根据肌内神经分布定位髂腰肌和腰方肌痉挛的阻滞靶点

Localization of blocking targets based on intramuscular nerve distribution of the iliopsoas and quadratus lumborum muscle spasticity

目的通过探索髂腰肌和腰方肌的肌内神经分布模式,定位其肌痉挛时肉毒毒素A的阻滞靶点。方法 12具24侧中国成人尸体髂腰肌和腰方肌。改良的Sihler’s染色法显示肌内神经分布。结果髂腰肌和腰方肌的神经支配源于T_(12)和L_1～L_4脊神经分支。腰大肌肌腹上1/2区内有一神经分支密集区,位于肌长的(12.10±0.65)%～(43.20±1.17)%水平,其中心点在肌长(23.90±0.82)%水平,向内平对第三腰椎体中部;髂肌中央有一与髂嵴平行的蚕豆形神经密集区,其中心点位于髂腰肌肌长的(58.0±1.61)%水平,向外平对髂结节;腰方肌的内上和下1/3部各存在1个肌内神经密集区,其中心点分别平对第一和第三腰椎体下部。结论这些肌内神经密集区及中心的定位研究能指导临床医生注射肉毒毒素A接近其作用部位。

Objective To localize the blocking targets for botulinum toxin A injection in iliopsoas and quadratus lumborum muscles by exploring the intramuscular nerve distribution pattern. Methods Iliopsoas and quadratus lumborum muscles of 12 adult cadavers were collected from both sides. Modified Sihler’s staining was used to reveal intramuscular nerve distribution. Results The innervation of the iliopsoas and quadratus lumborum originated from the branches of T12 and L1~L4 spinal nerves. There was a nerve branch dense region in the upper 1/2 of psoas major muscle. It was located about(12.1±0.65)%^(43.2±1.17)% of muscle length with a central point at(23.90±0.82)% of muscle length corresponding medially to the middle of L3 vertebral body. There was a broad bean-shaped nerve dense region parallel to the iliac crest in the center of the iliacus muscle. The central point of this region was at(58.0 ± 1.61)% of iliopsoas muscle length corresponding laterally to iliac tubercle. There was an intramuscular nerve dense region in the superomedial 1/3 and inferior 1/3 of the quadratus lumborum muscle respectively, each having a central point medially corresponding to the lower part of the L1 and L3 vertebral bodies. Conclusion The localization study of these intramuscular nerve dense regions and centers of the iliopsoas and quadratus lumborum muscle can allow the clinician to inject BTX-A close to its site of action.