ABSTRACT
El músculo cuadríceps femoral es un músculo que participa principalmente en los movimientos de la rodilla y también en la cadera, pudiendo ser afectado por alteraciones en el trofismo muscular, tras lesiones de estas articulaciones o afecciones en el tono muscular, como la espasticidad, tras lesiones cerebrovasculares. Cada una de sus cabezas está inervada por ramos del nervio femoral. El presente estudio tuvo por objetivo la identificación y medición de la distancia de los puntos motores (Pm) del músculo cuadríceps femoral, en relación a estructuras anatómicas de relevancia clínica. Se utilizaron 30 miembros inferiores de 23 cadáveres formolizados, de individuos brasileños adultos. El estudio fue realizado en la Universidade Estadual de Ciências da Saúde de Alagoas (UNCISAL), Maceió, Brasil. Se realizó la disección por planos en la zona medial, anterior y lateral del muslo, identificando a los ramos del nervio femoral para cada componente, músculos recto femoral (mRf), vasto medial (mVm), vasto intermedio (mVint) y vasto lateral (mVlat), localizando cada uno de los Pm. Las mediciones se realizaron con un cáliper marca Mitutoyo de 0,05 mm de precisión. Los datos obtenidos fueron tratados estadísticamente, utilizando para ello, el software STATA (versión 14.1). El mRf, tuvo un promedio de 2,45 ± 1,39 Pm, estando la gran mayoría de los Pm (63 %), en la zona distal del tercio proximal del muslo; el mVm presentó 4,42 ± 2,74 Pm en promedio, encontrándose el 41 % de ellos en el tercio medio del muslo, zona distal; el mVint tuvo 3,99 ± 2,34 Pm en promedio y el 58 % de ellos, se localizaron en la zona proximal del tercio medio del muslo; el mVlat presentó un promedio de 3,88 ± 2,37 Pm y el 50 % de éstos se encontraron en del tercio proximal del muslo. La localización biométrica de los Pm se informa en resultados. La ubicación biométrica de los Pm, favorecerá el quehacer, tanto clínico como quirúrgico, de la zona anterior del muslo.
The quadriceps femoris muscle is a muscle that participates mainly in the movements of the knee and also in the hip, being able to be affected by alterations in muscle trophism, after injuries of these joints or muscular tone conditions, such as spasticity, after injuries cerebrovascular. Each of its heads is innervated by branches of the femoral nerve. The objective of this study was to identify and measure the distance of the motor points (MP) of the quadriceps femoris muscle, in relation to anatomical structures of clinical relevance. Thirty lower limbs of 23 formolized corpses of adult Brazilian individuals were used. The study was conducted at the State University of Ciências da Saúde de Alagoas (UNCISAL), Maceió, Brazil. The dissection was performed by planes in the medial, anterior and lateral thigh, identifying the femoral nerve branches for each component, rectus femoris muscles (Rfm), medial vastus (mVm), vastus intermedius (intVm) and vastus lateralis ( latVm), locating each of the MP. The measurements were made with a Mitutoyo caliper of 0.05 mm accuracy. The data obtained were treated statistically, using the STATA software (version 14.1). The Rfm had an average of 2.45 ± 1.39 MP, the great majority of the MP (63 %) being in the distal area of the proximal third of the thigh; the mVm presented 4.42 ± 2.74 MP on average, with 41 % of them in the middle third of the thigh, distal zone; the intVm had 3.99 + 2.34 MP on average and 58 % of them were located in the proximal area of the middle third of the thigh; the latVm presented an average of 3.88 ± 2.37 MP and 50 % of these were found in the proximal third of the thigh. The biometric localization of the MP is reported in results. The biometric location of the MP, will favor the task, both clinical and surgical of the anterior thigh area.
Subject(s)
Humans , Quadriceps Muscle/anatomy & histology , Femur/anatomy & histology , Anatomic Landmarks , Brazil , Cadaver , Quadriceps Muscle/innervation , Femur/innervationABSTRACT
El nervio femoral (NF) se describe originándose desde el plexo lumbar (L2, L3 y L4) y en su recorrido emite ramos destinados a cada una de las porciones del músculo cuádriceps femoral (mCF), los cuales nacen de forma aislada o bien, a partir de troncos comunes. El detalle de la distribución del NF en el mCF, permite disminuir riesgos asociados a diferentes intervenciones quirúrgicas llevadas a cabo en la zona anterior del muslo. Con el propósito describir la distribución del NF en los componentes del mCf. Se utilizaron 15 miembros inferiores formolizados, 10 del lado izquierdo y 5 del lado derecho, de individuos adultos, Brasileños, localizados en los Laboratorios de Anatomía de la Universidade Estadual de Ciências da Saúde de Alagoas (UNCISAL), Maceió, Brasil. El NF se clasificó en cuatro tipos de acuerdo a su ramificación y distribución. El Tipo II se subdividió en 3 subtipos y se presentó en 60 % de las muestras y el tipo III en 20 %. El NF se dividió de medial a lateral hasta en 5 ramos (R1,R2,R3,R4,R5), donde el R1 fue el más medial. El R1 dio origen en promedio a 2,47 ramos secundarios (Rs) y a 2,58 ramos terciarios (Rt), en 13,3 % el R1 no emitió Rs. En 73,3 % inervó a sólo a un componente del mCF; el R2 dio origen en promedio a 3,93 Rs y a 3,58 Rt. En 26,7 % inervó a sólo a un componente del mCF; el R3 dio origen en promedio a 3,33 Rs y a 2,0 Rt. En 80 % inervó a sólo a un componente del mCF. La distribución de R4 y R5 se muestran en el texto. Resultados biométricos de origen, diámetro y longitud de los ramos mencionados son mostrados en tablas. Los datos obtenidos en esta investigación complementan el conocimiento de la anatomía regional, pudiendo ser utilizados por la clínica quirúrgica y para efectuar tratamientos que mejoren trastornos neurológicos que afectan a la región.
The femoral nerve (FN) is described as originating from the lumbar plexus (L2, L3 and L4) and in its course it emits branches destined to each one of the quadriceps femoral muscle (QFm), which are originated in an isolated way or, from common trunks. The detail of the distribution of the FN in the QFm, allows to diminish risks associated with different surgical interventions carried out in the anterior thigh area. With the purpose of describing the distribution of FN in the QFm components. Fifteen formalized lower limbs were used, 10 on the left side and 5 on the right side of adult individuals, Brazilians, located in the Anatomy Laboratories of the State University of Ciências da Saúde de Alagoas (UNCISAL) , Maceió, Brazil. The FN was classified into four types according to its branch and distribution. Type II was subdivided into 3 subtypes and presented in 60 % of the samples and type III in 20 %. The FN was divided from medial to lateral in 5 branches (B1, B2, B3, B4, B5), where B1 was the most medial. The B1 gave rise to an average of 2.47 secondary branches (sB) and to 2.58 tertiary branches (tB), in 13.3 % the B1 did not emit sB. In 73.3 %, only one component of the QFm was invested; B2 gave rise to an average of 3.93 sB and 3.58 tB. In 26.7 %, it invested only one component of the QFm; B3 gave rise to an average of 3.33 sB and 2.0 tB. In 80 %, it invested only one component of the QFm. The distribution of B4 and B5 are shown in the text. Biometric results of origin, diameter and length of the mentioned branches are shown in tables. The data obtained in this research complements the knowledge of the regional anatomy, being able to be used by the surgical clinic and to carry out treatments that improve neurological disorders that affect the region.
Subject(s)
Humans , Male , Female , Adult , Quadriceps Muscle/innervation , Femoral Nerve/anatomy & histology , BrazilABSTRACT
PURPOSE: To study the effective recovery of the quadriceps femoris by spinal ventral root cross-anastomosis in rats. METHODS: End-to-end anastomosis was performed between the left L1 and L3 ventral roots using autogenous nerve graft ,and the right L1 and L3 roots were left intact. In control animals, the left L3 ventral root was cut and shortened, and anastomosis was not performed. Six months postoperatively, the movement of low extremities was detected by electrophysiological examination, hindlimb locomotion and basso, beattie and bresnahan (BBB) scoring at one, three, seven, 14, 21 and 28 days after SCI. Fluorescence retrograde tracing with TRUE BLUE (TB) and HE staining were performed to observe the nerve regeneration. RESULTS: Six months after surgery, the anastomotic nerve was smooth and not atrophic. The amplitudes of action potential were 7.63±1.86 mV and 6.0±1.92 mV respectively before and after the spinal cord hemisection. The contraction of left quadriceps femoris was induced by a single stimulation of the anastomotic nerve. The locomotion of left hindlimb was partially restored after spinal cord hemisection while creeping and climbing. In addition, there was significant difference in the BBB score at one, three and seven days after SCI. TB retrograde tracing and neurophysiologic observation indicated efficient reinnervation of the quadriceps femoris. CONCLUSION: The cross-anastomosis between spinal ventral root can partially reconstruct the function of quadriceps femoris following SCI and may have clinical implication for the treatment of human SCI.
OBJETIVO: Investigar a recuperação efetiva do músculo quadríceps femoral pela anastomose cruzada via raiz espinhal ventral em ratos. MÉTODOS: Anastomose término-terminal foi realizada entre as raízes ventrais L1 e L3 à esquerda usando enxerto autógeno de nervo e, à direita, as raízes L1 e L3 foram mantidas intactas. Nos animais controles, à esquerda, a raiz ventral de L3 foi cortada e encurtada sem realização de anastomose. Após seis meses, o movimento das extremidades posteriores foi estudado por exame eletrofisiológico, e pelo escore de basso, beattie e bresnahan (BBB) com um, três, sete, 14, 21 e 28 dias após SCI. Fluorescência retrograde feita com TRUE BLUE (TB) e coloração com HE foram realizadas para observar a regeneração do nervo. RESULTADOS: Seis meses após a cirurgia, a anastomose do nervo estava lisa e sem atrofia. As amplitudes dos potenciais de ação foram 7,63±1,86 mV e 6,0±1,92 mV respectivamente antes e após a hemisecção da medula espinhal. A contração do músculo quadríceps femoral foi induzida por um único estímulo do nervo anastomosado. A locomoção do membro posterior esquerdo foi parcialmente restaurada após hemisecção da medula espinhal ao rastejar e escalar. Ademais, houve diferença significante no escore BBB nos dias um, três e sete após SCI. O traçado da TB retrógrada e a observação neurofisiológica indicaram reinervação eficiente do quadríceps femoral. CONCLUSÃO: A anastomose cruzada entre as raízes espinhais ventrais podem reconstruir parcialmente a função do quadríceps femoral após SCI e pode ter implicação clínica para o tratamento da SCI.