Division in Anatomy and Developmental Biology, Department of Oral Biology, BK21 PLUS Project, Human Identification Research Institute, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seoul, 03722, Republic of Korea.
Maylin Clinic (Apgujeong), Seoul, Republic of Korea.
Surg Radiol Anat. 2024 Dec;46(12):2067-2073. doi: 10.1007/s00276-024-03482-y. Epub 2024 Oct 14.
A comprehensive understanding of neural distribution within the vastus medialis is crucial for the effective administration of botulinum neurotoxin injections to manage spasticity. The aim of this study was to develop an anatomically informed approach to guide the administration of botulinum neurotoxin injections into the vastus medialis muscle.
Using a modified Sihler's method, we examined the vastus medialis muscles (20 specimens) to delineate the distribution of nerves relative to a transverse line extending from the anterior superior iliac spine to the base of patella. The vastus medialis muscle was divided into 10 areas from top to bottom. Then, using two fresh cadavers, ultrasonography-guided injections were performed based on the distribution of nerves within the vastus medialis. Each specimen was subsequently dissected to verify if the dye was accurately directed to the most densely innervated regions of the vastus medialis and to assess the precision of the injections.
The intramuscular nerve distribution within the vastus medialis muscle showed distinct patterns, particularly in areas between 6 and 9. Four injections were successfully administered on each side, targeting the regions between 6 and 9 of the vastus medialis. Upon dissection of the cadavers, the dye was found to be distributed along the muscle fiber.
We recommend targeting botulinum neurotoxin injections toward regions displaying a prominent nerve distribution, specifically focusing on areas between 6 and 9. By adhering to these guidelines, clinicians can minimize doses and mitigate potential adverse effects, such as gait disturbances, antibody development, and bruising, resulting from multiple injections. Furthermore, these findings can be incorporated into electromyography practices.
全面了解股内侧肌内的神经分布对于有效管理痉挛性疾病的肉毒毒素注射至关重要。本研究旨在开发一种基于解剖学的方法，以指导肉毒毒素注射到股内侧肌。
使用改良的 Sihler 法，我们检查了股内侧肌（20 个标本），以描绘从髂前上棘到髌骨基底的横线上的神经分布。股内侧肌从顶部分为 10 个区。然后，使用两个新鲜尸体，根据股内侧肌内神经的分布进行超声引导注射。随后对每个标本进行解剖，以验证染料是否准确地导向股内侧肌最密集神经支配的区域，并评估注射的精确性。
股内侧肌内的肌内神经分布呈现出明显的模式，特别是在 6 到 9 区之间。每侧成功进行了 4 次注射，目标是股内侧肌的 6 到 9 区之间。对尸体进行解剖时，发现染料沿着肌纤维分布。
我们建议将肉毒毒素注射靶向神经分布明显的区域，特别是集中在 6 到 9 区之间。通过遵循这些指南，临床医生可以减少剂量，并减轻潜在的不良反应，如步态障碍、抗体产生和瘀伤，这是由于多次注射引起的。此外，这些发现可以纳入肌电图实践中。
