腕部桡尺神经浅支的解剖学研究

目的为在桡、尺骨远端骨折处经皮穿针固定提供一个安全进针区域,减少桡、尺神经浅支的损伤提供解剖学依据。方法成人前臂标本18侧,观察桡、尺神经浅支的走行规律。结果桡神经浅支从肱桡肌和桡侧腕长伸肌腱平均间穿出点与桡骨茎突纵向平均距离(L_1)为[(7．4±0．7)cm,(?)±s,下同]。其中16侧在穿出点与桡骨茎突纵向平均距离(L_2)为(4．5±0．6)cm处发出一级分支,称为尺侧支(Ⅰ)和桡侧支(Ⅱ)；尺侧支的桡侧分支(I a)与桡骨茎突的横向平均距离(L_3)为(1．0±0．3)cm,桡侧支与桡骨茎突横向平均距离(L_4)为(0．8±0．3)cm,纵向平均距离(L_5)为(1．5±0．4)cm。2侧桡神经浅支桡侧支被前臂外侧皮神经所替代。尺神经浅支手背支均从尺骨茎突的掌侧走行,与尺骨茎突距离为(0．9±0．3) cm。结论以桡骨茎突为中心,横向距离0．4cm．纵向距离0．6cm的椭圆形区域为桡神经分布相对盲区．从该区经皮克氏针固定桡骨远端,可有效地减少桡神经浅支损伤的发生率。尺骨远端骨折应从尺骨茎突背侧经皮进针相对较安全。     

桡神经浅支变异二例报道

上肢神经变异较多，尤以肌皮神经变异比较常见，桡神经浅支则相对比较恒定。近期我们在解剖过程中发现2例三侧桡神经浅支缺如，由前臂外侧皮神经分支分而于虎口区、拇指及示指近节背侧区域。     

桡神经浅支卡压的解剖与临床

目的:了解桡神经浅支卡压的依据并讨论了该征的诊断及治疗原则。方法:解剖观测了20具40侧成人上肢标本桡神经浅支穿出处的局部解剖特点及其距桡骨茎突的距离,随访了12例患者,9例采用局部封闭治疗,3例采用手术神经松解治疗。结果:桡神经浅支穿出部位为腱性组织所包绕。该处筋膜将肱桡肌腱挤在一起,从而易于受压。临床随访6个月至2年,保守及手术治疗患者症状均完全消失无复发。结论:解剖:桡神经浅支在前臂中下段易发生卡压有其解剖学基础。临床上病程短症状轻患者保守治疗往往能有较好疗效,病程长症状重或存在其它病理性压迫患者往往需要手术治疗。     

桡动脉腕上皮支前臂外侧逆行皮瓣的应用解剖

目的　为桡动脉腕上皮支前臂外侧岛状皮瓣的设计提供解剖学依据。　方法　 3 0侧经动脉灌注红色乳胶成人上肢标本 ,解剖观测桡动脉腕上皮支的起源、分支分布及其邻近动脉吻合。　结果　桡动脉腕上皮支于桡骨茎突上 (4 .2± 1.3 )cm始于桡动脉桡侧 ,干长 (0 .8± 0 .5 )cm ,外径 (0 .8± 0 .2 )mm。分出数支外径在 0 .3～ 5 .0mm皮支分布前臂远段桡侧面 ,腕上皮支与桡骨茎突返支、鼻烟壶皮支吻合 ,并构成头静脉、桡神经浅支和前臂外侧皮神经前支的营养血管。　结论　以桡动脉腕上皮支为蒂的前臂外侧岛状皮瓣 ,可移位修复手背组织缺损。     

桡神经浅支的功能解剖学观察

目的 对桡神经浅支进行功能解剖学观察,为桡神经浅支移植修复神经缺损提供解剖学依据.方法 取成人前臂防腐标本30侧,测量下列数据:桡神经浅段长,桡神经浅支深段长,桡神经浅支不同部位的横径以及桡神经浅支分支处与前臂外侧皮神经、正中神经之间的垂直距离.用8侧新鲜肢体的前臂神经作冰冻切片,进行HE染色,在显微镜下计数其内各自的...     

正中神经指浅屈肌肌支移位修复尺神经运动支的应用解剖

目的 通过对正中神经指浅屈肌肌支和尺神经运动支的解剖学研究,为正中神经指浅屈肌肌支移位修复尺神经运动支,恢复手内在肌功能的临床应用提供解剖学基础.方法 选用20例40侧近期经福尔马林浸泡固定的成人上肢标本,暴露正中神经、尺神经,测量正中神经指浅屈肌肌支各项解剖学数据;应用图像分析系统对组织切片做定量分析,测算该肌支有髓神经纤维数目.临床模拟操作正中神经指浅屈肌肌支移位修复尺神经运动支.结果 正中神经第4肌支发出部位距离桡骨茎突和尺骨茎突连线(48.4±2.4)mm,入肌部位距离桡骨茎突和尺骨茎突连线(21.4±1.8)mm,可分离长度(27.1±1.2)mm,横径(1.2±0.2)mm,前后径(0.7±0.1)mm;尺神经的运动支和感觉支之间自然分束无损伤分离.长度为(7.1±0.70)cm;组织切片及图片系统测得正中神经指浅屈肌第4肌支有髓神经纤维数目为(1378.9±107.9)条.结论 正中神经指浅屈肌第4肌支可修复尺神经运动支,以期恢复手内在肌的功能.     

手部尺神经及小鱼际肌的解剖学研究

目的研究小鱼际肌变异及手部尺神经树枝状模式,观察小鱼际肌和尺神经的关系。方法对30例防腐尸体手(延边大学解剖学教研室提供)进行了解剖学研究,在4倍放大镜下解剖手的尺侧,记录小鱼际肌肌腹的数量和它们的变异,尺神经深支裂隙处小鱼际肌腱弓的组成模式,尺神经在每一个手的分支。观察小鱼际肌的变异和树枝状尺神经之间的关系。结果小指展肌在4例手有一个肌腹,在25例手有2个肌腹,在1例手有3个肌腹。小指短屈肌在4例手缺如,在22例手有一个肌腹,在4例手有2个肌腹。所有小指对掌肌都有两层,尺神经深支通过两层之间,有3种尺神经深支的裂隙模式,5种尺神经树枝状分布模式,根据解剖形态特点把小指展肌的运动神经支配模式分为4种类型。3例手的尺神经深支起点有变异,起自于尺神经远端至分支处。3例手的两个感觉支之间有一个交通支。2例手的尺侧感觉支有分支进入小指展肌。结论尺神经和小鱼际肌之间的解剖学关系是非常复杂的,这些解剖知识可以为腕尺侧疾病的诊断和治疗及手术提供解剖学依据。     

桡神经浅支卡压

桡神经浅支在前臂的卡压,临床上并不少见,容易被误诊为“桡骨茎突狭窄性腱鞘炎”、“网球肘”、“腕关节背侧韧带损伤”等等,为了解桡神经浅支在前臂的解剖特点及其可能的受压因素,加深对桡神经浅支卡压征的认识,作者作相应的解剖研究并随访华山医院自1988年至1996年20例病人,报告如下:     

带血管蒂骨膜瓣移位修复舟骨骨折的解剖与临床

目的通过解剖学观测,为腕背支骨膜瓣的临床应用提供依据.方法50侧成成人尸体上肢标本,观测骨间前动脉腕背支的走行、分支、分布及吻合情况,设计腕背支及其分支为蒂骨膜瓣移位术.结果(1)腕背支距桡骨茎突上(6.0±1.0)cm处,贴骨间膜背份下行分为内、外侧终支,分别与尺、桡动脉的腕背支相吻合.腕背支近端两侧分出尺、桡侧骨皮支,二者降支循尺、桡骨背份走行,并分出骨膜支分布;(2)临床应用15例,术后3～5个月骨折愈合,腕关节功能恢复.结论以骨间前动脉腕背支为蒂的骨膜瓣可用于舟、月骨损伤修复.     

桡神经浅支卡压的治疗体会

桡神经在行程中,其主干与分支均可因受压而发生卡压综合征。但桡神经浅支在前臂的卡压较少见,多为慢性反复劳损所致。其临床表现又不尽相同,常被误诊为桡骨茎突狭窄性腱鞘炎,因此对桡神经浅支卡压征的诊断和治疗日益受到重视。我科自l994年7月起共收治15例,经保守治疗及手术治疗效果满意,报告如下:1 临床资料本组15例,男12例,女3例。年龄18~45岁,平均29岁。其中工人6名,农民4名,战土3名,干部1名,学生1名。发生于右侧10例,左     

Superficial branch of the radial nerve piercing the brachioradialis tendon to become subcutaneous: an anatomical variation with clinical relevance.

We dissected 20 preserved Caucasian cadaveric upper limbs looking at the relation of the superficial branch of the radial nerve (SBRN) to the brachioradialis tendon. SBRN emerged from deep to superficial position by piercing the brachioradialis tendon near its dorsal border in four limbs. The resulting dorsal tendinous band compressed the nerve and prevented longitudinal gliding movement during ulnar flexion. This is likely to increase the risk of chronic compression neuropathy (Wartenberg's syndrome). In two of these four limbs, there was a communication between the SBRN and lateral cutaneous nerve of the forearm. No such communication was found in the remaining 16 forearms. This communication could contribute to the minimal area of sensory loss observed in Wartenberg's syndrome. We recommend that this anatomical anomaly is looked for and if present dealt with during surgical treatment of Wartenberg's syndrome, as it is likely to predispose to chronic compression neuropathy.     

Exposure of distal radius fractures using a direct radial approach with mobilization of the superficial branch of the radial nerve

Extraarticular and simple intraarticular fractures and malunions of the distal radius can be addressed through a direct radial approach that entails careful and meticulous handling of the soft tissues. This approach involves mobilization of the superficial branch of the radial nerve (SBRN) and extensor tendons of the first dorsal compartment. A Type I SBRN pattern is when the nerve presents as a single bundle. In Type II pattern, there are 2 major nerve groups present. With Type II branching patterns of the SBRN, careful intraneural dissection is required to mobilize the nerve branches into a safe location during surgery. The primary advantage of this approach is the ease of surgical dissection and avoidance of the flexor tendons of the fingers during surgery.     

The Variability of the Achilles Tendon Insertion: A Cadaveric Examination

Pathology associated with the Achilles tendon is a common problem, particularly at the site of insertion. A better understanding of the anatomy in this area would assist in developing and fine-tuning treatment options. A cadaveric examination was conducted using 60 human lower extremities (40 cadavers) to determine the location for the terminal insertion site of the Achilles tendon on the posterior aspect of the calcaneus. The average age of the specimens was 67.8 years (range, 43-98 years). Three different investigators examined each specimen, and a consensus as to the site of termination of the Achilles tendon was made. Upon inspection, 55% (22/40) of the limbs had the Achilles tendon inserting on the superior 1/3 aspect of the calcaneus, 40% (16/40) of the limbs inserted on the middle 1/3, and 5% (2/40) of the limbs inserted on the inferior 1/3. The distribution of the insertion was statistically different from random (P = .000371). Further, 8% (3/40) of the specimens revealed a partially contiguous relationship between the Achilles tendon and the plantar fascia. This correlated with the younger specimens (P < .0001). This study provides a better understanding of the anatomical relationship between the Achilles tendon, the calcaneus, and the plantar fascia.     

The prevalence of Chlamydia trachomatis infections in new patients at the Infertility Clinic, UOFS, Bloemfontein

Chlamydia trachomatis is a common sexually transmitted agent causing infertility. Routine screening tests or empirical antibiotic treatment of infertile couples may be justified by the prevalence of this organism. In this study the female partner of 40 consecutive infertile couples was investigated. As a screening test direct immunofluorescence (DIF) was performed on fixed smears from endocervical swabs. Of a total of 40 specimens, 11 (27.5%) were positive, 25 (62.5%) were negative and 4 (10.0%) were equivocal. DIF was repeated on smears from 3 of the last 4 patients and all 3 specimens were positive for C. trachomatis. One patient was lost to follow-up and excluded from the study. Of a total of 39 specimens the final results yielded 14 (35.9%) positive and 25 (64.1%) negative. Statistical analysis showed no correlation between the clinical history and the presence of C. trachomatis infection.     

The microbiological etiology of acute pelvic inflammatory disease in Pelonomi Hospital, Bloemfontein

In 40 women with acute pelvic inflammatory disease (APID) specimens for microbiological study were obtained from the rectum, urethra, vagina, cervix and peritoneal cavity. In most patients (83%) the aetiology of the infection was polymicrobial. Chlamydia trachomatis was the most common invader (73.3%), followed by anaerobic organisms (46.6%), Neisseria gonorrhoeae (40%) and aerobic organisms (26.6%). Only 1 patient had a positive peritoneal culture for N. gonorrhoeae. All the other positive Chlam. trachomatis and N. gonorrhoeae cultures were obtained from rectal, urethral and cervical specimens. The positive anaerobic and aerobic cultures were all from peritoneal cavity specimens.     

对人子宫内膜月经周期中增殖细胞核抗原标记细胞的探讨

本实验使用因子宫肌瘤摘出的子宫标本４０份。根据主诉与子宫内膜标本ＨＥ染色，将标本分成８个期。免疫组织化学法进行子宫内膜月经周期增殖细胞核抗原（ＰＣＮＡ）染色反应。结果发现，ＰＣＮＡ标记细胞在增殖初期腺上皮（４０％）和增殖中期间质中部（４８％）标记率最高，而表面上皮细胞中很少；排卵期可见腺上皮的ＰＣＮＡ标记细胞再次增加；分泌期只有间质中可见ＰＣＮＡ标记细胞。本结果对人月经周期正常子宫内膜细胞增殖变化情况提供了新资料。     

Biomechanical Comparison of Intramedullary Beaming and Plantar Plating Methods for Stabilizing the Medial Column of the Foot: An In Vitro Study

Charcot neuroarthropathy often results in a rocker-bottom foot deformity, which leads to ulceration, infection, and amputation. Surgical techniques to reconstruct the medial column include intramedullary beaming and plantar plating, with disagreement regarding which approach provides a stronger construct with superior stability and fixation. The objective of the present cadaveric study was to compare the construct rigidity and strength of beaming and plantar plating of the medial column of 5 paired bilateral feet. Cannulated titanium beams and plates were implanted in the right and left feet, respectively. The specimens underwent interval testing to generate load-displacement and load-strain curves, cyclic loading at low loads, and then were loaded to failure. The beamed and plated specimens had statistically similar stiffness (p?=?.80) with a mean of 11.1?±?3.9 N/mm and 11.3?±?5.9 N/mm, respectively. The beamed and plated specimens had a statistically similar mean strain of ?164?±?75.1 µε and ?208?±?87.8 µε on the dorsal (p?=?.45) and 92?±?90.4 µε and 221?±?100.5 µε on the plantar (p?=?.08) surfaces of the first metatarsal. Three beamed specimens failed from talus fracture (60%), and 2 beams plastically deformed (40%). Two plated specimens failed from talus fracture (40%), and 3 experienced screw pullout (60%). The beamed and plated specimens withstood a mean load to failure of 234?±?111.4 N and 140?±?68.9 N, respectively, with the difference statistically significant (p?=?.04). Overall, beaming was more robust than plantar plating, because it was less sensitive to specimen size and bone quality.     

Immunohistochemical analysis of primary breast tumors and tumor-draining lymph nodes by means of the T-cell costimulatory molecule OX-40

OBJECTIVES: The OX-40 receptor (OX-40R/CD134) is expressed primarily on activated CD4(+) ("helper") T cells. We have previously reported the presence of OX-40(+) T cells in head and neck cancer and melanoma, where they appear to be restricted to tumor compartments (primary tumor infiltrating lymphocytes [TILs] and draining lymph node cells) and therefore may represent the tumor antigen-specific CD4(+) T cells. METHODS: In order to determine the degree of OX-40R expression, and any relationship with the presence of tumor cells (lobular and/or infiltrating ductal carcinoma), 45 archived paraffin-embedded breast primary tumors and their associated draining (axillary) lymph nodes were retrospectively analyzed using standard immunohistochemical techniques. RESULTS: Seven of 45 primary tumors (16%) and 7 of 29 with lympocytic infiltrates (24%) were noted to have elevated levels of OX-40R(+) lymphocytes within the tumor specimens, including 2 of 4 specimens thought to have only "pure" ductal carcinoma in situ (DCIS). No OX-40R(+) lymphocytes were noted in normal breast tissue. Twenty-one (43%) patients had axillary metastases at the time of resection. High levels of OX-40R expression was seen in 9 (45%) of these 21 axillary node specimens, whereas no such staining was seen in the node-negative specimens (P <0.001). Furthermore, in a patient thought to be without axillary disease, several subcapsular single-cell metastases were retrospectively discovered near a lone cluster of OX-40R(+) lymphocytes. In general, visual inspection showed OX-40R(+) T cells to be in close proximity to tumor and often in direct contact with metastatic cells. CONCLUSIONS: The OX-40R is upregulated on lymphocytes within tumor draining lymph nodes, and these lymphocytes are specifically localized around tumor deposits. These data imply that OX-40R immunostaining may be useful for both determination of occult involvement of lymph nodes by tumor and for identification of potential candidates for future OX-40 based immunotherapy.     

胃癌和 EB病毒感染相关性研究

目的 探讨本地区胃癌和EB病毒感染的关系。方法 用聚合酶甸反应（PCR）方法检测本地区经临床病理确诊的胃癌组织和癌旁正常胃签膜组织各40例。结果 40例胃癌组织标本中EB病毒DNA阳性7例（17.5%)；而40例癌旁正常黏膜组织EB病毒DNA均为阴性。结论 本地区胃癌的发生可能与EB病毒感染有密切的关系。     

Volar fixation for dorsally angulated extra-articular fractures of the distal radius: a biomechanical study

PURPOSE: To compare the biomechanical properties of 10 volar plate-fixation designs in 2 fracture models (dorsal wedge osteotomy, segmental resection osteotomy models). METHODS: Forty-eight radiuses were used in this study including 8 pairs. In 40 specimens a 15-mm dorsally based wedge osteotomy was performed and the volar cortex was fractured manually. They were arranged into 10 fixation groups with 5 different fixation designs (test 1). In the contralateral specimens of 8 paired radiuses a 10-mm segment of bone was excised (test 2). Four of the 10 fixation systems were chosen for these specimens. Cadaver hands and the proximal radiuses were potted in polymethylmethacrylate and tested with a servohydraulic materials testing machine with 300 N of axial compression load at 1 N/s initially and after each 1,000 cycles up to 5,000 cycles. After cyclic loading the specimens were loaded to failure in axial compression at 2 mm/min. The stiffness, failure peak load, and failure mode of each specimen were recorded. RESULTS: In test 1 in the wedge osteotomy specimens the T plate was the stiffest and the Synthes titanium plate was the least stiff; however, all specimens completed the 5,000 cycles of loading with no failures. There was no significant difference between the 10 fixation groups in failure peak load and only 7 of 40 failed at the distal portion of the hardware in the final load to failure testing. In test 2 the resection osteotomy specimens were less stiff and failed at a lower failure peak load compared with the wedge osteotomy specimens. Failure at the distal portion of the fixation system was seen in 7 of 8 specimens; nonlocking screws loosened and tines compressed the surrounding bone, resulting in tine-hole enlargement. CONCLUSIONS: All of the plate-fixation systems delivered sufficient stability to permit the simulated postoperative regimen of 1 week of immobilization followed by 5 weeks of early mobilization until expected union at 6 weeks after surgery. Based on these results a preferable volar fixation system would appear to benefit from the following: (1) sufficient plate strength to support the distal fragment from the volar side, (2) a locking system with sufficient strength to remain locked during the healing process, and (3) a distal design that does not affect the bone adversely. The anatomic reduction of the volar cortex in the wedge osteotomy specimens added stability to the construct.