人的<em>股外侧肌</em>骨骼肌活检使用韦尔 - Blakesley Conchotome
Summary
This video demonstrates the technique of percutaneous muscle biopsy of the human vastus lateralis using the Weil-Blakesley conchotome.
Abstract
使用韦尔 – Blakesley conchotome经皮肌活检是公认的在临床和科研实践。它是一种安全，有效和耐受性良好的技术。在韦尔 – Blakesley conchotome有一个尖锐的针尖刺骨用4 – 第6毫米宽的空洞。它是通过一个5插入 – 10毫米皮肤切口，并且可以被操纵用于受控的组织穿透。尖端被打开，在组织内关闭，然后通过90 -180°旋转切割肌肉。下面重复获得的肌肉量采样可以从20毫克至290毫克，可以为组织学和分子生物学研究进行处理而变化。伤口需要保持干燥和剧烈的身体活动保持最小为大约72小时，虽然活动的正常水平可以立即重新启动之后的过程。当接近注重的是主体，全无菌和后期护理程序选择此过程是安全有效的。右和left-component左侧astus外侧适于活检取决于参与者偏好。
Introduction
获得骨骼肌的肌病和其他神经肌肉退化性疾病的诊断依赖于安全和有效的方法这是可以接受的，而不是失能向患者1。从历史上看，获得的肌肉组织进行分析的方法包括在全身麻醉或验尸进行开放式活检。这些技术使肌肉的直接可视化，并允许更大的一块肌肉进行活检。给定这些技术必须在患者住院和恢复方面的潜在的缺点，经皮“半开放”肌肉活组织检查方法被引入作为替代。最初是由杜氏（1806年至1875年），谁使用用套针自行建造针，并能获得来自活受试者的肌肉样品没有全身麻醉2中执行了这种技术。自那时以来，各种形式的活组织检查针已经使用3,4,5。然而，活组织检查Ñ通过贝里斯特伦在1962年开发的eedle已在临床实践中最常用的;无论是在儿童和成人，以及在研究6,7,8,9,10。它拥有锐利的套管针，切割套管和推杆驱逐组织后活检。从该过程获得的肌肉的产量已报告从25 -293毫克的范围内重复采样11,9之后。
HENRIKSSON介绍了1979年韦尔- Blakesley conchotome作为替代半开放式的肌肉活检的方法（ 图1）12。该仪器是不像贝里斯特伦结构单一的结构和设计就像一个锋利的尖咬钳子。针尖大小的范围可以从4毫米到6毫米的宽度。当刺骨尖端的两个边缘相对，中空形成确保肌肉的捕获。该conchotome通过5插入 – 10毫米皮肤切口并且避免需要一个套管针穿透肌肉和上覆筋膜作为scalpel可被用来使一个轨道下降到肌肉。
此方法允许受控的组织穿透具有高度的机动性13,14。它是网站，不当的压力可能损坏的神经血管或底层骨结构如特别有用的。在胫骨前15,14的部位。使用conchotome肌肉收益率是可变的，并在我们的实践20 – 200毫克的肌肉已经多次取样后获得。该conchotome过的Bergstrom针的一个潜在的优势，此外，以高度的机动性它提供的，是该咬尖端并不需要被削尖或作为贝里斯特伦的套管针构造16取代经常。
使用韦尔Blakesley conchotome肌肉活检的总体目标是为了获得足够量的肌肉组织，以使能对诊断和resear组织化学和分子分析CH研究。这是一个简单而安全的过程，可以很容易地了解到。利用这种技术，适合于活检肌肉包括二头肌，三头肌，三角肌，腓肠肌，胫骨前肌，比目鱼和sacrospinals 17,15,7,18,14。 股外侧的最外部分是用于活检最常见的部位，因为它避免了大腿内的主要神经血管结构。它被识别大约三分之二向下的假想线接合髂前上棘和髌骨。肌肉形态学数据，例如肌纤维区域，肌纤维的比例，毛细血管密度从股衍生外侧采样是在文献中允许研究11,19之间的比较广泛的应用。
Protocol
Representative Results
Discussion
为了保证参与者的安全，高效地进行肌肉活检，至关重要的是要注意协议中的关键步骤。
参加者必须在认真考虑排除标准，以避免并发症，如出血，伤口愈合不良选择。整个手术过程中严格无菌是必不可少的。正确的技术的应用将保证参加者的舒适性，最大限度地减少不必要的创伤参与者的组织，并允许分析足够的样本产量。有时候，可能很难获得肌肉样品，特别是如果参?…
Disclosures
The authors have nothing to disclose.
Acknowledgements
We wish to thank the study participants for making this work possible and the staff at the NIHR Southampton Biomedical Research Centre and the Wellcome Trust Clinical Research Facility, University Hospital Southampton for assistance with study measurements.
This work was supported by the NIHR Southampton Biomedical Research Centre, Nutrition, the MRC Lifecourse Epidemiology Unit and the University of Southampton. This report is independent research by the NIHR BRC Funding Scheme. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. AMB is supported by a NIHR Clinical Research Fellowship, HPP is supported by the NIHR Southampton Biomedical Research Centre.
Materials
| Weil-Blakesley conchotome | Gebrüder Zepf Medizintechnik, Dürbheim, Germany | None | 6 mm biting tip |
| 5 ml 2% lidocaine | Generic use | None | One 5ml vial should suffice for adequate anaesthesia |
| Alcohol swab | Generic use | None | |
| 5 mls syringe | Generic use | None | |
| 25G and 23G sterile needles | Generic use | None | |
| Sterile scalpel size 11 | Generic use | None | |
| Sterile gauze squares | Generic use | None | |
| Sodium chloride 0.9% 10 ml | Fannin | 1122/002/001 | |
| Steri-Drape™ Small Drape with Adhesive Aperture | 3M | 1020 | |
| ChloraPrep 2% w/v /70% v/v cutaneous solution | CareFusion | 270400 | Two |
| Steri-Strip™ 1/4 inch x 3 in Reinforced Adhesive Skin Closures | 3M | R1541 | |
| PRIMAPORE sterile dressing 15cm x 8cm | Smith & Nephew |
66000318 | |
| Cotton crepe bandage Hospicrepe 233 7,5 cm x 4,5 m | Hartmann | 915562 | |
| Flexible cohesive bandage Co-Plus LF | BSN medical | 2904565 | |
| Disposable absorbent sheet | Generic use | None | |
| Micropore or transpore tape | Generic use | None | |
| Sterile gown with sterile paper towels | Generic use | None | |
| Sterile gloves | Generic use | None |
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