利用神经入肌点定位肩胛下肌痉挛的阻滞靶点

Using the nerve entry point as the blocking target for the subscapularis muscle spasticity

目的准确定位肩胛下肌神经入肌点(NEP)的体表位置和穿刺深度,为实现肩胛下肌痉挛乙醇或苯酚注射的化学神经溶解术提供指导。方法 20具中国成年人尸体,仰卧。紧贴皮肤连接颈静脉切迹最下点与肩峰尖和颈静脉切迹最下点与剑胸结合处的曲线分别为NEP的横向参考线(H线)和纵向参考线(L线)。解剖暴露肩胛下肌各神经肌支的NEP,涂抹硫酸钡,螺旋计算机断层扫描(CT)与三维重建。Syngo系统下确定NEP在体表的投影点(P),P通过NEP投射至背部皮肤上的P’点;经P的垂线与H线、经P的水平线与L线的交点分别记为PH和PL,测量PH和PL在H和L线上的百分位置及NEP的深度。结果肩胛下肌上神经支和下神经支的PH分别位于H线的(46.89±2.73)%和(42.56±2.59)%处,PL分别位于L线的(7.58±2.88)%和(17.42±3.31)%处;NEP深度分别位于PP’线的(16.32±2.52)%和(29.93±2.89)%处。结论上述结果可为提高肩胛下肌痉挛化学神经溶解术的疗效和效率提供指导。

Objective This study is aimed to accurately localize the nerve entry point（ NEP） of the subscapalaris muscle,and to provide guidance for implementing the chemical neurolysis of the ethanol or phenol injection for the treatment of subscapalaris muscle spasticity. Methods Twenty Chinese adult cadavers in the supine position were examined. The joining lines from the most inferior point of the jugular notch to the apex of the acromion and from the most inferior point of the jugular notch to the junction of sternal body and xiphoid process were designated as the horizontal（ H line） and the longitudinal（ L line） reference lines of the NEP,respectively. The cadavers were dissected to expose the NEPs of muscular branches of subscapalaris muscle. The NEPs were marked by barium sulfate. Spiral CT scanning and three-dimensional reconstruction were performed. The body surface projection points（ P） of the NEPs were determined under Syngo system,P by N projecting to the back skin was designated as P＇. The intersections after the vertical P and the H line,after the horizontal P and L line were designated as PHand PL,respectively. The percentage location of PHand PL points on H line and L line and depth of NEPs were measured respectively. Results The points PHof the upper branch and lower branch of subscapular muscle were located at（ 78. 49 ± 5. 48） % and（ 86. 17 ± 1. 68） % of the H line,and at（ 21. 94 ± 3. 59） % and（ 30. 00 ± 1. 79） % of the L line,respectively. The depth of NEPs was located at（ 46. 65 ±2. 74） % or（ 45. 87 ± 2. 39） %,respectively. Conclusion These results provide guidance for improving the efficacy and efficiency of the chemical neurolysis of the subscapalaris muscle spasticity.