{"@context":{"@vocab":"https://cir.nii.ac.jp/schema/1.0/","rdfs":"http://www.w3.org/2000/01/rdf-schema#","dc":"http://purl.org/dc/elements/1.1/","dcterms":"http://purl.org/dc/terms/","foaf":"http://xmlns.com/foaf/0.1/","prism":"http://prismstandard.org/namespaces/basic/2.0/","cinii":"http://ci.nii.ac.jp/ns/1.0/","datacite":"https://schema.datacite.org/meta/kernel-4/","ndl":"http://ndl.go.jp/dcndl/terms/","jpcoar":"https://github.com/JPCOAR/schema/blob/master/2.0/"},"@id":"https://cir.nii.ac.jp/crid/1390282680551361920.json","@type":"Article","productIdentifier":[{"identifier":{"@type":"DOI","@value":"10.14900/cjpt.2012.0.48101062.0"}},{"identifier":{"@type":"NAID","@value":"130004585401"}}],"dc:title":[{"@language":"ja","@value":"後脛骨筋支配神経の形態学的解析"}],"dc:language":"ja","description":[{"type":"abstract","notation":[{"@language":"ja","@value":"【はじめに、目的】ヒトは進化の過程で二足直立歩行を採用した為、特に下肢において他の霊長類と比べて特徴的な筋骨格系が認められる。後脛骨筋（TP）はヒトで発達した筋と言われ（Langdon, 1990）、内側縦足弓を挙上する働きがある。TPは腓骨・脛骨・下腿骨間膜から起始し、筋腹のほぼ中央部に長い停止腱を持つ羽状筋とされるが、Morimoto（1983）によればTPは典型的な羽状筋とは異なり、腓骨より起始する筋束が筋間中隔により浅深2 層に分かれ、停止腱は水平面でU字型を呈するとされる。TPの特徴的形態の発達過程を知る為には、支配神経の解析が有用である（e.g. 児玉, 1986; Arakawa et al., 2006）。また、運動点ブロックの注射部位に適した部位を探すことを目的とし、神経筋終末部の分布を調べることは有用とされる（Lee et al. 2011）。TPは内反尖足に関わる筋であり、本筋に対するボツリヌス毒素を用いた運動点ブロックは痙性内反尖足に対する治療の1 つである （Deltombe et al., 2003）。すなわち、TPはその特徴的形態の発達過程を知る為だけでなく、臨床的にもその筋内分布の精査が必要であるが、未だTP支配神経の詳細な解析は成されていない。そこで今回我々は、TP支配神経の筋内分布パターンを精査することとした。【方法】平成24 年度本学医学部解剖学実習における実習体2 体3 側を用いた。両標本ともに外科的既往は特になく、TPが欠除することはなかった。1側のTPは骨から取り外した後、後面（浅層）から前面（深層）に向かって、腱および筋束を除去し、筋束の構成を観察した。他の2 側においては、TPを、それを支配する脛骨神経の分枝とともに骨から取り外し、ゴムボード上に固定し、水浸させた。続いて、手術用双眼実体顕微鏡（オリンパス社製）を使用し、標本の神経上膜を取り除き、周膜レベルでのTP支配神経の筋内分布パターンを解析した。【倫理的配慮、説明と同意】本研究で使用した遺体は死体解剖保存法・献体法に基づき、生前に適切な説明をし、文書による解剖の同意を得ている。解剖は全て、定められた解剖実習室内にて行った。【結果】腓骨より起始する筋束は筋間中隔により浅深2 層に分かれ、腓骨から起始する筋束を集める停止腱の形状は水平面でU字型であることを確認した。脛骨から起始する筋束は停止腱によって2 分されていることが新たにわかった。 また、停止腱に対する筋束の羽状角は近位端で最も小さかった。TPを支配する脛骨神経の枝は2 本存在し、それぞれ同筋の近位と遠位から筋へ入った。本筋を支配する近位の枝はTPの筋膜と起始腱に放散し、筋への直接支配は確認できなかった。一方、TPを主として支配する遠位の枝の分岐パターンと筋内分布を周膜レベルで精査した結果、TPの筋束は、下腿骨間膜から起始する深層の筋束とそれ以外の浅層の筋束の2 グループに分けられることがわかった。また、本解析レベルにおいて確認された神経終末部はTPの部位によらず筋全体に存在した。【考察】TPの個体発生を調べたBardeen（1907）によれば、TPの筋原基は発生初期において脛骨遠位1/2 の外側に位置し、それが近位外側に成長することで成体のTPになるという。従って、TPは遠位に位置する筋成分に近位の要素が新しく加わって形成されている可能性がある。それは、本結果におけるTP支配神経の神経束が遠位と近位の枝に分かれていることと興味深い一致を見せた。また、哺乳類の中には、TPが浅層部と深層部の筋束に分かれる種があることより（Le Double, 1897）、遠位の枝の解析によりTPが浅層・深層の2 グループに分けられるという今回の結果は系統発生学的な意義を持つ可能性がある。今回得られたヒトTP支配神経の筋内分布の意義を明らかにする為、今後、TPの比較解剖学的な研究に加え、本筋の形態形成を個体発生学・系統発生学的に検討したい。ボツリヌス毒素の隣接筋への不要な拡散は、その濃度に依存する（Borodic et al., 1990; Eleopra et al., 1996）。そして同毒素は最も神経筋接合部が密である部位に反応するとされ、最小限の毒素注入で臨床的効果を得る為には注入部位が重要とされている（Childers, 2004）。しかし本研究では、TP支配神経の神経筋終末部は、その部位によらず筋全体に存在した。TP筋束の停止腱に対する羽状角は近位端で最も小さいことから、他の部に比べ、近位端の筋束の張力が、腱を含めたTP全体の短縮に、より影響すると思われる。よって、ボツリヌス毒素の注入部位はTP近位端とすることが最も効果的ではないかと考えられた。【理学療法学研究としての意義】TPの形態形成を理解することは、ヒト下肢の運動における本筋の役割を深く考察することを可能とし、臨床上問題となるTPの様々な症状に対する治療法を考察する基礎となり得る。"}],"abstractLicenseFlag":"disallow"}],"creator":[{"@id":"https://cir.nii.ac.jp/crid/1410282680551361923","@type":"Researcher","personIdentifier":[{"@type":"NRID","@value":"9000258378068"}],"foaf:name":[{"@language":"ja","@value":"堤 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一般社団法人日本理学療法学会連合）"}],"prism:publicationDate":"2013","prism:volume":"2012","prism:number":"0","prism:startingPage":"48101062","prism:endingPage":"48101062"},"availableAt":"2013","foaf:topic":[{"@id":"https://cir.nii.ac.jp/all?q=%E5%BE%8C%E8%84%9B%E9%AA%A8%E7%AD%8B","dc:title":"後脛骨筋"},{"@id":"https://cir.nii.ac.jp/all?q=%E8%84%9B%E9%AA%A8%E7%A5%9E%E7%B5%8C","dc:title":"脛骨神経"},{"@id":"https://cir.nii.ac.jp/all?q=%E8%A7%A3%E5%89%96","dc:title":"解剖"}],"dataSourceIdentifier":[{"@type":"JALC","@value":"oai:japanlinkcenter.org:1003391743"},{"@type":"CIA","@value":"130004585401"}]}