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[日本成年人腋窝的肌肉弓及其神经供应]

[The muscular arch of the axilla and its nerve supply in Japanese adults].

作者信息

Takafuji T, Igarashi J, Kanbayashi T, Yokoyama T, Moriya A, Azuma S, Sato Y

机构信息

First Department of Anatomy, Kyorin University School of Medicine, Tokyo, Japan.

出版信息

Kaibogaku Zasshi. 1991 Dec;66(6):511-23.

PMID:1816715
Abstract

We examined 94 axillary regions of 47 Japanese adults and found the muscular arch of the axilla (Maa) in five sides of three cadavers as well as the tendinous arch of the axilla (Taa) in two sides of two cadavers. The results are summarized as follows: 1) The frequency of Maa was 6.4% of the total bodies and 5.3% of the sides in this series. 2) In the left side of a 57-year-old male (No. 427), Maa was attached to the surface of the coracobrachialis muscle after fusing with the dorsal surface of the inserting tendon of the pectoralis quartus muscle. Both muscles were supplied by the caudal pectoral nerve (Npc) from the medial pectoral nerve. Moreover, in this same specimen, the sternalis muscle was recognized on the ventral surface of the pectoralis major muscle. In the left side of a 93-year-old female (No. 386), the cranial part of the muscular arch of the axilla (Cpa) was extended to the coracoid process by a tendon and attached to the abdominal part of the pectoralis major by two muscle bundles supplied by independent branches from Npc. One muscle bundle was attached to the lower margin of the abdominal part of the pectoralis major on the same plane, and the other bundle was located on the dorsal surface of the abdominal part. In a 74-year-old female (No. 411), the well-developed lateral part of the muscular arch of the axilla (Lpa) was attached to the inferior side of the tendinous arch. According to Ruge (1914) and Kasai et al. (1977), this arch was in the transition of the muscle bundle of Cpa to the arch. In the right side of the same specimen, only the thoracodorsal nerve (Ntd) was distributed into Lpa, whereas in the left side, only Npc supplied branches to Lpa. 3) The axillary arch was classified into 8 types based on the form and the supplying nerve of Cpa and Lpa. Cpa consisting of the muscle bundle is Type I, and Cpa consisting of the tendinous arch is Type II. We proposed that only Type II-A, with Cpa as tendinous arch and no Lpa, be designated as Taa (found in two cases), and the others as Maa. The following types were found in this study: Type I-A, consisting of only Cpa supplied by Npc (two cases); Type I-D, consisting of Cpa supplied by Npc and Lpa supplied by Ntd (one case); Type II-B, consisting of the tendinous arch and Lpa supplied by Npc (one case); Type II-D, consisting of the tendinous arch and Lpa supplied by Ntd (one case). 4) From the above findings, it can be suggested that Maa of varying shapes have been formed by a portion of the latissimus dorsi muscle supplied by Ntd, together with the pectoralis subcutaneous muscle, consisting of the pectoralis abdominalis, humeroabdominalis, humerodorsalis and ventrolateralis muscles supplied by Npc. The latter three muscles were proposed by Ura (1937) as the panniculus carnosus muscle, which was well developed in some lower mammalian orders. However, early investigators suggested that Maa was derived from the panniculus. Maa might have occurred as a rudimentary phylogenetic remainder in an early human embryonic stage.

摘要

我们检查了47名日本成年人的94个腋窝区域,在3具尸体的5侧发现了腋肌弓(Maa),在2具尸体的2侧发现了腋腱弓(Taa)。结果总结如下:1)本研究系列中,Maa的出现频率在全身为6.4%,在各侧为5.3%。2)在一名57岁男性(编号427)的左侧,Maa在与胸四头肌插入腱的背面融合后附着于肱二头肌短肌表面。这两块肌肉均由胸内侧神经发出的胸尾神经(Npc)支配。此外,在同一标本中,在胸大肌腹面发现了胸骨肌。在一名93岁女性(编号386)的左侧,腋肌弓头侧部分(Cpa)通过一条腱延伸至喙突,并通过Npc发出的独立分支支配的两条肌束附着于胸大肌腹部。一条肌束附着于胸大肌腹部同一平面的下缘,另一条位于胸大肌腹部的背面。在一名74岁女性(编号411)中,发育良好的腋肌弓外侧部分(Lpa)附着于腱弓下侧。根据鲁格(1914年)和笠井等人(1977年)的研究,该弓处于Cpa肌束向弓的过渡阶段。在同一标本的右侧,只有胸背神经(Ntd)分布至Lpa,而在左侧,只有Npc向Lpa发出分支。3)根据Cpa和Lpa的形态及支配神经,腋弓分为8种类型。由肌束组成的Cpa为I型,由腱弓组成的Cpa为II型。我们建议仅将以Cpa为腱弓且无Lpa的II - A型指定为Taa(在两例中发现),其他类型为Maa。本研究中发现了以下类型:仅由Npc支配的Cpa组成的I - A型(两例);由Npc支配的Cpa和Ntd支配的Lpa组成的I - D型(一例);由腱弓和Npc支配的Lpa组成的II - B型(一例);由腱弓和Ntd支配的Lpa组成的II - D型(一例)。4)从上述发现可以推测,形态各异的Maa是由Ntd支配的背阔肌的一部分,与由Npc支配的胸皮下肌共同形成的,胸皮下肌由胸腹肌、肱腹肌、肱背肌和腹外侧肌组成。后三块肌肉是由乌拉(1937年)提出的皮肌,在一些低等哺乳动物目中发育良好。然而,早期研究者认为Maa起源于皮肌。Maa可能是人类胚胎早期阶段系统发育残留的痕迹。

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