Determination of Intramuscular Nerve Distribution and Innervation Areas and Their Clinical Significance Using the Modified Sihler Technique

Project no. 32519 · Status: Kapanmış (Yayın bekleniyor) · 2024

Summary

<p class="ql-align-justify">Objective:&nbsp;This&nbsp;study&nbsp;aimed&nbsp;to&nbsp;identify&nbsp;the&nbsp;motor&nbsp;entry&nbsp;points&nbsp;(MEP),&nbsp;intramuscular&nbsp;nerve&nbsp;distribution&nbsp;and&nbsp;innervation&nbsp;zones&nbsp;of&nbsp;the&nbsp;rhomboid&nbsp;minor&nbsp;(rhMi)&nbsp;and&nbsp;rhomboid&nbsp;major&nbsp;(rhMa)&nbsp;muscles&nbsp;by&nbsp;applying&nbsp;the&nbsp;modified&nbsp;Sihler’s&nbsp;staining&nbsp;technique&nbsp;(MST);&nbsp;their&nbsp;intramuscular&nbsp;arterial&nbsp;arborization&nbsp;using&nbsp;the&nbsp;vascular&nbsp;filling&nbsp;method,&nbsp;and&nbsp;to&nbsp;analyze&nbsp;the&nbsp;nerve&nbsp;and&nbsp;vascular&nbsp;structures&nbsp;together.</p><p class="ql-align-justify">Materials&nbsp;and&nbsp;Methods:&nbsp;10&nbsp;cadavers&nbsp;(9&nbsp;males&nbsp;and&nbsp;1&nbsp;female)&nbsp;between&nbsp;the&nbsp;ages&nbsp;of&nbsp;43&nbsp;to&nbsp;91&nbsp;were&nbsp;included&nbsp;at&nbsp;the&nbsp;Department&nbsp;of&nbsp;Anatomy,&nbsp;Ege&nbsp;University&nbsp;Faculty&nbsp;of&nbsp;Medicine.&nbsp;A&nbsp;total&nbsp;of&nbsp;19&nbsp;rhMi&nbsp;and&nbsp;rhMa&nbsp;muscles&nbsp;-10&nbsp;left&nbsp;and&nbsp;9&nbsp;right-&nbsp;were&nbsp;investigated&nbsp;because&nbsp;one&nbsp;cadaver's&nbsp;right&nbsp;side&nbsp;had&nbsp;muscle&nbsp;deformation.&nbsp;The&nbsp;morphometric&nbsp;parameters&nbsp;of&nbsp;the&nbsp;rhMi&nbsp;and&nbsp;rhMa&nbsp;muscles,&nbsp;MEP's&nbsp;locations&nbsp;and&nbsp;the&nbsp;distances&nbsp;to&nbsp;anatomical&nbsp;landmarks&nbsp;were&nbsp;measured.&nbsp;Biodur®&nbsp;S14&nbsp;red&nbsp;silicone&nbsp;(BIODUR®&nbsp;Products&nbsp;GmbH,&nbsp;Germany)&nbsp;and&nbsp;Biodur®&nbsp;S1&nbsp;catalyst&nbsp;(BIODUR®&nbsp;Products&nbsp;GmbH,&nbsp;Germany)&nbsp;were&nbsp;used&nbsp;in&nbsp;a&nbsp;vascular&nbsp;filling&nbsp;method&nbsp;to&nbsp;observe&nbsp;intramuscular&nbsp;arterial&nbsp;vascular&nbsp;structure.&nbsp;Then,&nbsp;a&nbsp;7-stage&nbsp;MST&nbsp;procedure&nbsp;was&nbsp;applied&nbsp;to&nbsp;the&nbsp;muscles.&nbsp;After&nbsp;the&nbsp;technique,&nbsp;the&nbsp;muscles,&nbsp;which&nbsp;become&nbsp;transparent,&nbsp;were&nbsp;examined&nbsp;to&nbsp;evaluate&nbsp;MEP,&nbsp;intramuscular&nbsp;nerve&nbsp;distribution,&nbsp;and&nbsp;terminal&nbsp;nerve&nbsp;endings&nbsp;with&nbsp;led&nbsp;light&nbsp;panel&nbsp;(negatoscope).&nbsp;The&nbsp;region&nbsp;with&nbsp;the&nbsp;highest&nbsp;density&nbsp;of&nbsp;intramuscular&nbsp;nerve&nbsp;terminals&nbsp;were&nbsp;identified&nbsp;as&nbsp;innervation&nbsp;zones&nbsp;based&nbsp;on&nbsp;vertebral&nbsp;levels&nbsp;and&nbsp;10%&nbsp;sections&nbsp;of&nbsp;muscle&nbsp;length.&nbsp;Two-Way&nbsp;ANOVA&nbsp;was&nbsp;used&nbsp;in&nbsp;statistical&nbsp;analyzes&nbsp;to&nbsp;compare&nbsp;the&nbsp;right&nbsp;and&nbsp;left&nbsp;sides,&nbsp;and&nbsp;statistical&nbsp;significance&nbsp;was&nbsp;set&nbsp;at&nbsp;p&lt;0.05&nbsp;</p><p class="ql-align-justify">Results:&nbsp;The&nbsp;average&nbsp;lengths&nbsp;of&nbsp;the&nbsp;rhMi&nbsp;and&nbsp;rhMa&nbsp;were&nbsp;10.35&nbsp;±&nbsp;2.07&nbsp;cm&nbsp;and&nbsp;11.23&nbsp;±&nbsp;1,45&nbsp;cm,&nbsp;respectively.&nbsp;There&nbsp;was&nbsp;no&nbsp;statistically&nbsp;significant&nbsp;difference&nbsp;in&nbsp;the&nbsp;length&nbsp;of&nbsp;the&nbsp;right&nbsp;and&nbsp;left&nbsp;sides&nbsp;of&nbsp;the&nbsp;muscles.&nbsp;After&nbsp;MST,&nbsp;rhMi&nbsp;and&nbsp;rhMa&nbsp;shrank&nbsp;an&nbsp;averageof&nbsp;10.65%&nbsp;and&nbsp;9.08%,&nbsp;respectively.&nbsp;MST&nbsp;revealed&nbsp;some&nbsp;MEPs&nbsp;that&nbsp;could&nbsp;not&nbsp;be&nbsp;detected&nbsp;during&nbsp;dissection,&nbsp;and&nbsp;it&nbsp;was&nbsp;determined&nbsp;that&nbsp;there&nbsp;were&nbsp;1-3&nbsp;MEPs&nbsp;in&nbsp;rhMi&nbsp;and&nbsp;2-4&nbsp;in&nbsp;rhMa.&nbsp;MEPs&nbsp;were&nbsp;highly&nbsp;clustered&nbsp;in&nbsp;50-60%&nbsp;of&nbsp;the&nbsp;muscle&nbsp;length&nbsp;and&nbsp;at&nbsp;the&nbsp;T1-T2&nbsp;and&nbsp;T2-T3&nbsp;vertebral&nbsp;levels&nbsp;in&nbsp;rhMi;&nbsp;in&nbsp;50-70%&nbsp;of&nbsp;the&nbsp;muscle&nbsp;length&nbsp;and&nbsp;at&nbsp;the&nbsp;T2-T3&nbsp;and&nbsp;T3-T4&nbsp;vertebral&nbsp;levels&nbsp;in&nbsp;rhMa.&nbsp;Nerve&nbsp;fibers&nbsp;revealed&nbsp;extensive&nbsp;intramuscular&nbsp;arborization&nbsp;after&nbsp;entering&nbsp;the&nbsp;muscle,&nbsp;branching&nbsp;off&nbsp;into&nbsp;multiple&nbsp;small&nbsp;branches&nbsp;that&nbsp;could&nbsp;be&nbsp;followed&nbsp;all&nbsp;the&nbsp;way&nbsp;to&nbsp;terminal&nbsp;branches.&nbsp;Terminal&nbsp;nerve&nbsp;endings&nbsp;were&nbsp;concentrated&nbsp;at&nbsp;the&nbsp;40-60%&nbsp;of&nbsp;the&nbsp;muscle&nbsp;length&nbsp;and&nbsp;at&nbsp;the&nbsp;T1-T2&nbsp;and&nbsp;T2-T3&nbsp;vertebral&nbsp;levels&nbsp;particularly&nbsp;close&nbsp;to&nbsp;the&nbsp;T2&nbsp;vertebral&nbsp;segment&nbsp;in&nbsp;rhMi;&nbsp;at&nbsp;the&nbsp;40-60%&nbsp;of&nbsp;the&nbsp;muscle&nbsp;length&nbsp;and&nbsp;at&nbsp;the&nbsp;T2-T3&nbsp;vertebral&nbsp;level,&nbsp;40-70%&nbsp;of&nbsp;the&nbsp;muscle&nbsp;length&nbsp;and&nbsp;at&nbsp;the&nbsp;T3-T4&nbsp;vertebral&nbsp;level,&nbsp;at&nbsp;the&nbsp;50-80%&nbsp;of&nbsp;the&nbsp;muscle&nbsp;length&nbsp;and&nbsp;at&nbsp;the&nbsp;T4-T5&nbsp;vertebral&nbsp;level&nbsp;and&nbsp;50-70%&nbsp;of&nbsp;the&nbsp;muscle&nbsp;length&nbsp;and&nbsp;at&nbsp;the&nbsp;T5-T6&nbsp;vertebral&nbsp;level&nbsp;in&nbsp;rhMa.&nbsp;Arterial&nbsp;filling&nbsp;was&nbsp;successful&nbsp;in&nbsp;10&nbsp;out&nbsp;of&nbsp;19&nbsp;cases;&nbsp;after&nbsp;MST,&nbsp;arterial&nbsp;branching&nbsp;was&nbsp;traceable&nbsp;down&nbsp;to&nbsp;the&nbsp;finest&nbsp;intramuscular&nbsp;branches&nbsp;in&nbsp;6&nbsp;of&nbsp;these&nbsp;samples.&nbsp;Intramuscular&nbsp;nerves&nbsp;and&nbsp;arteries&nbsp;overlapped&nbsp;at&nbsp;some&nbsp;vertebral&nbsp;levels,&nbsp;while&nbsp;they&nbsp;diverged&nbsp;in&nbsp;others.&nbsp;&nbsp;</p><p class="ql-align-justify">Conclusion:&nbsp;MST&nbsp;was&nbsp;found&nbsp;to&nbsp;be&nbsp;an&nbsp;effective&nbsp;method&nbsp;for&nbsp;revealing&nbsp;the&nbsp;MEPs,&nbsp;intramuscular&nbsp;nerve&nbsp;distribution&nbsp;and&nbsp;innervation&nbsp;zones&nbsp;of&nbsp;rhMi&nbsp;and&nbsp;rhMa.&nbsp;Nerve&nbsp;and&nbsp;vascular&nbsp;distributions&nbsp;might&nbsp;be&nbsp;analyzed&nbsp;simultaneously&nbsp;on&nbsp;the&nbsp;same&nbsp;sample&nbsp;by&nbsp;applying&nbsp;to&nbsp;the&nbsp;technique&nbsp;of&nbsp;viewing&nbsp;arterial&nbsp;structures&nbsp;through&nbsp;vascular&nbsp;filling.&nbsp;Our&nbsp;findings&nbsp;may&nbsp;contribute&nbsp;to&nbsp;the&nbsp;planning&nbsp;of&nbsp;intramuscular&nbsp;injections&nbsp;of&nbsp;rhMi&nbsp;and&nbsp;rhMa,&nbsp;the&nbsp;protection&nbsp;of&nbsp;motor&nbsp;nerve&nbsp;and&nbsp;vascular&nbsp;structures,&nbsp;and&nbsp;the&nbsp;provision&nbsp;of&nbsp;anatomical&nbsp;information&nbsp;for&nbsp;reconstructive&nbsp;and&nbsp;surgical&nbsp;applications.&nbsp;</p>

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