足底内侧和外侧群肌的肌内神经整体分布模式及临床意义

Whole-mount intramuscular nerve distribution pattern of medial and lateral plantar muscles and its clinical significance

目的揭示足底内侧和外侧群肌的肌内神经整体分布模式,探讨其临床意义。方法24具成年尸体,完整取下足底内侧和外侧群肌,采用改良Sihler染色显示肌内神经分布模式。结果收肌的神经支从肌止端的深面入肌,而展肌、短屈肌、小趾展肌和小趾短屈肌的神经支常从肌起端的深面入肌。展肌中有1个半月形和1个长方形的肌内神经密集区(INDR);收肌横头内有2个肾形INDRs,斜头内有1个肾形和1个长方形的INDR;短屈肌、小趾展肌和小趾短屈肌内均有2个长方形的INDRs。这5块肌均可分为2个神经肌肉亚部,但各肌的INDR及其中心点在肌长上的百分位置不同。结论上述结果可为外科手术免于神经损伤,肌移植的选材匹配,以及注射肉毒毒素A阻滞这些肌肉的痉挛提供形态学指导依据。

Objective To reveal the whole-mount distribution pattern of intramuscular nerves in the medial and lateral plantar muscles and to explore its clinical significance.Methods Twenty-four adult cadavers were dissected to remove the medial and lateral groups of the plantar muscles.The distribution pattern of the intramuscular nerves was demonstrated by modified Sihler’s staining.Results The nerve branch for adductor hallucis muscle entered the muscle from the deep surface of the insertion of the muscle,while those nerve branches for abductor hallucis,flexor hallucis brevis,abductor digiti minimi and flexor digiti minimi brevis muscles entered the muscle from the deep side of the origin of the muscle.There were one lunate and one rectangular intramuscular nerve dense regions(INDRs)in the abductor hallucis muscle;two reniform INDRs in the transverse head of the adductor hallucis muscle,one reniform and one rectangular INDRs in the oblique head of the adductor hallucis muscle;there were two rectangle INDRs in the flexor hallucis brevis,abductor digiti minimi and flexor digiti minimi brevis muscles.These five muscles were divided into two neuromuscular compartment,but the percentage position of INDR and the center of INDR on muscle length in each muscle were different.Conclusion These result may provide morphological guidance for surgical operation to avoid nerve injury,the selection and matching of muscle transplantation and the injection of botulinum toxin A to block the spasticity of these muscles.