[足母]长伸肌神经支配的解剖学研究和临床意义

An anatomical study and clinical value of the innervation of hallucis longus muscle

目的明确[足母]长伸肌神经支配的解剖学特征及其对临床的指导意义。方法10具新鲜成人标本，男6具，女4具；年龄41-73岁，平均53-2岁。取左小腿标本9具，右小腿标本10具，共获得19具小腿标本。解剖标本，确认胫骨前肌和趾长伸肌深面的[足母]长伸肌，并沿腓深神经解剖[足母]长伸肌的神经肌支，观察神经肌支的位置、数量。测量神经肌支长度（nerve length，NL）、神经肌支起点与腓骨头尖部的距离（nerve—fibula head length，NFL）以及腓骨长度（fibula length，FL）。应用苏木精一伊红染色，观察神经肌支内神经束的数量。结果19具小腿标本共发现23支[足母]长伸肌的神经肌支，其中15具肢体由单支神经肌支支配，4具肢体由双支神经肌支支配，1具标本的左、右侧肢体均由双支神经肌支支配。所有神经肌支均起源于腓深神经。神经肌支由腓侧进入蹲长伸肌14支，由前方进入3支，由胫侧进入6支。19具标本小腿长度为34．5—40．6cm，平均（37．0±1．9）cm；神经肌支起点与腓骨头尖部的距离为75．4～97．2mm，平均（89．0±5．2）mm；神经肌支长度为33．6-57．4mm，平均（48．5±5．0）mm；神经肌支起点与腓骨头尖部的距离／腓骨长度为0．211－0．280，平均0．245±0．020。前方进入坶长伸肌的神经肌支长度最短。单神经肌支支配的15具标本的神经肌支中，12支有两个神经束、3支仅有一个神经束；而在双神经肌支支配的4具标本的8个神经肌支中，除1支有两个神经束外，其余7支均仅有一个神经束。结论[足母]长伸肌神经肌支的特殊解剖学特征可能是其出现孤立性损伤和损伤以后预后不佳的原因。

Objective To study the anatomy of the innervation of hallucis longus muscle, and discuss the clinical value of the innervation. Methods Nineteen limbs of 10 cadavers were studied. There were 4 female cadavers and 6 male cadavers. Nine were left legs and 10 were right legs. The specimens were anatomied to confirm the tibialis anterior, extensor digitorum longus and hallucis longus muscle. The innervation of hallucis longus muscle was been observed along the deep peroneal nerve. Measuring the muscular branches length （nerve length, NL）, the distance from the tip of the fibular head to the muscular brance （nerve-fibula head length, NFL）, and fibular length （fibula length, FL）. The hematoxylin and eosin stain was used to observe the numbers of nerve fascicle for each branch of EHL. Results Twenty-three muscle branches of hallucis longus muscle were found in 19 limbs, 15 limbs had a single branch, 4 limbs had the double branches. All branches were originated in the deep peroneal nerve. Fourteen branches were into hallucis longus muscle from the fibular side, 3 from anterior side, 6 from the tibial side. The fibula length was 37.0±1.9 cm （range, 34.5±0.6 cm）; the nerve-fibula head length was 89.0±5.2 mm （range, 75.4-97.2 mm）; nerve length was 48.5±5.0 mm （range, 33.6-57.4 mm）; the nerve-fibula head length/fibula length was 0.245 ±0.020 （range, 0.211-0.280）. Among 15 specimens with single branch, 3 branches had a unique nerve fascicle and 12 had two fascicles. Among 4 specimens with doulbe branches, only 1 branch had two fascicles, 7 branches had a unique fascicle. Conclusion Special anatomical features of muscular branches might be the reason of isolated extensor hallucis longus dysfunction.