anatomy basis for the clinical therapy and the localization of the pain of myofascial trigger points characteristic of sternocleidomastoid muscle. Methods 15 fresh cadavers and 1 preservative cadaver were used in this research. Observing the anatomical structures and the relations between nerves and bloodvessels,which including the width and thickness of the myofacial and muscle besides mastoid processus,and the vertical range between mastoid processus to earlobe, carotid artery sheath and the posterior of the mandible and so on. Results The anterior muscle thickness of the myofacial and muscle besides mastoid processus was（9.63±0.05）mm,the middle muscle thickness of the myofacial and muscle besides mastoid processus was （10.36±0.07） mm and the posterior ones was（3.74±0.01）mm;the vertical range between mastoid processus to earlobe was（17.42±2.53）mm,the posterior sternocleidomastoid muscle to the earlobe was（62.74±12.53） mm and the length of mastoid processus to the carotid artery sheath was（35.52±6.31）mm. Conclusions From the anatomical observation of the sternocleidomastoid muscle we can know that the posterior areas of the mastoid processuses were the most security ones when trigger point injection or the acupuncture in the clinic,but the depth should not surpass 20.00mm when trigger point injection or the acupuncture at the areas of the middle and anterior areas of the mastoid processuses.