骶腰段脊柱多裂肌地应用解剖实验研究摘要

骶腰段脊柱多裂肌地应用解剖实验研究摘要 人生就象一场旅行，不必在乎目的地，在乎的是沿途的风景以及看风景的心情——心灵的旅行，没有止境，只有方向～ 胸九十二主小肠，十一腰一大肠乡; 颈一后头通大脑，颈二耳目视听舌; 颈三脸面和外耳，三叉神经及喉咽; 膀胱十一至腰二;输尿管加前列腺; 颈四绕项连双肩，耳鼻口咽与膈肌; 睾丸卵巢十十一，下至腰一主生殖; 颈五上臂三角肌，声带腺体咽喉炎; 腰一上主骼腰肌，内络大肠下股沟; 颈六颈肩二头肌，拇食两指扁桃体,; 腰二斜下大腿前，还连腹部和兰尾; 颈七肩肘三头肌，前臂中指甲状腺; 腰三主管膝周炎，子宫膀胱性器官; 颈八无名与小指，前臂掌面指屈肌; 腰四小腿内侧面，坐骨神经前列腺; 胸一上臂至肘下，食管气管小鱼际; 腰五腿外胫前肌，足背拇次两趾连; 胸二循腋至肘上;三至十二胸肋肌; 骶一跟腱通小趾.，亦主小腿腓肠肌; 胸二至五主心疾，肺与气管二三四; 骶二大小腿后面;下至足底掌小肌; 食道胸一至胸六，六胃七胰八属脾; 骶三四五连尾椎，直肠肛门会阴肌。. 肝胆七九胸节间，肾脏胸十至腰一; 骶腰段脊柱多裂肌地应用解剖实验研究摘要 山东省文登整骨医院脊柱外科中心 张恩忠 脊柱后路手术途径视临床最常见的手术途径，在腰骶骨段位于棘突两旁、椎板之后主要的结构是多裂肌，但目前对多裂肌的解剖一直未引起教学和临床的重视。为能减少某些腰椎后路手术对脊柱稳定性的破坏，山东文登骨伤研究所与山东医科大学解剖教研室合作，对腰骶骨段多裂肌进行了应用解剖研究，对多裂肌的起、止点，形态及肌纤维的走行进行了详细观察和测量，目的是为临床应用提供参考资料，如下: 一) 不分性别、年龄、民族及死亡原因，25具经过福尔马林处理的成人尸体 二) 方法:从腰骶部至胸腰段采用后正中皮肤切开，从棘突为中心向两侧逐层解剖，从多裂肌的外侧和内侧进行显露，对起、止点进行详细的解剖和止点短腱测量 三) 观察和测量的:1).多裂肌与周围组织结构的关系2).多裂肌的起点与肌纤维的走行3).多裂肌束的构成.4)多裂肌短腱、止点及其棘突、棘间韧带的关系 二:观察和测量结果: 1.多裂肌与周围组织结构的相邻关系 从棘突旁两侧切开腰背筋膜并向外侧掀开，腰骶段深筋膜内侧直接覆盖在多裂肌的浅面，多裂肌的外侧与腰最长肌和骼腰肋肌相邻，中间有疏松的结缔组织相隔;完全剥除腰骶骨段的深筋膜，并全部显露多裂肌背侧和外侧;多裂肌在腰骶骨段发达，下端两侧占据整个骶三角区，腰段自下而上逐渐变窄;内前侧覆盖着椎板及回旋肌，棘突和棘突间肌位于两侧多裂肌之间，在腰段多裂肌基本位于腰椎乳突外缘与棘突背侧的连线范围内 2.多裂肌的起点与肌纤维的走向特点 for computer software engineering GB/T50314-2000 of electrical installations code for construction and acceptance of GBJ232- 92 intelligent building weak design construction figure set GJBT-471 2. system description this times engineering weak design including: hours a Kok information facilities system integrated wiring system (containing room network, communications part) wired TV system information guide and the released system hours II Kok public security system fire automatically alarm system (containing public broadcast part) security technology prevention system security monitoring system out entrance control system car library management system hours three Kok building equipment monitoring system hours four Kok information application system queued station ICU visitation system operation the system monitoring and training system call intercom system hours, five hours Kok Kok intelligent integrated system of information system (1) cabling systems (including computer room network, communication component) computer network systems and voice communications systems Center of information on medical floor computer room located in the engine room. Voice communication system using a local telecommunications operator providing voice service, configuration-independent integrated services digital program-controlled switchboards. Operators providing communications ... If any compatibility requirements, by way of increased access to the Communications Board within the chassis to meet 在骶三角内的多裂肌浅层起于骶骼长韧带，有一部分起于骶骼后上棘内侧，深层起于骶骨椎板、骶骼短韧带。内侧纤维起于骶骨中嵴;在骶部起点处无任何形式的短腱存在，肌纤维向上内行走，填充整个骶骨后区，起于骶区内侧的肌纤维较短，主要止于L或L的棘514突，起于骶骨区内侧的肌纤维较长，斜向内上行走，主要参与L-L棘突为止点的多裂肌构311 成。另一部分多裂肌以膜状短腱形式起于L-L乳突外侧，大部分几肌纤维位于多裂肌的背51 外侧，并且复有一层较薄的筋膜，只跨越中间2个椎骨，与其他下位来的肌纤维形成短腱主要止于肌突下端。偏内侧的肌纤维斜度较大，往往跨越3-4个椎骨再参与构成止点的短腱。 3.多裂肌的构成 从骶骨背侧到L多裂肌每侧可分为5束，每束分别以短腱的形式止于L-L棘突尖部两152侧结节，近止点形成短腱的部分可以较明显的分清各束，在起点附近和外侧部肌纤维向上走的斜度不一致，互相交织在一起，不能将各束分开，但起于乳突外侧的外层肌纤维有着特定的走行方向和止点，它只跨越2个椎骨参与肌束构成止点短腱的构成。 4. 多裂肌短腱与止点及其与棘突和棘间韧带的关系 多裂肌在近止点的部分从肌束中心开始形成肌腱，并且周围的肌纤维逐渐加入，短腱随肌纤维的加入而增粗形成圆柱状;末端大部分止于棘突下端两侧的结节，一部分反折向下与棘间韧带相交织。测量各束多裂肌数据如下: 25具尸体标本多裂肌束止点短腱数据(X?S单位mm) 左 侧 右 侧 肌束 直径 长度 长度 直径 L1 15.10?2.43 4.72?0.99 15.10?2.91 4.64?1.01 L2 15.68?2.79 5.42?1.14 15.36?2.83 5.18?0.89 L3 14.82?2.77 5.86?0.99 14.34?2.91 5.64?0.93 L4 14.16?3.62 5.90?1.06 13.24?3.35 6.02?0.92 L5 11.58?2.46 4.68?0.62 11.30?2.68 4.66?0.57 结论: 经过解剖和测量，多裂肌在腰骶段位于骶椎骨背侧和腰椎椎板棘突槽沟内，背面浅层被腰背筋膜覆盖，起于骶骨背侧的韧带和椎板及L-L乳突的外侧缘，各束肌纤维以短腱的形51 式与L-L棘突尖部两侧的结节连接，一部分腱纤维向下前反折与棘间韧带相互交织。它的51 功能主要参与脊柱背伸运动，维持脊柱腰段前凸的存在，是脊柱动力性稳定的重要因素。 诊断方法;三步定位诊断法; 1.主诉;根据患者的主诉初步确定患者的发病部位和原因以及疾病的性质. 2.触诊;触诊检查是脊椎相关疾病诊断中最关键的一环.通过医生用手指对病者脊椎的棘突(或横突、关节突) 、以及其他骨性标志(如髂嵴、髂前上棘、髂后上棘),脊柱附近的肌肉韧带进行细致触摸比较,从中发现骨关节解剖位置的改变、肌肉紧张度的变化、韧带剥离的情况、有无摩擦音、硬结、压痛等,来判断是否有因脊椎 -independent integrated services digital program-ce, configurationr room located in the engine room. Voice communication system using a local telecommunications operator providing voice serviompute, communication component) computer network systems and voice communications systems Center of information on medical floor c, five hours Kok Kok intelligent integrated system of information system (1) cabling systems (including computer room networkhours lication system queued station ICU visitation system operation the system monitoring and training system call intercom systemtrol system car library management system hours three Kok building equipment monitoring system hours four Kok information appce cony alarm system (containing public broadcast part) security technology prevention system security monitoring system out entrancations part) wired TV system information guide and the released system hours II Kok public security system fire automaticallwiring system (containing room network, communi471 2. system description this times engineering weak design including: hours a Kok information facilities system integrated -92 intelligent building weak design construction figure set GJBT -eptance of GBJ2322000 of electrical installations code for construction and acc-for computer software engineering GB/T503142f any compatibility requirements, by way of increased access to the Communications Board within the chassis to meetcontrolled switchboards. Operators providing communications ... I 或骨盆的内外平衡失调、移位、刺激或压迫神经、血管等而导致脊柱相关疾病.必要时做特殊检查进行神经定位诊断. 3.X线检查;在前两项诊断相符的情况下，再经X检查.从不同角度投照的X片中观察脊柱及骨盆骨结构的改变、骨与骨相对位置的改变、以及骨关节功能的状态、韧带的改变等(最后将以上三步检查结果综合分析归纳，作出错位椎体的诊断(但是，看X线片首先要排除禁忌症;如有骨折、肿瘤、结核或骨关节退变明显、有骨桥形成、骨质明显疏松等，都是手法复位的禁忌症( ,(整脊疗法;手法整复是治疗脊柱相关疾病最重要的手段之一(也称之为脊椎手疗法.医生通过手力、手指的变化、刺激患者体表的特定部位，以实现调节平衡，矫正椎体来完成治疗。 ,(小针刀疗法;是微创软组织松解术，对变性的软组织进行松解、剥离、减压，疏通调节生物信息通道(此疗法有简 便 廉 验，变不治为可治，变复杂为简单，变难治为速愈等特点。 ,(药物疗法;有些软组织伤病如局部淤滞肿胀、疼痛、机体营养障碍等，如接受中药的内服、外敷和熏蒸以及西药的消炎、镇痛等治疗，也常立见奇效。 ,(牵引疗法;牵引系应用力学的作用力与反作用力原理，利用人体本身重量与牵引重量的对抗作用，使软组织的紧张痉挛得到缓解，使骨关节整复，改变被卡压神经根的位置，从而矫正错位畸形。 ,(局部注射疗法(封闭疗法);将一定的药物注射于痛点、有消炎镇痛作用、促进劳损组织重新修复作用、内固定作用(中医叫水针疗法或穴位注射疗法、经络疗法。 ,(另外还有红外线、微波、离子导入、激光、高中底频等物理疗法( 定位诊断;国内外对脊柱相关疾病的定位和疾病的治疗点的分析大同小异,但也不尽相同.现代医学对此的诊断和定位是根据脊神经和锥体的分布排列以及对应的脏器的反应来确定:中医对此是根据经络学说中的督脉和足太阳膀胱经腧穴为主,用整体观念、辨证论治做为基本理论而进行。 临床提示; 1(心率不齐C3-C5向右弯曲。 ,(气喘T4-T5向右弯曲。 ,(肝功能障碍，肋间神经痛T7-T10棘突向左捻转(糖尿病向右捻转。(此区是幽门梗阻，十二指肠疾病，胰腺疾病的发生源) ,(大量留鼻血，经血，吐血等病症如果矫正T10-T12会有止血作用，对白血病也有治疗作用。 ,(痛风患者是腰骶关节向右弯曲引起。 ,(右侧骨盆移位为副交感神经紧张病症，出现胃肠功能紊乱，肝脏机能能不良，腹泻，消瘦，易患妇科病(左侧移位为交感神经紧张病症;出现肺功能不良，便秘，肥胖，心脏机能不良易患感冒。 v 平衡脊柱治病求本 v 以上介绍的各种疗法的目的;调节纠正脊柱(颈椎 胸椎 腰椎 骶尾椎和骨盆)的错位(移位)以及脊柱周围软组织的损伤,恢复其平衡关系,是一种综合性的外治疗法。人们以前对脊柱(包括骨盆)错位及其周围软组织损伤的病因病机认识不足,因此在诊断上存在着盲目性,在治疗上缺乏针对性,遇到这类病人就难免“头痛治头 脚痛医脚”给病人造成了更危险的隐患. 脊柱疾病治疗学帮助我们打破这一局限,基于对脊柱解剖学,生物力学及软组织损伤引起的内外动态平衡失调理论等的深刻认识,本疗法倡导对脊椎各关节的移位和周围软组织损伤采取各种矫正手法 针刀松解 药 nt) computer network systems and voice communications systems Center of information on medical floor computer room located intelligent integrated system of information system (1) cabling systems (including computer room network, communication componeok intation ICU visitation system operation the system monitoring and training system call intercom system hours, five hours Kok Kmanagement system hours three Kok building equipment monitoring system hours four Kok information application system queued s ibrarying public broadcast part) security technology prevention system security monitoring system out entrance control system car lsystem information guide and the released system hours II Kok public security system fire automatically alarm system (containwiring system (containing room network, communications part) wired TV 471 2. system description this times engineering weak design including: hours a Kok information facilities system integrated -ntelligent building weak design construction figure set GJBT92 i -2000 of electrical installations code for construction and acceptance of GBJ232-for computer software engineering GB/T503143uirements, by way of increased access to the Communications Board within the chassis to meetcontrolled switchboards. Operators providing communications ... If any compatibility req-independent integrated services digital program-ngine room. Voice communication system using a local telecommunications operator providing voice service, configurationthe e 物治疗等,以使错位的脊柱骨盆归位,使损伤的软组织或受压迫刺激的神经,血管恢复自然的平衡关系;使人体各组织脏器恢复正常的功能,从而达到“平衡脊柱治病求本”的目的。 附:脊椎移位引起的疾病和临床症状 第一颈椎;颈项强急疼痛，舌强不语，声音沙哑，精神病，神经衰弱，忧郁症，歇斯底里症，头痛，眩晕，失眠，脑瘫，脑出血，中风后遗症，面痛，脑膜炎，骨髓炎，癫痫，面神经麻痹，面肌痉挛，咽喉痛等。 第二颈椎;神经衰弱，歇斯底里症，面肌痉挛，忧郁症，头部盗汗，头痛，脑炎，面瘫，眼疾，盲视，眼花，耳疾 。 第三颈椎;白内障，青光眼，眼结膜等眼部疾病，耳鸣，失眠，鼻炎，牙病，呕吐，神经炎，神经痛，高血压，粉刺，咳嗽。 第四颈椎;神经衰弱，忧虑症，鼻腔狭窄，三叉神经痛，面瘫，头痛，落枕，中风后遗症，弱视，迎风流泪，呕吐，鼻炎，牙周炎，失聪等。 第五颈椎;口腔疾病，颈部疼痛，咽喉肿痛，喉头炎，扁桃体炎，味觉失调，肩周炎，上手臂痛，手麻痹，百日咳等。 第六颈椎;哮喘，咽喉疾病，呼吸困难，喉头炎，支气管炎，甲状腺炎，甲亢，肩周炎，上手臂痛，手麻痹，百日咳。 第七颈椎;颈肩项部强急疼痛，颈椎病，落枕，咳嗽喘急，小儿惊风，癫狂，动脉硬化，支气管炎，风疹，动脉硬化，手指麻痛，上肢肌肉酸痛。 第一胸椎;头项肩部上肢疼痛，颈椎病，感冒，热病，支气管及肺出血，气管炎，肩膀手痛，手软无力。第二胸椎;心肌炎，心脏内膜炎，心包炎，心率失常，心肌肥大，心肌梗塞，心功不全，动脉硬化，支气管炎，上肢疼痛。 第三胸椎;支气管炎，肺结核，肺气肿，小儿疯癫，神经衰弱，癫狂，胸膜炎，肺动脉狭窄，肩膀下痛，感冒。 第四胸椎，胆汁过多，肝炎，肝硬化，黄疸，胁痛，疱疹，心脏病，心率失常，忧虑症，心部痛。 第五胸椎;肋间神经痛，骨质增生，心惊，心悸，神经衰弱，健忘，胃下垂，胃炎，小儿风痫，荨麻疹，肝炎，易倦，低血压，背部硬化。 第六胸椎;消化不良，支气管炎，肩背痛，胃痛，胃灼热感，呕吐，消化不良。 第七胸椎;胃扩张，胃酸过多，胃溃疡，幽门狭窄，胃下垂，胃炎，神经衰弱，忧虑症，黄疸，胆囊炎，胆石症。 第八胸椎;腰背神经痛，肋间神经痛，脑膜炎，肝炎，胰腺结石 ，肠痉挛，胆结石，糖尿病，尿频。 第九胸椎;脾脏肿大，消化不良，胃炎，胃痛，结肠炎，肾亏，肾上腺病症。 第十胸椎;骨质增生，腰背强痛，风湿，急慢性肾脏病，肾结石，肾亏，易倦，肋间神经痛 。 第十一胸椎;肾脏病，尿毒症，肾脏疾病与中毒性疾病，泌尿系统疾病，出疹性发烧，糖尿病，浮肿。第十二胸椎;脂肪堆积，肝炎，消化不良，间歇性便秘，肝脏肥大，风湿痛，食欲不振，小便不出。第一腰椎;肾功能底下，肾虚腰痛，阳痿，遗尿，习惯性流产，腹泻，腰软无力。 -independent integrated services digital program-ce, configurationr room located in the engine room. Voice communication system using a local telecommunications operator providing voice serviompute, communication component) computer network systems and voice communications systems Center of information on medical floor c, five hours Kok Kok intelligent integrated system of information system (1) cabling systems (including computer room networkhours lication system queued station ICU visitation system operation the system monitoring and training system call intercom systemtrol system car library management system hours three Kok building equipment monitoring system hours four Kok information appce cony alarm system (containing public broadcast part) security technology prevention system security monitoring system out entrancations part) wired TV system information guide and the released system hours II Kok public security system fire automaticallwiring system (containing room network, communi471 2. system description this times engineering weak design including: hours a Kok information facilities system integrated -92 intelligent building weak design construction figure set GJBT -eptance of GBJ2322000 of electrical installations code for construction and acc-for computer software engineering GB/T503144f any compatibility requirements, by way of increased access to the Communications Board within the chassis to meetcontrolled switchboards. Operators providing communications ... I 第二腰椎;月经不调，消化不良，肠胃炎，便秘，腹泻，结肠炎，前列腺肥大，神经衰弱，不孕症，腹部肿胀。 第三腰椎;月经不调，闭经，不孕症，子宫及卵巢炎，子宫生殖性疾病，小产，膝无力。 第四腰椎;前列腺肥大，膀胱炎，尿频，痔疮，脱肛，便血，腰膝酸痛，月经不调，盆腔炎，阳痿，遗精，腰椎间盘突出，坐骨神经痛，行走不便，小儿麻痹。 第五腰椎及骶骨 腰背疼痛，坐骨神经痛，风湿痛，下肢关节炎，半身不遂，膀胱疾病，下肢关节足部疾病，下肢静脉曲张，类风湿，行走不便，足冷麻木，盆腔炎，阴道炎，阳痿，贫血，痔疮，脱肛，便秘，便血，结肠炎，淋病。 尾骨;尾骨疼痛，生殖器疾病，痔疮，便秘，阴茎勃起，小便不利。 ngine room. 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Operators providing communications ... If any compatibility req-independent integrated services digital program-