PDF(Pubmed)
Abstract：
The centre of the highest region of muscle spindle abundance (CHRMSA) in the intramuscular nerve-dense region has been suggested as the optimal target location for injecting botulinum toxin A to block muscle spasms. The anterior forearm muscles have a high incidence of spasticity. However, the CHRMSA in the intramuscular nerve-dense region of the forearm anterior muscle group has not been defined. This study aimed to accurately define the body surface position and the depth of CHRMSA in an intramuscular nerve-dense region of the anterior forearm muscles. Twenty-four adult cadavers (57.7 ± 11.5 years) were included in this study. The curved line close to the skin connecting the medial and lateral epicondyles of the humerus was designated as the horizontal reference line (H line), and the line connecting the medial epicondyle of the humerus and the ulnar styloid was defined as the longitudinal reference line (L line). Modified Sihler\'s staining, haematoxylin-eosin staining and computed tomography scanning were employed to determine the projection points (P and P\') of the CHRMSAs on the anterior and posterior surfaces of the forearm. The positions (PH and PL) of point P projected onto the H and L lines, and the depth of each CHRMSA, were determined using the Syngo system. The PH of the CHRMSA of the ulnar head of pronator teres, humeral head of pronator teres, flexor carpi radialis, palmaris longus, flexor carpi ulnaris, ulnar part of flexor digitorum superficialis, radial part of flexor digitorum superficialis, flexor pollicis longus, ulnar part of flexor digitorum profundus, radial portion of flexor digitorum profundus and pronator quadratus muscles were located at 42.48%, 45.52%, 41.20%, 19.70%, 7.77%, 25.65%, 47.42%, 53.47%, 12.28%, 38.41% and 51.68% of the H line, respectively; the PL were located at 18.38%, 12.54%, 28.83%, 13.43%, 17.65%, 32.76%, 57.32%, 64.12%, 20.05%, 45.94% and 88.71% of the L line, respectively; the puncture depths were located at 21.92%, 27.25%, 23.76%, 18.04%, 15.49%, 31.36%, 26.59%, 41.28%, 38.72%, 45.14% and 53.58% of the PP\' line, respectively. The percentage values are the means of individual values. We recommend that the body surface puncture position and depth of the CHRMSA are the preferred locations for the intramuscular injection of botulinum toxin A to block anterior forearm muscle spasms.
摘要：
肌内神经密集区域中肌肉纺锤体丰度最高区域（CHRMSA）的中心已被建议为注射肉毒杆菌毒素A以阻断肌肉痉挛的最佳目标位置。前臂前肌痉挛的发生率很高。然而,前臂前肌组肌内神经密集区域的CHRMSA尚未确定.这项研究旨在准确定义CHRMSA在前臂前肌肉的肌内神经密集区域中的体表位置和深度。本研究包括24具成人尸体（57.7±11.5年）。连接肱骨内侧和外侧上髁的靠近皮肤的曲线被指定为水平参考线(H线)。将连接肱骨内侧上髁和尺骨茎突的线定义为纵向参考线（L线）。改良的Sihler染色，苏木精-伊红染色和计算机断层扫描用于确定CHRMSA在前臂前表面和后表面上的投影点（P和P'）。点P投影到H和L线上的位置（PH和PL），以及每个CHRMSA的深度，使用Syngo系统确定。旋前圆柱尺骨头CHRMSA的PH，肱骨头，径向腕屈肌，长尺,尺尖腕屈肌，指浅屈尺部，趾浅屈的径向部分，长屈肌，指深屈肌尺骨部分，指前屈肌和旋前方肌的径向部分位于42.48％，45.52%,41.20%，19.70%,7.77%,25.65%,47.42%,53.47%,12.28%，H线的38.41%和51.68%，分别为18.38%，12.54%,28.83%,13.43%,17.65%,32.76%,57.32%,64.12%,20.05%,L线的45.94%和88.71%，穿刺深度分别为21.92%，27.25%,23.76%,18.04%,15.49%，31.36%，26.59%,41.28%，38.72%,PP线的45.14%和53.58%，分别。百分比值是单个值的平均值。我们建议CHRMSA的体表穿刺位置和深度是肌内注射肉毒杆菌毒素A以阻断前臂前肌痉挛的首选位置。
