前锯肌肌内神经整体分布模式和密集区定位

Overall distribution pattern and localization of the dense region of the intramuscular nerves of the serratus anterior muscle

目的:揭示前锯肌肌内神经的整体分布模式,探索亚部划分,准确定位其肌内神经密集区中心(CINDR)的体表位置和深度。方法:成人尸体24具。采用改良的Sihler′s染色法显示前锯肌肌内神经的整体分布模式。紧贴皮肤连接颈静脉切迹最低点到剑胸结合处的曲线为纵向参考线(L线),经CINDR水平紧贴皮肤连接腋前线与腋后线的曲线为横向参考线(H线);硫酸钡标记CINDR,螺旋CT扫描与三维重建,Syngo系统下确定CINDR的体表百分位置和深度。结果和结论:Sihler′s染色发现,前锯肌上4个肌齿各有1支来自胸长神经的分支,这些神经支在各自的肌齿内呈树枝样分支,行向肩胛骨内侧缘。第1~4个肌齿可作为4个肌神经亚部;胸长神经干在第5肌齿中部水平入肌后,密集分支分布于第5~8(9)肌齿中部,形成一个较大的肌神经亚部。该亚部内的CINDR分别位于H和L线的(84.73±2.44)%和(76.79±1.53)%处,深度为(1.87±0.50) cm;男女及左右侧差异均无统计学意义(P>0.05)。上述结果可为前锯肌亚部化移植的选材设计和注射肉毒毒素A治疗前锯肌痉挛所致疼痛的靶点定位提供形态学指导和依据。

Aim:To reveal the overall distribution pattern and compartmentalization of intramuscular nerves, and localize the body surface position and depth of the center of intramuscular nerve dense region(CINDR) in the serratus anterior muscle.Methods:Twenty-four adult cadavers were used, and a modified Sihler′s staining was performed to show the overall distribution pattern of intramuscular nerves in the serratus anterior muscle.The curve line close to the skin connecting the lowest point of the jugular notch to the xiphisternal junctions was designated the longitudinal reference line(line L),the curve joining the anterior axillary line to the posterior axillary line through the CINDR level was designated the horizontal reference line(line H).The CINDR was labelled with barium sulfate, spiral CT scanning and three-dimensional reconstruction was performed, and Syngo system was used to measure the percentage position and the depth of CINDR on the body surface.Results and Conclusion:Sihler′s staining showed that each of the 4 muscle fleshy digitations near the upper part of the serratus anterior muscle had a branch from the long thoracic nerve.These nerve branches were arborized in their own muscle fleshy digitations and run to the medial edge of the scapula.Thus the 1st to the 4th fleshy digitations could be regarded as four neuromuscular compartments;after entering the middle level of the 5th fleshy digitation, the long thoracic nerve trunk branched densely in the middle of the 5th to 8th(9th) fleshy digitations and formed a larger neuromuscular compartment.The CINDR in this compartment was located at(84.73±2.44)% and(76.79±1.53)% of line H and L,respectively, with a depth of(1.87±0.50) cm, and there were no significant differences between males and females or left and right side(P>0.05).These results may provide morphological guidance for the selection and design of compartmentalized transplantation of the serratus anterior muscle and the target localization of botulinum toxin A injection in the treatment of pain caused by the serratus anterior muscle spasticity.