坐骨神经几种表面定位数据

对80具成人尸体坐骨神经进行了定位测量。结果如下:1.在大转子与髂后上棘连线中点垂线下33.3mm;2.骶尾连合与大转子连线中点外侧9.7mm;3.坐骨结节与大转子连线上距坐骨结节外29.2mm;4.坐骨结节与髂后上棘连线中点外31.6mm。此外,还对坐骨神经与梨状肌关系进行了分型统计。     

臀三角的应用解剖

目的确定臀三角内梨状肌上、下孔和坐骨神经的体表定位,为临床应用提供解剖学资料。方法解剖观察30侧成人臀区标本。以同侧股骨大转子外侧缘最突出点(A)、坐骨结节(B)、髂后上棘(C)三点,形成的三角形区域称为臀三角。观测臀三角内梨状肌、坐骨神经、梨状肌上、下孔以及穿梨状肌上、下孔的血管神经与臀三角的位置关系。结果臀三角各边的长度分别为:髂后上棘转子间距,男(15.2±1.35)cm,女(11.5±0.72)cm;髂后上棘结节间距,男(13.3±0.87)cm,女(10.3±0.49)cm;转子结节间距,男(8.3±0.83)cm,女(5.5±0.61)cm。臀上动脉、静脉、神经出入梨状肌上孔的体表投影在髂后上棘与大转子连线中、上2/5交界处向下0~6.8 mm内;臀下动脉、静脉、神经出入梨状肌下孔处的体表投影在髂后上棘与坐骨结节连线中、下2/5处;坐骨神经出梨状肌下孔处的体表投影在坐骨结节与大转子连线中外3/5处。结论臀三角的相关数据对临床应用具有一定的参考价值。     

臀上神经的应用解剖

为髋关节直接外侧入路确定臀上神经的体表投影和手术安全区 ,在 44侧的成人尸体标本上 ,解剖观测了与该入路关系紧密的臀上神经最下支分支的分布。结果手术入路的安全区为①在经大转子尖分别作与髂后上棘连线、髂嵴垂直连线、髂前上棘上方 3cm和髂前上棘连线 ,在这些连线上 ,最下支距大转子尖的距离分别为 5 5± 0 6、 4 8± 0 6、 4 3± 0 6、 6 4± 0 8cm ;②在经大转子外侧最凸点分别作与髂后上棘连线、髂嵴垂直连线、髂前上棘上方 6cm和 3cm的髂嵴连线 ,最下支距大转子外侧最凸点的距离分别为 1 0 0± 0 8、 9 0± 0 8、 7 5± 0 6、 8 9± 0 7cm。上述两组数值所在点作连线即分别为最下支神经的体表投影。结果表明 :投影以下至大转子尖或大转子外侧最凸点之间无明显血管神经分布 ,在此区内撑开臀中、小肌肌纤维显露髋臼均不会损伤臀上神经     

坐骨神经桥接颈7神经根二期移位重建截瘫下肢功能的应用解剖

目的:为带血供的坐骨神经桥接颈7神经根二期移位重建截瘫下肢功能提供解剖学依据。方法:在动脉内灌注红色乳胶30侧成人下肢标本上,解剖观测坐骨神经营养血管的来源、分布和吻合;坐骨神经与自身躯干长度比例;选择性臀下动脉墨汁注射。结果:坐骨神经臀段营养血管来自臀下动脉,由前内侧进入,外径(1.5±0.7)mm(0.6～3.8mm);股后段来自股深动脉穿支,由前外侧进入;小腿段胫神经来自胫后动脉分支。上述节段血管在神经干表面分出升支和降支,彼此吻合,形成一个纵贯神经全长和供血丰富纵向的吻合血管链。自梨状肌下缘至内外踝连线,神经长(79.3±3.6)cm(70.0～86.0cm),梨状肌下缘至锁骨上缘中点距离为(60.6±3.1)cm(51.0～66.0cm)。选择性臀下动脉墨汁注射显示胫神经远端有墨染。结论:臀下动脉坐骨神经营养支是带血供坐骨神经移位桥接重要的供血途经。     

髋关节内侧入路应用解剖

目的:为髋关节内侧手术入路及如何避免易损伤结构提供解剖学依据。方法:对60侧成尸下肢标本,参照髋关节内侧入路的层次对相关结构和神经血管进行解剖观测。结果:耻骨肌由股神经支配占97.2%,由闭孔神经支配占2.8%;长收肌由闭孔神经前支支配,入肌点与同侧耻骨结节之间的距离为(71.4±23.2)mm(50~95mm);股薄肌由闭孔神经前支支配,入肌点与同侧耻骨结节之间的距离为(138.8±35.1)mm(105~175mm);短收肌和大收肌的前部纤维由闭孔神经后支支配,进入大收肌的神经入肌点与同侧耻骨结节之间距离为(122.2±18.4)mm(102~145mm)。结论:1、髂腰肌与耻骨肌间隙为腰丛分支与股神经的神经界面,耻骨肌与短收肌、大收肌的间隙为股神经和闭孔神经、坐骨神经神经界面。2、手术入路中长收肌是手术的重要标志性结构,从该肌外侧缘深入经缝匠肌与长收肌之间再经髂腰肌与耻骨肌间隙(神经界面)到达病变部位路径;从其内侧缘深入即为从长收肌与股薄肌间隙经短收肌、大收肌与耻骨肌间隙(神经界面)到手术部位路径。     

梨状肌形态和止点变异一例

在解剖一成年女尸右下肢时,见梨状肌形态和止点变异,现报道如下:梨状肌起于第四骶前孔前外侧骨面,起端宽19mm,厚1.5mm,于坐骨神经背侧出坐骨大孔.出坐骨大孔后被高位分出的胫神经和腓总神经夹持下行,肌的周围被脂肪组织和筋膜包裹,最后以细长扁腱止于腓骨头后外侧。梨状肌从始端到止端全长为42.7cm,依其形态结构可分为四段(附图):上段为始端至坐骨结节与股骨大转子尖连线之间的一段,     

梨状肌上下孔血管神经多处变异一例

在局部解剖学课的尸体解剖过程中发现1例左侧穿经梨状肌上、下孔的血管神经均存在变异,臀上、下神经共干穿过梨状肌;臀下血管由梨状肌上孔穿出;坐骨神经属Ⅱ型变异;股后皮神经由2个神经根汇合而成.现报道如下. 男尸,身高约165 cm,年龄约50岁.左侧梨状肌起自骶骨前面,穿坐骨大孔,止于股骨大转子,肌腹长7.5 cm,宽3.1cm.臀上神经和臀下神经共干穿过梨状肌,臀上神经分支进入臀中肌支配该肌,臀下神经分支进入臀大肌支配该肌.臀下血管未经由梨状肌下孔穿出,而由梨状肌上孔穿出,分支进入臀大肌.臀上血管未见异常.坐骨神经属Ⅱ型变异,胫神经穿梨状肌下孔,腓总神经穿梨状肌.股后皮神经由2个神经根汇合而成,1根穿梨状肌,1根穿经梨状肌下孔,2根在距梨状肌下缘0.5cm处汇合成股后皮神经.阴部内血管和阴部神经未见异常.右侧梨状肌上下孔穿经结构未见异常.     

髋关节外侧入路安全区的解剖定位与临床应用

目的　为髋关节直接外侧入路确定臀上神经最下支的体表投影和手术安全区。方法　在 46侧无下肢疾患的成人尸体标本上 ,解剖定位臀上神经最下支的体表投影 ,并在临床进行应用。结果　手术入路的安全区为①术前 :以大转子外铡最凸点为圆点 ,该点与髂嵴垂直连线上的 9cm处为半径作一弧线 ,该线即为臀上神经最下支的体表投影 ,弧线与大转子外侧最凸点之间的扇形区域即为安全区。②术中 :以大转子尖为圆心 ,该点与髂嵴垂直连线上的 5cm处为半径作一弧线 ,弧线与大转子尖的扇形区域为安全区。结论　安全区内无重要血管神经分布 ,在此区内撑开臀中、小肌肌纤维显露髋臼不会损伤臀上神经。临床应用 2 0 0余例 ,均未发生髋关节外展功能障碍 ,效果良好     

臀大肌的血管和神经供给

本文观察了50具成年尸体(男43具,女7具)共100例臀大肌的形态以及血管神经供给。臀大肌的主要营养动脉,系由臀上动脉、臀下动脉以及股深动脉的第一穿动脉分支所供给。臀上动脉出梨状肌上孔处的管径,平均为3.14±0.8mm。该动脉出梨状肌上孔处的体表位置,恰在从坐骨结节向上至髂嵴垂直连线的中点,且以刚好位于垂直连线上的占多数(84%±3.66)。在100例臀大肌中,只有96例具有臀下动脉。它们出梨状肌下孔处的管径平均为3.52±0.74mm。该动脉出梨状肌下孔处的体表位置相当于上述垂直连线的下中三分之一交点的内侧,距离此线平均为15.29±0.45mm。根据臀上动脉与臀下动脉的分布范围,我们将臀大肌的动脉分布区分为5个类型:其中Ⅰ型有67例(67%);Ⅱ型有18例(18%);Ⅲ型有9例(9%);Ⅳ型有4例(4%);Ⅴ型有2例(2%)。40例臀大肌的伴行静脉中,臀上动脉的伴行静脉32例(80%)为二支,8例(20%)为一支;臀下动脉的伴行静脉,35例(87.5%)为二支,5例(12.5%)为一支。臀大肌由臀下神经供给,二支的较多(24例),一支和三支的次之(各8例)。它们的直径平均为1.69±0.05mm,长度平均为62.78±2.12mm,并且多从臀大肌的中部或下部进入肌内。     

坐骨神经在坐骨结节及股骨大转子间的体表定位

目的:通过对成人坐骨结节宽度的测量及坐骨神经与坐骨结节及股骨大转子距离观察测量,得出从体表定位坐骨神经的方法。方法:测量40块髋骨的坐骨结节最大宽度及最后突处的宽度;解剖成人尸体28具(56侧),测量坐骨神经在坐骨结节与股骨大转子间的宽度、坐骨结节最突处与股骨大转子最外突点距离及坐骨结节最后突处与坐骨神经内侧缘间距离。结果:坐骨神经在坐骨结节的最后突处与股骨大转子最外凸点连线的内中1/3交点走行,即在坐骨结节最内侧缘与股骨大转子最外突点连线的中点处走行。结论:体表投影的描述需要明确体表标志的准确部位,才能准确定位血管神经,避免定位时的误差。     

大鼠异体神经移植后再生神经生物力学性质研究

用Ｗｉｓｔａｒ鼠作为实验模型,切下１ｃｍ坐骨神经,再用同系Ｗｉｓｔａｒ鼠坐骨神经异体桥接,修复坐骨神经的缺损,术后２４周对Ｗｉｓｔａｒ鼠的手术侧与正常侧用指标抗张强度与弹性模量（ε＝１０％）进行测试,辅以电镜,光镜观察。     

Masseteric nerve: A possible donor for facial nerve anastomosis?

In the medical treatment of facial nerve paralysis a large number of different techniques have been developed to restore the function of the facial nerve. These include (a) the ipsilateral nerve grafting (e.g., partial hypoglossal-facial, spinal accessory-facial, partial glossopharyngeal-facial), (b) crossfacial nerve grafting and (c) temporal muscle flaps or even free muscle transfers. None of these techniques uses the masseteric nerve as a graft for reconstruction of the facial nerve. This preliminary report deals with the anatomical basis, which could lead to a new technique. The masseteric nerve leaves the infratemporal fossa through the mandibular notch, accompanied by the masseteric artery. At this level the nerve consists in nine of 36 cases studied of only one branch (25.0%), in 17 cases of two branches (47.0%), in nine cases of three (25.0%), and in the remaining case of four branches (2.8%). There are three main reasons for considering the masseteric nerve as a possible donor for at least the orbicular branch of the facial nerve: (1) The approach to the mandibular notch is quite simple; (2) since the nerve consists of two or more branches in 75.0% of the cases, severe dysfunction of the masseter muscle should not occur; (3) if there is complete denervation of the masseter muscle, its function may be taken over by the temporalis muscle. Clin. Anat. 11:396–400, 1998. © 1998 Wiley-Liss, Inc.     

bFGF对同种异体神经移植后周围神经再生的影响

目的 :探讨bFGF对同种异体神经移植后周围神经再生的影响。方法 :将反复冻融的大鼠神经移植于另一大鼠的坐骨神经 ,实验组注射bFGF 1 0 0u/d共 1 0d ,对照组注射生理盐水 1 0d。术后大鼠存活 1 2周 ,光镜下用体视学方法测试再生神经纤维的面数密度 (NA)、面积密度 (AA)、横切面面积 (AE)、脊髓前角运动细胞和脊神经节细胞的体密度 (VV)、数密度 (NV)。结果 :两组均可见再生神经纤维长入异体移植神经并向远段延伸。实验组再生神经纤维的NA、AA、脊髓前角运动细胞和脊神经节细胞的VV、NV 与对照组的比较 ,有显著性差异。结论 :bFGF能促进周围神经再生 ,对脊髓前角运动细胞和脊神经节细胞的存活有保护作用。     

Intramuscular Martin-Gruber anastomosis

The incidence and morphology of the intramuscular Martin-Gruber anastomosis are presented based on the study of 118 human cadavers (55 male, 63 female). The Martin-Gruber anastomosis was found in 25 (21.2%) of the 118 cadavers. It occurred in 11 (20%) of the 55 male cadavers (4 bilateral, 7 unilateral; 5 left and 2 right) and in 14 (22.2%) of the 63 female cadavers (2 bilateral, 12 unilateral; 8 left and 4 right). Therefore, the Martin-Gruber anastomosis was found in 31 (13.1%) of the 236 upper limbs. According to a recent classification (Rodríguez-Niedenführ et al., 2000), pattern I was found in 29 cases (93.5%), corresponding to Type A in 13 (41.9%), Type B in 3 (9.7%) and Type C in 13 (41.9%), whereas pattern II was found in 2 cases (6.5%), both being a duplication of Type IC. Intramuscular Martin-Gruber anastomosis was a single anastomosis that originated in all cases from the anterior interosseous nerve (pattern IC) and then passed through a muscle bundle of the flexor digitorum profundus and behind the ulnar artery to join the ulnar nerve as a single connecting branch. It did not send branches to the flexor digitorum profundus. This intramuscular course was observed in 3 of the 13 cases of Type C anastomosis (23.1%) or 3 cases out of 31 Martin-Gruber anastomoses (10%).     

Sural-tibial nerve communications in humans

We investigated the occurrence of a communication between the sural and tibial nerves in 49 legs of 28 Japanese cadavers. In front of the calcanean tendon, we found the communication in 7 legs (14.3%) or in 5 cadavers (18.9%). The sural nerve gave rise to a number of medial and lateral branches, including the lateral calcanean branch at the lateral side of the ankle. The communicating branch with the tibial nerve arose from the first medial branch and pierced the deep fascia of the leg. In 4 cases, the U-shaped communication was formed between the sural and tibial nerves, and in 3 cases, the Y-shaped communication. Electrophysiologi-cal evidence of an anomalous motor function of the sural nerve has been reported recently. We consider that the U-shaped communication between the sural and tibial nerves gives a morphological basis to the motor function of the sural nerve.     

Martin-Gruber anastomosis revisited

Based on a study of 70 human cadavers (31 male, 39 female) and on cases described previously, we propose a new classification of the Martin-Gruber anastomosis, a neural connection between the median and ulnar nerves in the forearm. The anastomosis was found in 16 (22.9%) cadavers, being bilateral in three (18.7%) and unilateral in 13 (81.3%), five right and eight left. It occurred in eight (25.8%) of the 31 male cadavers and in eight (20.5%) of the 39 females. Therefore, the anastomosis was found in 19 (13.6%) of the 140 forearms. In Pattern I (89.5%) the anastomosis was made by only one branch, whereas in Pattern II (10.5%) it was made by two. The individual branches were classified as Types a, b, and c based on the nature of their origin from the median nerve. Type a (47.3%) arose from the branch to the superficial forearm flexor muscles, Type b (10.6%) from the common trunk, and Type c (31.6%) from the anterior interosseous nerve. Pattern II was a duplication of Type c (10.5%). The anastomotic branch took an oblique or arched course before joining the ulnar nerve, undivided in 15 cases, but divided into two branches in four cases. The anastomosis passed in front of the ulnar artery in four cases, behind it in six, and in nine cases it was related to the anterior ulnar recurrent artery.     

The normal and variant clinical anatomy of the sensory supply of the orbit

Orbital and retro‐orbital pain are relatively common clinical conditions that are associated with such disorders as trigeminal, lacrimal, and ciliary neuralgia, cluster headaches, paroxysmal hemicrania, inflammatory orbital pseudotumor, trochleitis, and herpetic neuralgia ophthalmicus, thus making the nerves supplying the orbit of great clinical importance. Surprisingly, how pain from this region reaches conscious levels is enigmatic. Classically, it has been assumed that pain reaches the ophthalmic division of the trigeminal nerve (V₁) and travels to the descending spinal trigeminal nucleus. However, exactly where the receptors for orbital pain are located and how impulses reach V₁ is speculative. In this project, we reviewed all of the reported connections between the orbital nerves and V₁ in order to understand how pain from this region is transmitted to the brain. We found reported neural connections to exist between cranial nerve (CN) V₁ and CNs III, IV, and VI within the orbit, as well as direct neural branches to extra‐ocular muscles from the nasociliary, frontal, and supraorbital nerves. We also found reported neural connections to exist between the presumed carotid plexus and CN VI and CN V₁, CN VI and CN V₁ and V₂, and between CN V₁ and CN III, all within the cavernous sinus. Whether or not these connections are sympathetic or sensory or some combination of both connections remains unclear. An understanding of the variability and frequency of these neural connections could lead to safer surgical procedures of the orbit and effective treatments for patients with orbital pain. Clin. Anat. 27:169–175, 2014. © 2014 Wiley Periodicals, Inc.     

骨间前神经转位重建鱼际肌功能

前臂或腕部正中神经断裂,直接吻合后鱼际肌功能的恢复常常令人失望,为了解决这一难题,本文在120侧成人上肢解剖学研究的基础上,采用骨间前神经转位术修复鱼际肌支9侧,获得成功.     

神经生长因子对周围神经损伤后再生和修复的实验研究

手术切除５ｍｍ兔的尺神经，在两断端间连接肌桥并套装硅胶管，形成一个封闭腔，向腔内注入神经生长因子。间隔不同时间取尺神经桥接区、桥接区近段、远段、尺神经的脊髓投射节段和相应脊神经节，用光镜和电镜观察神经溃变和再生情况并作图像分析；用酶标示踪和电生理方法检测神经通路的重建状况。结果显示，周围神经离断后，肌束桥接并用硅胶管套装后注入外源性神经生长因子，可明显地促进离断神经的再生和修复。     

红白肌纤维为肌桥缝接狗神经缺损的实验形态学研究

目的 :试图从作肌桥的肌肉条件 (红、白肌、长、短肌纤维和肌纤维排列等 )方面 ,能探讨出最适宜神经再生长条件的肌肉 ,作为临床应用的肌桥。方法 :根据文献肌纤维分型记载和本实验用SDH染色 ,确定的的红白肌纤维肌桥 ,再分别给狗股神经和正中神经缺损 3cm外缝接上 ,待术后 3 0 0d ,切取桥接神经部位 ,并将它分成神经近段、肌桥段、神经远段和远、近端缝合段五个部分。常规制成光电镜标本最后镜下观察和Luzex -F图像分析仪测定。结果 :红肌纤维为主的肌桥明显较白肌纤维为肌桥的再生效果好 (P <0 .0 5 )特别是缝匠肌尾侧部 (红肌纤维为主 )为肌桥更明显较其颅侧部 (白肌纤维为主 )的神经纤维再生数量多 (P <0 .0 5 )。结论 :并非机体肌肉为肌桥都有同样神经再生效果 ,缝匠肌尾侧部可能是一个适宜神经再生条件的肌肉。