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[Abstract] Objective To study the morphology, muscle architecture index and distribution pattern of intramuscular nerve dense area of elbow muscle, so as to provide anatomical location for poster-lateral approach of elbow joint and transplantation of elbow muscle flap. Methods Through gross anatomy, muscle architecture index and modified Sihler’s intramuscular nerve staining, 10 cases with an average age of 64. 2 years were selected. Results The elbow muscle was approximate triangle, the muscle wet weight was (6. 31±0. 85) g, the muscle length was (6. 24±0. 78) cm, the muscle fiber length was (4. 74±0. 88) cm, pennation angle(70. 60±6. 41)°and the muscle physiological cross-sectional area was (0. 41±0. 15) cm
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SUMMARY: This study aimed to accurately localize the location and depth of the centre of the highest region of muscle spindle abundance (CHRMSA) of the triceps brachii muscle. Twenty-four adult cadavers were placed in the prone position. The curve connecting the acromion and lateral epicondyle of the humerus close to the skin was designed as the longitudinal reference line (L), and the curve connecting the lateral and the medial epicondyle of the humerus was designed as the horizontal reference line (H). Sihler's staining was used to visualize the dense intramuscular nerve region of the triceps brachii muscle. The abundance of muscle spindle was calculated after hematoxylin and eosin stain. CHRMSA was labelled by barium sulphate, and spiral computed tomography scanning and three- dimensional reconstruction were performed. Using the Syngo system, the projection points of CHRMSA on the posterior and anterior arm surface (P and P' points), the position of P points projected to the L and H lines (PL and PH points), and the depth of CHRMSA were determined. The PL of the CHRMSA of the long, medial, and lateral heads of the triceps brachii muscle were located at 34.83 %, 75.63 %, and 63.93 % of the L line, respectively, and the PH was located at 63.46 %, 69.62 %, and 56.07 % of the H line, respectively. In addition, the depth was located at 34.73 %, 35.48 %, and 35.85 % of the PP' line, respectively. These percentage values are all the means. These body surface locations and depths are suggested to be the optimal blocking targets for botulinum toxin A in the treatment of triceps brachii muscle spasticity.
RESUMEN: Este estudio tuvo como objetivo localizar con precisión la ubicación y la profundidad del centro de la región más alta del huso muscular (CHRMSA) del músculo tríceps braquial. Se colocaron veinticuatro cadáveres adultos en posición prona y se designó la curva que conecta el acromion y el epicóndilo lateral del húmero cerca de la piel como la línea de referencia longitudinal (L), y la curva que conecta los epicóndilos lateral y medial del húmero fue designada como la línea de referencia horizontal (H). Se usó la tinción de Sihler para visualizar la región nerviosa intramuscular densa del músculo tríceps braquial. La abundancia de huso muscular se calculó después de la tinción con hematoxilina y eosina. CHRMSA se marcó con sulfato de bario y se realizó una tomografía computarizada espiral y una reconstrucción tridimensional. Usando el sistema Syngo, fueron determinados los puntos de proyección de CHRMSA en la superficie posterior y anterior del brazo (puntos P y P'), la posición de los puntos P pro- yectados en las líneas L y H (puntos PL y PH) y la profundidad de CHRMSA. Los PL de la CHRMSA de las cabezas larga, medial y lateral del músculo tríceps braquial se ubicaron en el 34,83 %, 75,63 % y 63,93 % de la línea L, respectivamente, y el PH se ubicó en el 63,46 %, 69,62 %, y 56,07 % de la línea H, respectivamente. La profundidad se ubicó en el 34,73 %, 35,48 % y 35,85 % de la línea PP', respectivamente. Estos valores porcentuales son todas las medias. Se sugiere que estas ubicaciones y profundidades de la superficie corporal son los objetivos de bloqueo óptimos para la toxina botulínica A en el tratamiento de la espasticidad del músculo tríceps braquial.
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Humans , Male , Female , Adult , Middle Aged , Aged , Muscle, Skeletal/anatomy & histology , Muscle Spasticity , Arm/innervation , Cadaver , Muscle, Skeletal/innervation , Muscle, Skeletal/diagnostic imaging , HumerusABSTRACT
SUMMARY: The purpose of this study was to reveal the overall distribution pattern of the intramuscular nerves of each extraocular muscle and provide morphological guidance for the selection of the neuromuscular compartment during extraocular muscle transplantation and target localization of the botulinum toxin A injection to correct strabismus. We studied 12 Chinese head specimens that were fixed with formalin. The extraocular muscles from both sides of each head were removed, and a modified Sihler's staining technique was used to reveal the overall distribution pattern of the intramuscular nerves. We observed an intramuscular nerve-dense region formed by the intramuscular arborized branches in the semitransparent superior rectus, inferior rectus, medial rectus, lateral rectus, superior oblique, inferior oblique, and levator palpebrae superioris muscles with Sihler's staining technique. The seven extraocular muscles can each be divided into two neuromuscular compartments. The intramuscular nerve-dense regions of the superior, inferior, medial, and lateral rectus and the superior oblique, inferior oblique, and levator palpebrae superioris muscles were positioned at 33.50 % -72.72 %, 40.21 % - 66.79%, 37.92 % - 64.51 %, 31.69 % - 56.01 %, 26.35 % - 64.98 %, 40.46 % - 73.20 %, and 27.72 % - 66.07 % of the lengths of the muscle bellies, respectively, and the centers of intramuscular nerve dense regions were located at 59.50 %, 54.18 %, 51.68 %, 50.08 %, 48.38 %, 56.49 %, and 50.77 % of the length of each muscle belly, respectively. The aforementioned values are the means of the actual values. These results suggest that when the strabismus is corrected with muscle transplantation, the extraocular muscle should be transplanted based on the neuromuscular compartment, which would benefit the function of both donor and recipient muscles. The localization of these nerve dense regions is recommended as an optimal target for the injection of botulinum toxin A to treat strabismus.
RESUMEN: El objetivo de este estudio fue revelar el patrón de distribución de los nervios intramusculares de cada músculo extraocular y, proporcionar una guía morfológica para la selección del compartimento neuromuscular durante el trasplante de músculo extraocular, y la localización de la inyección de toxina botulínica A para corregir el estrabismo. Estudiamos 12 muestras de cabezas de individuos chinos fijadas en formalina. Se extrajeron los músculos extraoculares de ambos lados de cada cabeza y, se utilizó una técnica de tinción de Sihler modificada para revelar el patrón de distribución general de los nervios intramusculares. Observamos una región densa en nervios intramusculares formada por los ramos intramusculares en los músculos recto superior semitransparente, recto inferior, recto medial, recto lateral, oblicuo superior, oblicuo inferior y elevador del párpado superior con técnica de tinción de Sihler. Los siete músculos extraoculares se pueden dividir cada uno en dos compartimentos neuromusculares. Las regiones intramusculares densamente nerviosas de los músculos recto superior, inferior, medial y lateral y los músculos oblicuo superior, oblicuo inferior y elevador del párpado superior se colocaron en 33,50 % -72,72 %, 40,21 % -66,79 %, 37,92 % -64,51 % , 31,69 % -56,01 %, 26,35 % -64,98 %, 40,46 % -73,20 % y 27,72 % -66,07 % de las longitudes de los vientres musculares, respectivamente, y los centros de las regiones densamente nerviosas intramusculares se ubicaron en 59,50 %, 54,18 % , 51,68 %, 50,08 %, 48,38 %, 56,49 % y 50,77 % de la longitud de cada vientre muscular, respectivamente. Los valores antes mencionados son medios de los valores reales. Estos resultados sugieren que cuando el estrabismo se corrige con trasplante de músculo, el músculo extraocular debe trasplantarse en función del compartimento neuromuscular, lo que beneficiaría la función tanto de los músculos donantes como receptores. Se recomienda la localización de estas regiones densas en nervios, como un objetivo óptimo para la inyección de toxina botulínica A para tratar el estrabismo.
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Humans , Male , Female , Adult , Middle Aged , Aged , Oculomotor Muscles/innervation , Oculomotor Nerve/anatomy & histology , Staining and LabelingABSTRACT
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.
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To accurately localize the centers of intramuscular nerve dense regions (CINDRs) of rotator cuff muscles. Twenty adult cadavers were used. The curves on skin connecting the superior angle of scapula with the acromion, and with the inferior angle of scapula were designed as the horizontal (H) and longitudinal (L) reference lines, respectively. One side of the rotator cuff muscles were removed and subjected to Sihler's staining to show intramuscular nerve dense regions, and the contralateral muscles' CINDRs were labeled with barium sulfate and scanned by computed tomography (to determine body surface projection points (P)). The intersection of the longitudinal line from point P to line H, and that of the horizontal line from point P to line L, were recorded as PH and PL, respectively. The projection of CINDRs on the anterior body surface across the saggital plane was defined as P' and the line connecting P to P' was recorded as Line PP'. Percentage positions of CINDRs of PH and PL on lines H and L, and the depths on line PP' were determined under the Syngo system. Two, four, one, and one CINDRs were identified in supraspinatus, infraspinatus, teres minor, and subscapularis muscles, respectively. The positions of PH of these CINDRs on the H-line are as follows: supraspinatus, 25.43 % and 26.59 %; infraspinatus, 53.85 %, 34.63 %, 35.96 % and 58.17 %; teres minor, 74.50 %; and subscapularis, 20.33 %. The PL on the L-line: supraspinatus, 11.09 % and 14.83 %; infraspinatus, 21.59 %, 27.93 %, 48.55 % and 57.52 %; teres minor, 68.28 %; and subscapularis, 52.82 %. The depth on line PP': supraspinatus, 24.83 % and 25.40 %; infraspinatus, 21.55 %, 16.10 %, 10.01 % and 8.14 %; teres minor, 13.27 %; and subscapularis, 22.88 %. The identification of these CINDRs should provide the optimal target position for injecting botulinum toxin A to treat rotator cuff muscles spasticity accompanied by shoulder pain and to improve the efficiency and efficacy of blocking target localization.
Con el objetivo de localizar con precisión los centros de las regiones densas del nervio intramuscular (CRDNI) de los músculos del manguito rotador, se utilizaron veinte cadáveres adultos. Las curvas en la piel que conectan el ángulo superior de la escápula con el acromion y con el ángulo inferior de la escápula se determinaron como líneas de referencia horizontales (H) y longitudinales (L), respectivamente. Se extrajo de un lado los músculos del manguito rotador y se sometió a la tinción de Sihler para mostrar regiones densas de nervios intramusculares, y los CRDNI de los músculos contralaterales se marcaron con sulfato de bario y se escanearon mediante tomografía computarizada (para determinar los puntos de proyección de la superficie corporal (P)). La intersección de la línea longitudinal desde el punto P a la línea H, y de la línea horizontal desde el punto P a la línea L, se registraron como PH y PL, respectivamente. La proyección de CRDNI en la superficie del cuerpo anterior a través del plano sagital se definió como P 'y la línea que conecta P a P' se registró como Línea PP '. Las posiciones porcentuales de los CRDNI de PH y PL en las líneas H y L, y las profundidades en la línea PP 'se determinaron bajo el sistema Syngo. Se identificaron dos, cuatro, uno y un CINDR en los músculos supraespinoso, infraespinoso, redondo menor y subescapular, respectivamente. Las posiciones de PH de estos CRDNI en la línea H son las siguientes: supraespinoso, 25,43 % y 26.59 %; infraspinatus, 53,85 %, 34,63 %, 35,96 % y 58,17 %; redondo menor, 74,50 %; y subescapular, 20,33 %. El PL en la línea L: supraespinoso, 11.09 % y 14.83 %; infraspinatus, 21,59 %, 27,93 %, 48,55 % y 57,52 %; redondo menor, 68.28 %; y subescapular, 52,82 %. La profundidad en la línea PP ': supraespinoso, 24,83 % y 25,40 %; infraspinatus, 21,55 %, 16,10 %, 10,01 % y 8,14 %; redondo menor, 13.27 %; y subescapularis, 22,88 %. La identificación de estos CRDNI debería proporcionar la posición objetivo óptima para inyectar la toxina botulínica A para tratar la espasticidad de los músculos del manguito rotador acompañada de dolor en el hombro y para mejorar la eficiencia y la eficacia del bloqueo de la localización del objetivo.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Peripheral Nerves/anatomy & histology , Rotator Cuff/innervation , Botulinum Toxins, Type A , Nerve Block , Cadaver , Anatomic Landmarks , Muscle SpasticityABSTRACT
Objective:To provide anatomical basis for clinical application of human pectoralis major (P.major).Methods:The intramuscular nerve branches and muscle architectural features of P.major were dissected and observed.Results:1.The clavicular part(clavic.part) and sternal part of P.major had their anatomically distinct nerve supply.Some final terminal branches went along their course to each muscle slip.2.The average muscle mass,muscle length,fiber length and cross sectional area of the clavic.part of P.major were 45.9?10.8g,18.5?2.1cm,10.7?1.4cm and 4.1?1.1cm2,respectively and those of sternal part of P.major were 220.4?44.3g,21.4?1.6cm,17.2?2.6cm, 12.4?3.1cm2,respectively.Conclusion:1.P.major could be divided into clavic.part and sternal part compartments according to the intramuscular nerve branches.2.The force produced by sternal part is 3 times as much as the clavic.part and the excursion produced by the former is 1.6 times as much as the latter.The two compartrnents of P.major could be used for muscle transplant respectively,so could each muscle slip.
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Objective:To explore the intramuscular nerve effect on the recovery of lacerated muscle. Methods:thirty (30) healthy New Zealand rabbits were involved in the study and randomly divided into groups A and B.The right musculus rectus femoris of the animal was chosen as the lacerated skeletal muscle model with the contralateral muscle as sham control. Group A underwent muscle laceration with the intramuscular nerve microsurgical repaired and muscle repaired;group B only with muscle repaired. After a postoperative period of 28weeks,measured the muscle wet weight and the muscle strength of musculus rectus femoris by electrical stimulation test and observed the change of morphology by Hematoxyline/eosin stain,Masson stain,NADH-TR stain and mATPase stain. Compared the difference of two groups through t-test and ANOVA to decide the effects of intramuscular nerve effect on muscle injury and repair. Results:At 28 weeks postoperative,Compared with the controls,wet weight and isometric contraction of musculus rectus femoris reduced in the intramuscular neurotmesis group (P
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Objective:To study the neural and vascular distribution in the triceps surae of rabbits for reconstructing the muscles of motor function.Methods: Triceps surae on one side was stained with the standard method of Sihler’s nerve staining, and the blood vessels on the other side were injected with a mixture of 30% barium sulfate and gelatin, and then they were X-photographed. The resulting pictures were compared to study the intramuscular nerve and blood vessel distribution. Results: Tricep surae on the first side became transparent or semi-transparent, and its shape kept intact after being stained. The intramuscular nerve branches were clearly visualized after being stained. The muscle was divided into 3 neuromuscular compartments and Lateral gastrocnemius (LG) was subdivided into 3 subunits. The intramuscular vascular configuration on the other side was also clear on soft X-ray films. The distribution maps of the nerves and blood vessels were grossly consistent.Conclusion: Sihler’s nerve staining is able to show the original 3-dimensional picture of the intramuscular nerve branches in the triceps surae of rabbits and can be used to observe the relation between the blood vessels and nerves in the muscle in combination with intramuscular angiography. According to the neurovascular distribution, tricep surae of rabbits can be divided into different subunits (compartments) as independent function units. The design and application of the subunit as a compartment can meet the need of muscular function after transplantation.
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Objective To investigate the distribution of intramuscular nerves in the different skeletal muscles of the rabbit. Methods Muscle architecture and modified sihler's neural staining methods were used. Results The nerve branches of innervating flat M.pectoralis major arose from the anterior pectoral and posterior pectoral nerve.The former innervated cross fibers mainly,it penetrated the middle of muscle belly and formed a “U-Shaped” nerve ansa.The latter innervated oblique fibers mainly.There were many anastomoses between them.The nerve of pennate M.plantaris derived from tibial nerve.After entering muscle,the nerve trunk gradually divided into many primary branches toward medial and lateral fibers,these branches then subdivided into numerous arboroid second and terminal branches toward all of muscle fibres;The nerve of innervating spindle M.extensor digitorum longus came from N.fibularis communis.Two extramuscular nerve trunk were seen.Superior trunk mainly innervated those muscle fibers of inserting in the second toe,Inferior one mainly distributed to the fibers of rest within this muscle.Conclusion The spatial arrangement of the muscle fibres were related to distribution of the intramuscular nerves;Walking of intramuscular nerve branches had two patterns which run perpendicular and/or parallel to muscle fasciculi.