基于Sihler's染色的眼外肌神经肌亚部划分与肌内神经密集区中心定位

Neuromuscular subdivision and central localization of intramuscular nerve dense region in extraocular muscles based on Sihler's staining

目的揭示眼外肌的神经肌亚部划分,肌内神经密集区中心(CINDR)的体表投影位置、穿刺角度和深度。方法中国成人头颅标本24个。紧贴眼眶边缘皮肤的弧线(眶缘线)为参考线,穿刺针与眼睑皮肤形成锐角为θ。改良的Sihler's染色显示眼外肌的肌内神经分布模式。用硫酸钡标记CINDR,螺旋CT扫描与三维重建,测量CINDR的体表投影点(P点)在参考线上的百分位置、经P点刺向CINDR所需的角度和深度。结果大体解剖发现7块眼外肌(上睑提肌、上直肌、下直肌、内直肌、外直肌、上斜肌和下斜肌)的神经入肌处均无血管伴行。神经入肌后,常先分为2条独立的初级神经支,再树枝状分支。依其神经分布模式,每块肌均可分为2个神经肌亚部。肌内树枝状神经支形成神经密集区,其CINDR的体表投影点分别位于眶缘线(内侧至外侧)上的68.42%、53.43%、53.21%、11.76%、98.56%、30.15%和43.73%处;穿刺角度分别为83.54°、69.75°、74.15°、82.98°、80.58°、83.69°和71.52°;穿刺深度分别为3.05 cm、2.71 cm、2.82 cm、3.02 cm、3.00 cm、3.09 cm和2.18 cm。左右侧间和男女性间的比较,P>0.05,差异无统计学意义。结论这些结果可为亚部化眼外肌移植和肌内注射肉毒毒素A纠正斜视提供形态学指导依据。

Objective To reveal the neuromuscular subdivision of extraocular muscle and the body surface projection position,angle and depth for puncture of center of intramuscular nerve dense region(CINDR).Methods Twenty-four Chinese adult.cranial specimens were used.The arc line(orbital edge line)on the skin close to the edge of the orbit was designed as the reference line,and the acute angle formed between the puncture needle and the eyelid skin wasθ.The Modified Sihler's staining was used for showing the distribution pattern of intramuscular nerves in the extraocular muscles.The CINDRs were labelled with barium sulfate,and the spiral CT scanning and three-dimensional reconstruction was performed.The percentage position of the surface projection point(P point)of CINDR on the reference line,the angle and depth required to penetrate CINDR through P point were measured.Results During gross dissection,it was found that there were no blood vessels accompanying at the nerve entry points of the seven extraocular muscles(levator palpebrae superioris,superior rectus,inferior rectus,medial rectus,lateral rectus,superior oblique and inferior oblique muscles).After the nerve entered the muscle,it was often divided into two independent primary nerve branches,and then followed by arborized branches.According to their nerve distribution pattern,each muscle could be divided into two neuromuscular compartments.The intramuscular arborized nerve branches formed nerve dense regions,and the body surface projection points of the CINDR were located at 68.42%,53.43%,53.21%,11.76%,98.56%,30.15%,and 43.73%on the orbital edge line(medial to lateral),respectively.The puncture angles were 83.54°,69.75°,74.15°,82.98°,80.58°,83.69°,and 71.52°,respectively.The puncture depths were 3.05 cm,2.71 cm,2.82c m,3.02 cm,3.00 cm,3.09 cm,and 2.18 cm,respectively.There were no statistical differences between left and right sides and between males and females(P>0.05).Conclusions These results may provide morphological guidance for correcting strabismus by compartmentalized transplantation of extraocular muscle and intramuscular injection of botulinum toxin A.