髋臼前柱拉力螺钉内固定的定量解剖学研究

目的 :为髋臼前柱拉力螺钉内固定提供解剖学基础。方法 :取半骨盆标本 3 0个 ,自髋臼切迹至髋臼上缘作系列截骨面 ,用一斯氏针由最小截面的圆心逆行打入 ,在髂骨后外侧穿出点为P。将该截面下方的系列截面解剖复位 ,再将斯氏针顺行打出 ,测量其在髋臼前柱骨皮质内的长度。作一参考线AB ,其中A为髂前上、下棘间的切迹 ,B为坐骨大切迹 ,并作AB的中垂线CD。结果 :P位于AB的中垂线上 ,P点距AB的距离为 (15 .3± 4.7)mm ,斯氏针与AB的夹角为 (90 .1± 4.7)° ,与CD的夹角为 (2 5 .3± 3 .9)° ,髋臼前柱骨皮质内斯氏针长度为 (82 .0± 7.9)mm。最小截面位于髋臼切迹上方 15 .0mm处 ,该截面平均直径为 :(5 .2± 1.9)mm。结论 :髋臼前柱拉力螺钉的入钉点在髂前上下棘之间切迹与坐骨大切迹连线中点上方 (15 .3± 4.7)mm处 ,其进针方向与该线呈 (90 .1± 4.7)° ,与该线中垂线呈 (2 5 .3± 3 .9)° ,该拉力螺钉直径为 (5 .2± 1.9)mm ,长度为 (82 .0± 7.9)mm。     

髋臼后柱拉力螺钉内固定的应用解剖学

目的:为髋臼后柱拉力螺钉内固定提供解剖学基础。方法:取半骨盆标本30个,采用截面法将一斯氏针由髋臼后柱最小截面的圆心打入,该斯氏针在髂翼内侧穿出点(即拉力螺钉的人钉点)为P。测量其在髋臼后柱骨皮质内的长度。作一参考线AB,其中A为骶髂关节最前缘,B为髂前下棘的基底,并经过P点作AB的垂线PC。将髂前上下棘间切迹命名为D点,作直线PD,并测量其距离。斯氏针与PD的夹角为α,斯氏钊与髂翼内侧的夹角为β。结果:PC为AB的中垂线,P点距AB的距离PC为(6.1±1.9)mm,PD平行于AB,PD距离为(2.5±2.6)mm,斯氏针与PD或AB的夹角仅为89.5°±3.2°,斯氏针与髂翼内侧的夹角β为24.1°±1.7°,髋臼后柱骨皮质内斯氏针长度(即拉力螺钉的长度)为(131.2±8.9)mm。最小截面位于髋臼切迹上方15.0mm处,位于髋臼中部,该截面平均直径(即拉力螺钉最大直径)为(12.8±2.1)mm。结论:髋臼后柱拉力螺钉内固定是可行的。     

耻骨上支逆行拉力螺钉内固定的应用解剖学研究

目的:为耻骨上支逆行拉力螺钉内固定提供解剖学基础。方法:取半骨盆标本30个,选取耻骨上支有代表性的两个截面,第1截面距髂耻隆起1.5cm,第2截面位于耻骨上支远端,采用圆盘法确定截面的圆心及直径,将一斯氏针经2截面的圆心顺行穿出耻骨上支,其出针点P1即为逆行拉力螺钉的入针点。两截面的最小直径即为逆行拉力螺钉的最大直径。将两截面解剖复位,将斯氏针逆行打入,其在耻骨上支内的长度即为逆行拉力螺钉的最大长度,该斯氏针即为耻骨上支的轴心。结果:第1截面呈棱形,直径为(6.8±0.9)mm,第2截面呈扁平状,直径为(5.3±0.3)mm,斯氏针于耻骨上支前端的出针点P1位于耻骨嵴中点下方(7.5±0.5)mm处,斯氏针平行于耻骨梳,斯氏针在耻骨上支内的最大长度为(61.1±9.7)mm。结论:耻骨上支逆行拉力螺钉入钉点位于耻骨嵴中点下方(7.5±0.5)mm,其方向平行于耻骨梳,最大直径为(5.3±0.3)mm,最大长度为(61.1±9.7)mm。     

逆行经皮髋臼后柱螺钉的影像解剖学

目的 探讨逆行髋臼后柱螺钉的进钉位置、方向及固定范围。方法 收集100例正常成人骨盆CT数据（男、女各50例）,利用交互式医学图像控制系统（Mimics）17.0软件三维重建骨盆并导入Geomagic Studio 2015软件。从坐骨结节至髂窝方向进行透视,垂直后柱“三棱柱”通道横断面放置虚拟螺钉,测量螺钉的最大直径、进钉点、方向、出钉点及螺钉安全倾角。确定螺钉固定的范围,螺钉在后柱通道易穿出部位及术中判断螺钉是否穿出的透视体位。结果 髋臼后柱安全通道近似“三棱柱”形,进钉点位于坐骨结节内外侧缘中线上,距离坐骨结节最远端男性为(12.99±1.99) mm,女性为 (13.26±2.58) mm,男女差异无显著性 (P＞0.05);髂窝出钉点距离同侧前方骶髂关节线男性为(23.65±2.42)mm,女性为(24.94±2.39) mm;距离真骨盆缘男性为(19.33±2.60)mm,女性为(17.63±2.00) mm;最大螺钉直径男性为(17.21±1.41) mm,女性为(15.54±1.51) mm;髋臼后柱逆行置钉方向与矢状面夹角男性为(10.52±3.04)°,女性为(7.72±2.99)°;与冠状面夹角男性为(15.00±4.92) °,女性为 (12.94±4.72)°,以上数据男女间差异均有显著性（P＜0.05）。逆行经坐骨结节置钉可固定股骨头中心所在水平面近端 4 cm 以下所有的髋臼后柱骨折,易穿出部位分别为髋臼后壁与坐骨支移行处、髋臼中部、坐骨大切迹水平下1 cm。“三棱柱”的3个侧面的切线位分别是髂骨斜位10°,闭孔斜位60°,髂骨斜位60°。结论 逆行髋臼后柱螺钉进钉点位于坐骨结节内外侧缘中线,距离坐骨结节最远端1.3 cm,方向约外倾10°,前倾15°,可固定股骨头中心所在水平面近端4 cm以下的髋臼后柱骨折。     

三维重建模型模拟拉力螺钉固定髋臼后柱骨折的研究

目的　为经坐骨小切迹置入拉力螺钉内固定髋臼后柱骨折提供应用解剖学基础。 方法　用60例正常成人骨盆CT数据（男30例,女30例）,导入Mimics14.1行三维重建,观测骨盆三维模型髋臼后柱的纵轴走向,模拟置钉并确立螺钉穿出点。测量髋臼后柱纵轴的长度、后柱纵轴与冠状面夹角α和矢状面的夹角β,测量进针点及后柱盆腔侧、髋臼侧骨皮质厚度。 结果　髋臼后柱轴线向下穿出点位于坐骨小切迹中点,向上穿出点位于弓状线后端与髂前上棘连线中点。髋臼后柱纵轴的长度男性（105.04±　4.29）mm、女性（101.80±3.20）mm,α角男(33.41±2.18)°、女(31.56±2.71)°,β角男(21.74±1.19)°、女(19.15±　1.24)°。进钉点骨皮质厚度为(5.54±0.46)mm,盆腔侧和髋臼侧分别为(1.45±0.13)mm、(1.04±0.10)mm。 结论　三维重建模拟经坐骨小切迹中点行后柱拉力螺钉内固定,可快捷、准确测量钉道参数并进行术前评估,用该方法置入拉力螺钉固定后柱安全简便。     

髋臼前柱骨折后入路拉力螺钉内固定应用解剖及临床应用

目的　为髋臼前柱骨折后入路置入拉力螺钉固定提供解剖学基础。 方法　(1)50侧(男32,女18)成人髋骨标本,观测前柱纵轴走向,将纵轴穿出髂骨翼外面的点定为进钉点。用直径3.5 mm导针经进钉点沿纵轴置入,经耻骨结节下方穿出。测量导针与矢状面夹角α及与冠状面夹角β,纵轴长度,导针易穿出骨皮质的薄弱区及穿出点与耻骨结节的距离,对测量数据行统计学处理。(2)34侧尸体标本解剖,观测进针点毗邻,模拟置钉,经X线、CT扫描验证结果。 结果　进钉点位于髂结节和坐骨结节连线与髂前上棘和坐骨大切迹顶点连线的交点,出钉点于耻骨结节下方,男（6.62±2.79）mm,女（11.71±1.66）mm, α（50.62±3.55）°,β男（22.32±3.66）°,女（19.57±2.07）°;纵轴长,男（108.64±5.49）mm,女（100.92±6.25）mm。以上数据除角α外男女间均有显著性差异。验证结果及临床应用疗效满意。 结论　髋臼前、后柱均骨折时,在后入路复位固定后柱的同时,经该方法置入拉力螺钉固定前柱安全、简捷。     

经皮逆行髋臼前柱螺钉的应用解剖与临床

目的 应用优化计算机辅助解剖测量技术,为经皮逆行髋臼前柱螺钉内固定术提供解剖学基础.方法 取骨盆CT数据40份,进行精确的三维重建得到骨盆模型.首先为使用单螺钉的内固定方法设计特定的最优化目标函数,并在约束条件下自动计算其最佳经皮逆行螺钉位置.统计分析测量结果,并设计解剖测量参考体系.结果 经皮逆行髋臼前柱螺钉的入钉点在耻骨上支耻骨结节与髂耻隆起中点处的闭孔嵴上,出钉点在髂前上下棘之间切迹与坐骨大切迹连线中点上方,其连线即为髋臼前柱纵轴.该线与弓状线接近平行,其进针方向与出钉点-髂前下棘连线为(42.84±2.61)°,与出钉点-髂结节连线为(31.96±2.58)°.螺钉骨内段长度为(101.12±7.28)mm.结论 优化计算机辅助解剖测量是一种非常有效的测量技术,克服了传统手工实物解剖测量的很多缺点,便于设计解剖测量参考体系和制定临床手术方案.经皮逆行髋臼螺钉技术可用于髋臼前柱骨折的临床治疗.     

经皮坐骨小切迹拉力螺钉内固定髋臼后柱骨折的应用解剖与临床应用

目的:研究经皮坐骨小切迹置入拉力螺钉内固定髋臼后柱骨折。方法:观测45具成人骨盆标本髋臼后柱的纵轴走向、上下穿出骨皮质的位置及其毗邻。用直径3.5mm的斯氏针经坐骨小切迹中点沿髋臼后柱纵轴打入,测量钉道深度、后柱纵轴与额状面夹角α及矢状面的夹角β。结果:拉力螺钉的进钉点为坐骨小切迹中点,后柱纵轴长男(105.7±6.3)mm、女(99.1±3.1)mm,α角男26.3°±5.6°、女21.5°±3.0°,β角男27.5°±3.8°、女24.1°±4.0°,男、女性均有显著性差异(P<0.01)。临床应用取得满意疗效。结论:经坐骨小切迹中点行后柱拉力螺钉内固定术,具有创伤小,操作简便、内固定可靠等优点。     

髋臼后柱骨折顺行拉力螺钉置钉导向器的研究

目的为髋臼后柱拉力螺钉导向器提供解剖学基础。方法收集31具半骨盆骨性标本(男性14例,女性17例),在髋臼后柱顺行置入拉力螺钉导针,测量进钉点的位置和进针方向。结果进针点与弓状缘的垂直距离女性为(0.96±0.32)cm,男性为(0.92±0.16)cm(P0.05),进针点与骶髂关节前缘距离,女性为(2.43±0.66)cm,男性为(1.87±0.26)cm(P0.05)。进钉方向与髂骨内板的后倾角∠θ女性为(59.68±6.28)°,男性为(56.75±3.22)°(P0.05)、进钉方向与髂骨内板的外倾角∠φ女性为(41.27±2.76)°,男性为(34.31±2.78)°(P0.05)。结论髋臼后柱骨折顺行拉力螺钉进钉点和进钉方向的测量为导向器的设计提供了解剖学基础,有助于提高髋臼后柱骨折顺行拉力螺钉置钉的成功率和准确性,降低手术风险和减轻手术损伤。     

髋臼前柱螺钉内固定的最优化计算机辅助测量

目的:研究专门的最优化计算机辅助解剖测量技术,为髋臼前柱拉力螺钉内固定提供解剖学基础。方法:取骨盆CT数据40份,进行精确的三维重建得到80个半骨盆模型。根据临床手术需要,对螺钉到骨边界的加权距离进行动态采样作为最优化目标函数,在约束条件下自动迭代修改螺钉两个端点位置,达到最佳位置,并设计新的解剖测量参考体系。结果:髋臼前柱拉力螺钉的入钉点在髂前上、下棘之间切迹与坐骨大切迹连线中点上方(15.72±2.71) mm处;其进针方向与入钉点-髂前下棘连线呈(42.84±2.61)°,与入钉点-髂结节连线呈(31.96±2.58)°;螺钉骨内段长度为(101.12±7.2)mm。结论:最优化计算机辅助解剖测量是一种非常有效的新测量技术,方便设计新的解剖测量参考体系和临床手术方案。     

Effects of the lesion of the postcommissural part of the septum on the behavior of the rat.

The effects of the lesion of the postcommissural part of the septum on behavior of the rat has been studied. Results may be summarized as follows. An increase in the exploratory behavior in the open field which decreases rapidly; a decrease in the number of defecations in this test and a decrease in time leaving a dark environment for exploration. In the shuttle box test, no facilitation of the acquisition, but a permanent and quite significant increase in the intertrial activity has been found. We conclude that the lesions tend to decrease the emotivity of the subjects. An interpretation on the basis of the species -- specific defensive reactions explains the transitory and permanent effects of the lesions on the spontaneous activity.     

Asymmetry of the internal connections of the striate cortex of the cat in the projection zone of the center of the field of vision

Studies were carried out on the organization of the internal connections of the striate cortex in cats in the projection zone of the center (0–5°) of the field of vision by microintophoretic application of horseradish peroxidase to electrophysiologically identified orientational columns. The area containing neurons showing retrograde labeling in most cases extended in the mediolateral direction. Labeled cells were located in the upper (II, III) and lower (V, VI) layers of the cortex, and the shapes and orientations of the areas containing labeled neurons in these layers coincided. Spatial asymmetry was detected in the distribution of labeled neurons relative to the orientational column studied. Labeled cells were located predominantly medial to the columns, regardless of the distance from the projection of the area centralis. Considering the visuotopical map of field 17, the asymmetry detected here provides evidence that neurons in orientational columns have more extensive connections with neurons of the peripheral part of the cortex. An asymmetrical distribution of “silent” zones around the receptive fields of neurons in orientational columns is suggested, and that these appear to receive influences from the periphery of the visual field. Laboratory of Visual Physiology and Laboratory of Central Nervous System Morphology, I. P. Pavlov Institute of Physiology, Russian Academy of Sciences, 6 Makarov Bank, 199034 St. Petersburg, Russia. Translated from Fiziologicheskii Zhurnal imeni I. M. Sechenova, Vol. 82, No. 12, pp. 23–29, December, 1996.     

Ultrastructure of the endothelium of the drainage system of the eye

The endothelium of the ocular drainage system (Schlemm’s canal, collector tubules, and aqueous veins) in primary juvenile glaucoma undergoes degenerative dystrophic changes with compensatory hypertrophy and proliferation at the initial stages of the glaucomatous process and atrophy and desquamation at advanced and terminal stages. Progressive decrease in the pinocytous function of endotheliocytes, reduction of the protein-synthesizing and mitochondrial compartments of the cytoplasm, and formation of autophagosomes reflect the process of endotheliocyte degeneration in general. __________ Translated from Byulleten’ Eksperimental’noi Biologii i Meditsiny, Vol. 145, No. 5, pp. 574–577, May, 2008     

Topical organization of the projections of neurons of the substantia nigra and the ventral field of the tegmentum of the midbrain to the head of the caudate nucleus of the cat

Neuroscience and Behavioral Physiology -     

The development of the ligament of the head of the femur

The hip joints of 30 human male and female fetuses and stillborns between 20 mm and 350 mm crown-rump length were studied by light microscopy. The ligament of the head of the femur developed in situ as a condensation of mesenchyme at the end of the second month of intra-uterine life (IUL), and was vascularized by branches of acetabular vessels early in the fourth month. In the majority of fetuses older than 5.5 months IUL, vessels in the ligament passed a short way into the femoral head within cartilage canals, to supply a small region around the fovea capitis. The remainder of the head was supplied by vessels in canals from around the upper part of the neck. The ligament changed from predominantly cellular to fibrous during the last 4 months of IUL. This increase in strength suggested significant mechanical functions in utero: limitation of adduction-flexion and opposition to postero-superior dislocation were the most likely.     

Counterpointing the functional role of the forebrain and of the brainstem in the control of the sleep-waking system

This paper reviews the lifetime contributions of the author to the field of sleep-wakefulness (S-W), reinterprets results of the early studies, and suggests new conclusions and perspectives. Long-term cats with mesencephalic transection show behavioral/polygraphic rapid eye movement sleep (REMS), including the typical oculo-pupillary behavior, even when the section is performed in kittens prior to S-W maturation. REMS can be induced as a reflex. Typical non-rapid eye movement S (NREMS) is absent and full W/arousal is present only after a precollicular section. The isolated forebrain (IF) rostral to the transection exhibits all features of W/arousal and NREMS [with electroencephalographic (EEG) spindles and delta waves], arousal to olfactory stimuli, and including the appropriate oculo-pupillary behaviors. These features also mature normally after neonatal transection. REMS is absent from the IF. After deprivation there is NREMS pressure and rebound in the IF, but the decerebrate cat only shows pressure for REMS. Most IF reactions to pharmacologic agents are within expectations, except for the tolerance/withdrawal effects of long-term morphine use which are absent. In contrast, these effects are supported by the brainstem (i.e. seen in the decerebrate cat). In cats with ablation of the telencephalon, or diencephalic cats, delta waves are absent in the thalamus. EEG thalamic spindle waves are seen triggering S for only 4-5 days after ablation. Therefore, true NREMS is absent in chronic diencephalic cats although pre- and postsomniac behaviors persist. These animals are hyperactive and show a pronounced, permanent insomnia; however, a low dose of barbiturate triggers a dramatic REMS/atypical NREMS rebound. Cats without the thalamus (athalamic cats), initially show a dissociation between behavioral hyperactivity/insomnia and the neocortical EEG, which for 15-20 days exhibits only delta and slower oscillations. Fast, low-voltage W rhythms appear later on, first during REMS, but spindle waves and S postures are absent from the start, such that these cats also display only atypical NREMS. Athalamic cats also show barbiturate-sensitive insomnia. Cats with ablation of the frontal cortices or the caudate nuclei remain permanently hyperactive. They also show a mild, but significant hyposomnia, which is permanent in afrontal cats, but lasts for about a month in acaudates. The polygraphic/behavioral features of their S-W states remain normal. We conclude and propose that: (a) the control of the S-W system is highly complex and distributed, but is organized hierarchically in a well-defined rostro-caudal manner; the rostral-most or highest level (telencephalon), is the most functionally complex/adaptative and regulates the lower levels; the diencephalic/basal forebrain, or middle level, has a pivotal role in inducing switching between S and W and in coordinating the lowest (brainstem) and highest levels; (b) W can occur independently in both the forebrain and brainstem, but true NREMS- and REMS-generating mechanisms exist exclusively in the forebrain and brainstem, respectively; (c) forebrain and brainstem S-W processes can operate independently from each other and are preprogrammed at birth; this helps understanding normal and abnormal polygraphic/behavioral dissociations in humans and normal dissociations/splitting in aquatic mammals; (d) NREMS homeostasis is present in the IF, but only REMS pressure after deprivation persists in the decerebrate cat; (e) the thalamus engages in both NREMS and W; (f) insomnia in diencephalic cats is the result of an imbalance between antagonistic W- and S-promoting cellular groups in the ventral brain (normally modulated by the telencephalon); (g) the EEG waves, which are signature for each S-W state, appear to truly drive the concomitant behaviors, e.g. a hypothetical human IF could alternate between behavioral NREMS and W/arousal/awareness; (h) a role for REMS is to keep the individual sleeping at the end of the self-limiting NREMS periods. The need for accelerating research on telencephaling NREMS periods. The need for accelerating research on telencephalic S-W processes and downstream control of the lower S-W system levels is emphasized.     

Involvement of the striatum in the central regulation of the hormonal functions of the gonads

Studies reported here show that intrastriatal administration of corticoliberin to rats decreases the blood testosterone level. However, in conditions of chemical deficiency of dopaminergic transmission in the dorsal striatum induced by injection of 6-hydroxydopamine, the effect of this neurohormone did not appear. It is concluded that extrahypothalamic corticoliberin is involved in regulating the hormonal reproductive system acting via dopaminergic mechanisms. Translated from Rossiiskii Fiziologicheskii Zhurnal imeni I. M. Sechenova, Vol. 85, No. 4, pp. 594–597, April, 1999.