Fetal development of the thoracolumbar fascia with special reference to the fascial connection with the transversus abdominis, latissimus dorsi, and serratus posterior inferior muscles
Fetal development of the thoracolumbar fascia with special reference to the fascial connection with the transversus abdominis, latissimus dorsi, and serratus posterior inferior muscles
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DOI：
10.1007/s00276-020-02668-4
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发表时间：
2021-01-12
影响因子：
1.4
通讯作者：
Jin, Zhe Wu
中科院分区：
文献类型：
--
作者：
Abe, Hiroshi;Hayashi, Shogo;Jin, Zhe Wu
目的三层胸腰筋膜包被竖脊肌和腰方肌，一直是理疗师关注的问题。方法对25例6~37周胚胎和胎儿(CRL，15~310 mm)进行组织学检查。结果6周时，腹肌向TLF的起始后层(PTLF)延伸，但至近足月时，腹肌的连接变窄，仅限于外斜筋膜。TLF的中层(MTLF)在9周时表现为横筋膜的后方延续，根据近期脊柱伸展的机械需求，它生长为髂肋肌和腰方肌之间的粗大肌间隔膜。因此，MTLF的侧端从腹壁变为背部或pTLF。后下锯肌在9周后始于pTLF，但背阔肌与筋膜的联系建立得较晚。近远期，臀大肌附着于覆盖骶骨后方多裂的腱膜上。结论我们否定了MTLF作为原始上轴肌和下轴肌之间边缘组织发育的假说。这项研究似乎是第一份报告，表明在产前生活中，筋膜间联系及其与肌肉的地形关系可能会发生剧烈变化；TLF可能是最好的样本。
Purpose The three-layered thoracolumbar fascia (TLF) encapsulates the erector spinae and the quadratus lumborum and has been a major concern for physical therapists. However, knowledge of its prenatal development and growth is limited.Methods Histological examination of 25 embryos and fetuses at 6-37 weeks (CRLs, 15-310 mm).Results At the posterior end, the abdominal muscles continued toward an initial posterior layer of the TLF (pTLF) at 6 weeks, but the connection became narrow and limited to the obliquus externus aponeurosis until near term. The middle layer of the TLF (mTLF) appeared as a posterior continuation of the transversalis fascia at 9 weeks and, depending on a mechanical demand for the vertebral column extension near term, it grew as a thick intermuscular septum between the iliocostalis and quadratus lumborum. Thus, the mTLF lateral end changed from the abdominal wall to the back or pTLF. The serratus posterior inferior originated from the pTLF after 9 weeks, but a connection of the latissimus dorsi with the fascia was established much later. Near term, the gluteus maximus was attached to an aponeurosis covering the multifidus behind the sacrum. Therefore, the pTLF extended to cover the gluteal muscles.Conclusion We rejected the hypothesis that the mTLF develops as a marginal tissue between the primitive epaxial and hypaxial muscles. This study seemed to be the first report showing a fact that, within prenatal life, a drastic change is likely to occur in interfascial connections and their topographical relation to muscles; the TLF might be the best sample.