Musculus splenius capitis'in motor giriş noktalarının belirlenmesi
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Tarih
2019
Yazarlar
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Yayıncı
Ege Üniversitesi, Sağlık Bilimleri Enstitüsü
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç:Boyun ve çevresindeki spazm ve ağrı ile karakterize çeşitli rahatsızlıkların tedavisinde kullanılan ajanların enjeksiyonunda bölgedeki kasların motor giriş noktalarının belirlenmesi tedavinin daha etkin, doğru ve kolay biçimde yapılabilmesi için gereklidir. Servikal distoni ve “whiplash” yaralanmaları gibi rahatsızlıklarda en çok etkilenen kaslardan biri olan musculus splenius capitis’e (MSC) Botulinum Toksin (BT)enjeksiyon uygulaması yapılmaktadır. Bu uygulamalarda ilacın yan etkilerinin azaltılması, çevre yapılara zarar verilmemesi ve tedavinin daha etkin yapılabilmesi için MSC'nin motor giriş noktalarının bilinmesi gerekmektedir. Bu kadavra çalışmasının amacı boyun kaslarının spazmı ile seyreden çeşitli rahatsızlıkların tedavisinde yer alan ajanların enjeksiyonuna yönelik MSC özelinde, hedef bölgelerin belirlenmesidir.
Yöntem: Ege Üniversitesi Tıp Fakültesi Anatomi Anabilim Dalı envanterine kayıtlı, eğitim ve araştırma amacıyla ilgili yasalar doğrultusunda temin edilmiş ve %10 formalin solüsyonu ile tespit edilmiş 10 erişkin insan kadavrasının ense bölgeleri (toplamda 20 taraf) diseke edilerek incelendi. Diseksiyonların ardından anatomik kılavuz noktaları belirlendi ve aralarındaki mesafeler ölçüldü.Cilt ve cilt altı yapıları korunmuş kadavralarda motor giriş noktalarının derinliği ölçüldü. Musculus splenius capitis’e sinirlerin giriş yaptığı noktalar (motor giriş noktaları-MGN) tespit edildi ve işaretlendi. Tespit edilen motor giriş noktalarının anatomik kılavuz noktalarına uzaklığı ölçüldü ve kaydedildi.
Bulgular:Diseksiyonların ardından MSC’ye ait, altı kadavrada sağ ve sol taraflarda ikişer MGN;iki kadavrada sağ ve sol taraflarda üçer MGN;bir kadavrada sağ ve sol taraflarda birer MGN;bir kadavrada ise sağ tarafta üç, sol tarafta bir adet MGN saptandı. Anatomik kılavuz noktaları arasındaki mesafeler ise,X ekseni için ortalama 88,48 mm (±7,66 mm),Y ekseni için ortalama 127,77 (±15,41 mm) olarak bulundu. Bütünlüğü bozulmamış beş kadavrada cilt, cilt altı doku ve m. trapezius’un kalınlığı ense bölgesinde ortalama 12,16 mm (± 2,04 mm) olarak bulunmuştur. Musculus splenius capitis’in ortalama kalınlığı ise 2,58 mm (± 0,76 mm) olarak bulunmuştur. X eksenine en yakın MGN olan 1. MGN’lerin, X eksenine ortalama uzaklığı 46, 41 mm (± 10,48 mm) ve Y eksenine ortalama uzaklığı 40,87 mm (±10,26 mm) olarak bulunmuştur. X eksenine en uzak MGN olan, 3. MGN’lerin, X eksenine ortalama uzaklığı 56,28 mm (± 12,44 mm) ve Y eksenine ortalama uzaklığı 33,72 mm (± 9,21 mm) olarak bulunmuştur.
Sonuç:Çalışmamızda MSC’ye yapılacak olan enjeksiyon uygulamaları için anatomik kılavuz noktaları ve MGN’ler belirlenmiştir. Elde ettiğimiz verilerin bu bölgede uygulama yapacak olan klinisyenlerin daha doğru ve güvenli hareket etmesine yardımcı olacağını ve bu alanda yapılacak diğer çalışmalar için rehberlik edeceğini düşünüyoruz.
Aim: For the treatment of various disorders characterized by spasm and pain in the neck and its surroundings, the motor entry points of the muscles in the region are necessary for treatment to be performed more effectively, accurately and easily. Musculus splenius capitis (MSC) is one of the most affected muscles for the neck disorders such as cervical dystonia and whiplash injuries, is often treated with injection of Botulinum Toxin (BT). In these procedures, it is necessary to know MSC's motor entry points in order to reduce the side effects of the drug, to make the application easier and not to damage the surrounding structures. The aim of this cadaver study was to determine the target sites for m.splenius capitis for the injection of agents involved in the treatment of various disorders associated with spasm of the neck muscles. Methods: The posterior neck regions of 10 adult human cadavers (20 sides in total), which fixed in 10% formalin solution and were recorded in the inventory of Ege University Faculty of Medicine Department of Anatomy and obtained in accordance with the relevant laws for educational and research purposes, were examined. After dissection, anatomical guide points were determined and the distances between them were measured. The depth and thickness of the MSC were measured in the cadavers with skin. Motor entry points (MEP) of the nerves entering the musculus splenius capitis were detected and marked. The distance of the motor entry points to the anatomical guide points was measured and recorded. Results: After dissections, in six cadavers two MEPs forboth right and left side, in two cadavers three MEPs for both right and left side, in one cadaver one MEP for both right and left side, and in one cadaver three MEP for the right side and one MEP for the left side were found. The mean distances between the processus mastoideus and protuberentia occipitalis externa (X-axis) were 88.05mm (±8.33mm) on the right side and 88.91mm (±7.35mm) on the left side. The mean distance between protuberentia occipitalis externa and processus spinosus of vertebra prominens (Y-axis) was 127,77mm (±15,41mm).The thickness of the skin, subcutaneous tissue and m. trapezius was found to be 12.16 mm (± 2.04 mm) in the nape of five intact cadavers.The mean thickness of musculus splenius capitis was 2.58 mm (± 0.76 mm).The first MGN’s, which are the closest to the X-axis,mean distance to the X-axiswas found to be 46, 41 mm (± 10.48 mm), and the mean distance to the Y axis was 40.87 mm (± 10.26 mm).The mean distance to the X-axis of the 3rd MGNs, which is the most distant MGN to the X axis, was 56.28 mm (± 12.44 mm) and the mean distance to the Y axis was 33.72 mm (± 9.21 mm). Conclusion: In this study, anatomical guide points and motor entry points were determined for injection applications to MSC. We believe that the data we have obtained will help clinicians who will practice in this region to act more accurately and safely and will guide other studies in this area.
Aim: For the treatment of various disorders characterized by spasm and pain in the neck and its surroundings, the motor entry points of the muscles in the region are necessary for treatment to be performed more effectively, accurately and easily. Musculus splenius capitis (MSC) is one of the most affected muscles for the neck disorders such as cervical dystonia and whiplash injuries, is often treated with injection of Botulinum Toxin (BT). In these procedures, it is necessary to know MSC's motor entry points in order to reduce the side effects of the drug, to make the application easier and not to damage the surrounding structures. The aim of this cadaver study was to determine the target sites for m.splenius capitis for the injection of agents involved in the treatment of various disorders associated with spasm of the neck muscles. Methods: The posterior neck regions of 10 adult human cadavers (20 sides in total), which fixed in 10% formalin solution and were recorded in the inventory of Ege University Faculty of Medicine Department of Anatomy and obtained in accordance with the relevant laws for educational and research purposes, were examined. After dissection, anatomical guide points were determined and the distances between them were measured. The depth and thickness of the MSC were measured in the cadavers with skin. Motor entry points (MEP) of the nerves entering the musculus splenius capitis were detected and marked. The distance of the motor entry points to the anatomical guide points was measured and recorded. Results: After dissections, in six cadavers two MEPs forboth right and left side, in two cadavers three MEPs for both right and left side, in one cadaver one MEP for both right and left side, and in one cadaver three MEP for the right side and one MEP for the left side were found. The mean distances between the processus mastoideus and protuberentia occipitalis externa (X-axis) were 88.05mm (±8.33mm) on the right side and 88.91mm (±7.35mm) on the left side. The mean distance between protuberentia occipitalis externa and processus spinosus of vertebra prominens (Y-axis) was 127,77mm (±15,41mm).The thickness of the skin, subcutaneous tissue and m. trapezius was found to be 12.16 mm (± 2.04 mm) in the nape of five intact cadavers.The mean thickness of musculus splenius capitis was 2.58 mm (± 0.76 mm).The first MGN’s, which are the closest to the X-axis,mean distance to the X-axiswas found to be 46, 41 mm (± 10.48 mm), and the mean distance to the Y axis was 40.87 mm (± 10.26 mm).The mean distance to the X-axis of the 3rd MGNs, which is the most distant MGN to the X axis, was 56.28 mm (± 12.44 mm) and the mean distance to the Y axis was 33.72 mm (± 9.21 mm). Conclusion: In this study, anatomical guide points and motor entry points were determined for injection applications to MSC. We believe that the data we have obtained will help clinicians who will practice in this region to act more accurately and safely and will guide other studies in this area.
Açıklama
Anahtar Kelimeler
M. Splenius Capitis, Botulinum Toksin, Motor Giriş Noktası, Enjeksiyon Uygulamaları, Servikal Distoni, Anatomik Kılavuz Noktaları, Botulinum Toxin, Motor Entry Point, Injection Applications, Cervical Dystonia, Anatomical Guide Points
