Chomiak Jiri, Dungl Pavel
1st Medical Faculty of Charles University Prague, Orthopaedic Hospital IPVZ, University Hospital Na Bulovce, Budinova 2, 18081, Prague 8, Czech Republic,
J Child Orthop. 2008 Oct;2(5):357-64. doi: 10.1007/s11832-008-0130-0. Epub 2008 Sep 16.
The anatomy and neurovascular supply of the pectoralis major muscle was studied in order to establish the safe and functional muscle transfer for the reconstruction of elbow flexion in patients with arthrogryposis multiplex congenita (AMC).
Twenty pectoralis major muscles were dissected in 11 adult cadavers. The distribution of the motor end plates was studied in five pectoralis major muscles in foetuses by the detection of esterases.
The pectoralis major muscle consists of clavicular, manubrial, sternocostal, costal and abdominal parts. Each part has a distinct vascular and nerve supply. The motor nerves arise from the medial and lateral pectoral nerves. The motor end plates are localised in one zone in the clavicular and manubrial parts and in two oblique zones in the distal parts of the muscle. In 15 cases, each of the muscle parts were supplied by one nerve branch. In four cases, six nerves were distinguished and the clavicular part was supplied by two nerves. In one case, four nerves were found, with the clavicular and manubrial parts supplied by one common nerve. Three branches (13 cases) or two arterial branches (seven cases) supplied the muscle, arising from thoracoacromial and lateral thoracic arteries, respectively. The superior branch supplied the clavicular and manubrial parts, whereas the dominant pectoral branch supplied the manubrial, sternocostal and costal parts of the muscle. The inferior branch of the lateral thoracic artery supplied the abdominal part in 13 cases. In seven cases, the inferior branch failed and the abdominal part was supplied from the dominant branch.
This study presents guidelines for the transfer of the distal parts of the pectoralis major muscle for the reconstruction of elbow flexion. The sternocostal, costal and abdominal parts of the muscle can be released as a unit from the chest wall after dissection between the second and third rib and be transferred to the brachium. They are sufficiently supplied from the dominant pectoral branch of the thoracoacromial artery in all cases and inconstantly from the inferior branch of the lateral thoracic artery and from three motor nerves.
研究胸大肌的解剖结构和神经血管供应，以便为先天性多发性关节挛缩症（AMC）患者重建肘关节屈曲建立安全且有效的肌肉转移方法。
在11具成年尸体上解剖了20块胸大肌。通过酯酶检测研究了5例胎儿胸大肌运动终板的分布情况。
胸大肌由锁骨部、胸骨柄部、胸骨肋部、肋部和腹部组成。各部分有独特的血管和神经供应。运动神经来自胸内侧神经和胸外侧神经。运动终板位于锁骨部和胸骨柄部的一个区域以及肌肉远端的两个斜形区域。15例中，每个肌肉部分由一个神经分支供应。4例中，区分出6条神经，锁骨部由两条神经供应。1例中，发现4条神经，锁骨部和胸骨柄部由一条共同神经供应。肌肉由分别来自胸肩峰动脉和胸外侧动脉的3个分支（13例）或2个动脉分支（7例）供应。上部分支供应锁骨部和胸骨柄部，而主要的胸肌分支供应肌肉的胸骨柄部、胸骨肋部和肋部。胸外侧动脉下部分支在13例中供应腹部。7例中，下部分支缺如，腹部由主要分支供应。
本研究为胸大肌远端部分转移用于重建肘关节屈曲提供了指导原则。在第二和第三肋骨之间进行解剖后，肌肉的胸骨肋部、肋部和腹部可作为一个整体从胸壁游离并转移至臂部。在所有情况下，它们均由胸肩峰动脉的主要胸肌分支充分供应，偶尔也由胸外侧动脉下部分支和3条运动神经供应。
