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大腿肌内侧群痉挛肌外神经阻滞靶点的定位
Extramuscular nerve block targets localization for the treatment of spasticity of the medial group of the muscles of the thigh
目的 精确定位大腿肌内侧群痉挛肌外神经阻滞靶点的位置。 方法 设计经耻骨结节至股骨大转子外侧皮肤的连线为横向的H参考线，经耻骨结节至股骨内上髁水平的连线为纵向的L参考线。解剖暴露经甲醛固定的10具成人尸体的20侧闭孔神经及其肌支，涂抹硫酸钡于它们表面，烘干，X线摄片，PACS软件测量闭孔神经肌支肌外阻滞靶点在H线和L线上的百分位置。 结果 闭孔神经股薄肌支、长收肌支、短收肌支以及大收肌支在肌外的近侧运动点（P点）分别位于距耻骨结节外侧的大腿宽度（H线）的（21.48±1.80）％、（25.85±1.23）％、（28.07±1.65）％和（29.18±2.07）％处，位于距耻骨结节远侧的大腿长度（L线）的（8.83±1.01）％、（8.83±1.01）％、（7.57±0.63）％和（7.57±0.63）％处；远侧运动点（D点）分别位于距耻骨结节外侧大腿宽度（H线）的（16.9±1.33）％、（27.70±2.15）％、（31.18±2.18）％和（35.78±2.79）％处，位于距耻骨结节远侧大腿长度（L线）的（35.57±2.77）％、（26.9±1.96）％、（24.26±1.91）％和（28.04±2.17）％处。 结论 这些靶点的准确定位可提高大腿肌内侧群痉挛肌外神经靶点阻滞的安全性和有效性。
Objective To determine the precise location of extramuscular nerve block targets of thigh adductor muscles. Methods A horizontal reference line (line H) was designed from the pubic tubercle to the skin lateral to the greater trochanter of the femur. Another longitudinal reference line (line L) was designed from the pubic tubercle to the level of the medial epicondyle of the femur. The obturator nerve and its muscular branches were dissected and exposed in 10 formalin fixed adult cadavers (20 sides). The nerves were coated barium sulfate on the surface and air-dried, X-ray radiography was performed. The percent positions of extramuscular nerve block targets of muscular branches of obturator nerve on line H and L were measured by PACS software. Results The proximal motor point (point P) of the gracilis branch, adductor longus branch, adductor brevis branch and adductor magnus branch of the obturator nerve were located at (21.48±1.80)%, (25.85 ± 1.23)%, (28.07 ± 1.65)% and (29.18 ± 2.07)% of the lateral of pubic tubercle along thigh width (line H) respectively; at (8.83 ± 1.01)%, (8.83 ± 1.01)%, (7.57 ± 0.63)% and (7.57 ± 0.63)% of the distal of pubic tubercle along thigh length (line L) respectively. The distal motor points (points D) were located at (16.9 ± 1.33)%, (27.70 ± 2.15)%, (31.18 ± 2.18)% and (35.78 ± 2.79)% of the lateral of pubic tubercle along thigh width (line H) respectively; at (35.57 ± 2.77)%, (26.9 ± 1.96) %, (24.26 ± 1.91)% and (28.04 ± 2.17)% of the distal of pubic tubercle along thigh length (line L) respectively. Conclusion Precise location of these targets can improve the safety and effectiveness for blocking the extramuscular nerve targets in medial femoral muscles spasticity.
大腿内侧群肌 / 痉挛 / 闭孔神经肌支 / 靶点定位 / X线摄片 / 成人
Medial femoral muscle / Muscle spasticity / Obturator nerve muscular branche / Target localization / X-ray radiography / Adult
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