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肩胛下肌的神经肌肉分区及其在肉毒毒素注射中的临床意义。

Neuromuscular compartmentation of the subscapularis muscle and its clinical implication for botulinum neurotoxin injection.

机构信息

Department of Anatomy, College of Korean Medicine, Semyung University, Jecheon, Republic of Korea.

Translational Research Unit for Anatomy and Analgesia, Seoul, Republic of Korea.

出版信息

Sci Rep. 2023 Jul 10;13(1):11167. doi: 10.1038/s41598-023-38406-0.


DOI:10.1038/s41598-023-38406-0
PMID:37430018
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10333283/
Abstract

In this study, using immunohistochemistry with fresh cadavers, deliberate histological profiling was performed to determine which fibers are predominant within each compartment. To verify the fascial compartmentation of the SSC and elucidate its histological components of type I and II fibers using macroscopic, histological observation and cadaveric simulation for providing an anatomical reference of efficient injection of the BoNT into the SSC. Seven fixed and three fresh cadavers (six males and four females; mean age, 82.5 years) were used in this study. The dissected specimens revealed a distinct fascia demarcating the SSC into the superior and inferior compartments. The Sihler's staining revealed that the upper and lower subscapular nerves (USN and LSN) innervated the SSC, with two territories distributed by each nerve, mostly corresponding to the superior and inferior compartments of the muscle, although there were some tiny communicating twigs between the USN and LSN. The immunohistochemical stain revealed the density of each type of fiber. Compared with the whole muscle area, the densities of the slow-twitch type I fibers were 22.26 ± 3.11% (mean ± SD) in the superior and 81.15 ± 0.76% in the inferior compartments, and the densities of the fast-twitch type II fiber were 77.74% ± 3.11% in the superior and 18.85 ± 0.76% in the inferior compartments. The compartments had different proportions of slow-fast muscle fibers, corresponding to the functional differences between the superior compartment as an early-onset internal rotator and the inferior compartment as a durable stabilizer of the glenohumeral joint.

摘要

在这项研究中,使用新鲜尸体进行免疫组织化学染色,对组织学特征进行了精心的分析,以确定每个隔室中占优势的纤维类型。为了验证 SSC 的筋膜分区,并使用宏观、组织学观察和尸体模拟来阐明其 I 型和 II 型纤维的组织学成分,从而为 BoNT 高效注射到 SSC 提供解剖学参考。本研究使用了 7 具固定尸体和 3 具新鲜尸体(6 名男性和 4 名女性;平均年龄 82.5 岁)。解剖标本显示出一种明显的筋膜,将 SSC 分隔成上隔室和下隔室。Sihler 染色显示,上肩胛下神经(USN)和下肩胛下神经(LSN)支配 SSC,每根神经支配两个区域,主要对应肌肉的上隔室和下隔室,但 USN 和 LSN 之间也有一些微小的交通枝。免疫组织化学染色显示了每种纤维的密度。与整个肌肉面积相比,上隔室慢收缩型 I 纤维的密度为 22.26±3.11%(平均值±标准差),下隔室为 81.15±0.76%,快收缩型 II 纤维的密度为上隔室 77.74%±3.11%,下隔室为 18.85%±0.76%。隔室之间具有不同比例的慢肌纤维和快肌纤维,这与上隔室作为早期内旋肌和下隔室作为肩肱关节持久稳定器的功能差异相对应。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/711d/10333283/e05d38375760/41598_2023_38406_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/711d/10333283/40107eb1cca3/41598_2023_38406_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/711d/10333283/ef24cfadcea3/41598_2023_38406_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/711d/10333283/15900731e541/41598_2023_38406_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/711d/10333283/c0160b0feb3e/41598_2023_38406_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/711d/10333283/e05d38375760/41598_2023_38406_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/711d/10333283/40107eb1cca3/41598_2023_38406_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/711d/10333283/ef24cfadcea3/41598_2023_38406_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/711d/10333283/15900731e541/41598_2023_38406_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/711d/10333283/c0160b0feb3e/41598_2023_38406_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/711d/10333283/e05d38375760/41598_2023_38406_Fig5_HTML.jpg

相似文献

[1]
Neuromuscular compartmentation of the subscapularis muscle and its clinical implication for botulinum neurotoxin injection.

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[2]
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[3]
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[5]
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[6]
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[7]
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[8]
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[10]
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引用本文的文献

[1]
The Elias University Hospital Approach: A Visual Guide to Ultrasound-Guided Botulinum Toxin Injection in Spasticity: Part II-Proximal Upper Limb Muscles.

Toxins (Basel). 2025-5-31

[2]
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Sports (Basel). 2024-12-18

[3]
A UK Single-Center, Retrospective, Noninterventional Study of Clinical Outcomes and Costs of Two BotulinumtoxinA Treatments for Limb Spasticity.

Toxins (Basel). 2023-8-30

本文引用的文献

[1]
Standardized statement for the ethical use of human cadaveric tissues in anatomy research papers: Recommendations from Anatomical Journal Editors-in-Chief.

Clin Anat. 2022-5

[2]
Acknowledging the use of human cadaveric tissues in research papers: Recommendations from anatomical journal editors.

Clin Anat. 2021-1

[3]
A Detailed Analysis of the Blood Supply to the Subscapularis Muscle.

Clin Anat. 2019-3-13

[4]
Intramuscular innervation of the subscapularis muscle and its clinical implication for the BoNT injection: An anatomical study using the modified Sihler's staining.

Clin Anat. 2019-1

[5]
Injection of high dose botulinum-toxin A leads to impaired skeletal muscle function and damage of the fibrilar and non-fibrilar structures.

Sci Rep. 2017-11-7

[6]
Multi-modal imaging of the subscapularis muscle.

Insights Imaging. 2016-12

[7]
Neuromuscular partitioning of subscapularis based on intramuscular nerve distribution patterns: implications for botulinum toxin injections.

Arch Phys Med Rehabil. 2014-7

[8]
Ultrasound-guided lateral approach for needle insertion into the subscapularis for treatment of spasticity.

Arch Phys Med Rehabil. 2012-3-6

[9]
[Painful hemiplegic shoulder in stroke patients: causes and management].

Neurologia. 2012-5

[10]
Botulinum toxin injection of the subscapularis muscle.

J Clin Neurosci. 2010-6-29

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