Inje County Public Health Center, Inje, Republic of Korea.
Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 PLUS Project, Yonsei University College of Dentistry, Seoul, Republic of Korea.
Clin Anat. 2021 Sep;34(6):822-828. doi: 10.1002/ca.23690. Epub 2020 Oct 12.
This study proposes an ideal botulinum toxin injection point of the trapezius muscle for shoulder line contouring, pain management, and functional impairment. This study describes the intramuscular nerve branching in the trapezius muscle, providing essential information for botulinum neurotoxin injection.
A modified Sihler's method was performed on the trapezius muscles (16 specimens). The intramuscular arborization areas were elucidated regarding the external occipital protuberance superiorly, spinous process of the 12th thoracic vertebra inferiorly and acromion of the scapula.
The intramuscular neural distribution for the superior, middle, and inferior regions of the trapezius muscle had the greatest arborized patterns in the horizontal 1/5-2/5 and vertical 2/10-4/10 sections, the horizontal 1/5-3/5 and vertical 4/10-5/10 sections, and the horizontal 1/5-2/5 and vertical 5/10-7/10 sections, respectively.
We propose that BoNT treatments should be directed to the horizontal 1/5-2/5 and vertical 2/10-4/10 sections of the superior trapezius, the horizontal 1/5-3/5 and vertical 4/10-5/10 sections of the middle trapezius and the horizontal 1/5-2/5 and vertical 5/10-7/10 sections of the inferior trapezius. Additionally, injective treatment at the horizontal 2/5-3/5 and vertical 2/10-4/10 nerve entry points should be avoided to prevent nerve trunk damage causing paralysis. According to our guidelines, clinicians can ensure minimal dose injections and fewer adverse effects in botulinum neurotoxin injective treatment.
本研究提出了斜方肌理想的肉毒毒素注射点，以改善肩部轮廓、缓解疼痛和改善功能障碍。本研究描述了斜方肌内肌支的神经分支，为肉毒毒素神经注射提供了重要信息。
对斜方肌（16 个标本）进行改良的 Sihler 法。根据枕外隆突的上缘、第 12 胸椎棘突的下缘和肩胛骨的肩峰，阐明了肌内分支区域。
斜方肌的上、中、下区域的肌内神经分布，在水平 1/5-2/5 和垂直 2/10-4/10 节段、水平 1/5-3/5 和垂直 4/10-5/10 节段、水平 1/5-2/5 和垂直 5/10-7/10 节段的分支模式最大。
我们建议 BoNT 治疗应针对斜方肌的上 1/5-2/5 和垂直 2/10-4/10 节段、中斜方肌的水平 1/5-3/5 和垂直 4/10-5/10 节段以及下斜方肌的水平 1/5-2/5 和垂直 5/10-7/10 节段。此外，应避免在水平 2/5-3/5 和垂直 2/10-4/10 神经进入点进行注射治疗，以防止神经干损伤导致瘫痪。根据我们的指南，临床医生可以确保在肉毒毒素神经注射治疗中最小剂量注射和更少的不良反应。
