早期Legg-Perthes病双重介入和显微外科治疗的解剖学基础

目的观察髋关节骨、内外静脉回流途径及构筑特点,论证早期Legg-Perthes病介入和显微外科治疗的可行性。方法采用多种形态学方法对25例胎儿、新生儿及儿童的髋关节骨内、外静脉回流途径及构筑特点进行观察。结果股骨头内静脉在近股骨头表面形成15～20条属支,即前、后、上、下骺静脉及内骺静脉,于头、颈交界处引流至骨外,汇入相应颈升静脉。股骨颈内的前、后、上、下干骺静脉,最终汇入颈升静脉及股骨颈表面滑膜下静脉网。股骨头、颈内的微动脉发自骺动脉,一般有2～3级,呈树状分支,一条微动脉一般有两条微静脉伴行,微静脉间有丰富的横行吻合支。四组颈升静脉可于头、颈交界处形成囊内静脉环,此环完整率为39%。旋股内、外侧静脉于股骨颈基底部形成囊外静脉环,其中旋股内侧静脉构成环的内、后、外侧部,旋股外侧静脉构成环的前部,且有10%臀下静脉和2%臀上静脉参与此环后外侧部构成,此环完整率为33%。结论髋关节骨内、外静脉回流及构筑特点为早期Legg-Perthes病双重介入和显微外科可行性治疗提供了直接的解剖学依据。     

股骨近侧端动脉的分布与吻合

通过动脉灌注,对100侧不同年龄(新生儿～67岁)尸体的股骨近侧端的血液供应进行了研究。囊外动脉环围绕股骨颈基部,由旋股内、外侧动脉组成,完整者占71％;囊内动脉环位于关节软骨缘滑膜下,由内侧、后、外侧和前颈升动脉组成,多见此环前部、后部和前、后部合并缺损,占74％。外骺动脉向关节软骨发出多级动脉弓,分布于股骨头的上、内、中央和外侧区。内侧颈升动脉分布于股骨头下后区。内骺动脉分布于有限的股骨头凹下区。关节软骨游离面由接近关节软骨缘和股骨头凹周缘的滑膜血管网及滑液营养,它的深部近骨—软骨接合处,由骺毛细管襻供给营养。上干骺部动脉分布于股骨颈外2/3,内侧颈升动脉和前、后颈升动脉短支分布于股骨颈相应区。在骺软骨骨化过程中,骺动脉与内侧颈升动脉在骨骺中建立一定的吻合弓。骺软骨板在成年骨化后消失,干骺部动脉穿入骨骺,与骺动脉建立广泛吻合。本文对股骨近侧端动脉的形态、行经、分布及其与临床的意义进行了讨论。     

胎儿和婴儿股骨近端的血供及其临床意义

对54侧8个月胎儿至1岁儿童股骨近端的血供进行了研究。骨外以前、后、外侧、内侧颈升动脉和股骨头韧带动脉,骨内以前、后、上、下、内骺动脉和前、后、上、下于骺动脉分布于股骨头颈部。对动脉分布特点与股骨头缺血性坏死的关系进行了讨论。     

髋关节的静脉回流及其临床意义

20侧新鲜髋部标本经盐酸腐蚀静脉瓣后逆行灌注观察。髋关节的静脉回流经施股内、外侧静脉,臀上、下静脉,闭孔及髂腰静脉。它们在髋关节周围形成近、远侧静脉环。股骨头内静脉回流为22～25对以其最高点为中心辐射状走向头、颈交界处的辐射静脉,主干与其深、浅属支组成犹如以股骨头中轴为中心的隔板,在头、颈交界处形成2～3个立体静脉环,再经10余条股骨颈颈升静脉下行汇入髋关节远侧静脉环。     

基于动脉铸型标本的猪股骨头内滋养动脉分布规律的解剖学研究

目的 探讨猪股骨头内滋养动脉的分布规律及其意义。方法 选择20例带髋周血管的新鲜猪股骨头标本,制备成股骨头内滋养动脉铸型标本。肉眼及显微镜下观察股骨头骨内动脉的来源、数量、走行特点及分布情况,显微镜下测量股骨头内滋养动脉中最粗骺动脉主干起始点的外径。结果 在猪股骨头内,动脉依其分支走行分布可分为骺动脉区、骺动脉网区和骺上动脉区共3个区。骺动脉起源于支持带动脉,其总数量为5~13（8.7±2.2）支;骺动脉区分为上骺动脉、下骺动脉、前骺动脉3组,分别为（3.2±1.4）、（3.2±1.3）、（2.3±0.8）支,各组中最粗支起始点外径分别为（0.43±0.16）、（0.50±0.08）、（0.34±0.12）mm。3组骺动脉沿皮质下走行,跨越骺板后直接吻合交通形成骺动脉网区。3组骺动脉及骺动脉网向上发出的呈辐射状分支组成骺上动脉区,分布于股骨头软骨下,近中央致密,近周边稀疏。结论 在猪股骨头内,动脉根据其分支、走行及分布分为3个区,其中骺动脉区动脉的走行特点和口径大小为显微吻合提供了解剖学基础,骺动脉网的存在可能为股骨头整体供血理论提供了解剖学依据。     

胎儿和婴儿股骨近端的静脉及其临床意义

对54侧8个月胎儿至1岁儿童股骨近端的静脉进行了研究。股骨近端的静脉与其动脉伴行。骨内静脉先以静脉网套在小动脉外周,再汇集成一或二条静脉与动脉伴行引流至骨外。骨外回流途径包括前、后、内侧和外侧颈升静脉,股骨头韧带静脉,闭孔静脉,臀上、下静脉,旋股内、外侧静脉。结合静脉分布特点,对髋部某些疾病的发病机制进行了讨论。     

股骨头血供来源的应用解剖学研究

<正> 作者对61具髋关节囊内、外动脉的分布进行了剖察,并报告了剖察和测量结果。结果表明,股骨头的血液供应来自囊外动脉环上发出的前、后、内侧和外侧颈升动脉以及股骨头韧带动脉。前后颈升动脉和股骨头韧带动脉较细小,内侧颈升动脉只供应股骨头的后下部,故均较次要。外侧颈升动脉是营养股骨头的最重要的血管,58例是旋股内侧     

股骨近端的血管构筑及其临床意义

<正>股骨近端的血管构筑极为复杂,其动脉血供及静脉引流对髋关节疾病如股骨头缺血性坏死的发生、发展及转归均有重要影响.众多文献表明任何一方面的功能紊乱和解剖异常均能引起股骨头缺血性坏死.本文就国内外研究现状作一总结.1 动脉血供股骨近端的血供来源于旋股内、外侧动脉,臀上、下动脉,闭孔动脉,第一穿动脉和股骨滋养动脉.依其分布部位分为骨内及骨外两个方面.1.1 骨外动脉1 .1.1 囊外动脉环 主要由旋骨内、外侧动脉在股骨颈基部构成,臀下动脉和臀上动脉     

正常髋关节静脉的解剖与 X 线观察

作者报告了成人尸体20侧髋关节静脉解剖,30侧正常髋关节静脉造影和3例新生婴儿尸体6侧髋关节静脉显影的结果。其中股骨头颈的静脉回流路线以颈后静脉和旋股内侧静脉为主,而髓腔中心静脉、营养静脉属于代偿性的静脉回流路线。     

microCT重建距骨骨内微小动脉三维结构的临床解剖学研究

目的获得距骨内微小动脉三维结构模型,对临床上不同分型的距骨骨折的预后做出更精确的解释和预测。方法对12例新鲜尸体下肢行股动脉插管并灌注铅造影剂。距骨取材,进行microCT扫描并且重建高精度模型,图像最终分辨率为52.30μm。最终获得距骨周围与距骨内血管在各个切面的图像,观察距骨表面动脉与骨内分支的走行和分布,并计数动脉的骨内分支数。结果距骨骨外血管集中分布于表面的韧带和关节囊内。距骨表面主要有4大血管分布区域,分别为跗骨管-跗骨窦区、距骨颈上表面、距骨体内侧面和后结节区。距骨颈周围血管环由跗骨管-跗骨窦区和距骨颈上表面的骨外血管连接而成(骨内分支数分别为5.1±1.3和5.6±1.9),是距骨的主要血供来源,分支分布于距骨头、距骨颈和大部分距骨体,并有丰富的吻合。此外,距骨体还接受距骨体内侧面(骨内分支3.2±1.4)和后结节区(骨内分支0.7±0.5)的骨内分支的血供。结论血管环是距骨的主要血供来源,骨内分支有丰富吻合。距骨颈骨折的坏死风险取决于该分型对血管环骨内分支和吻合的破坏程度。距骨体矢状面骨折和粉碎骨折对血管环的骨内分支的破坏较大,缺血坏死风险相对高。距骨头血供丰富,骨折时缺血坏死的可能小。     

胰腺静脉的临床解剖学研究

在50具成人尸体上观察研究了胰腺静脉。胰头、胰颈的静脉血由胰十二指肠上下静脉和胰颈静脉引流。胰体下1/3由胰下静脉引流;上2/3由5～10条小静脉引流入脾静脉。胰尾多见1～4条小静脉,大都汇入脾静脉。胰腺静脉均汇入门静脉系。文中对胰腺静脉的临床应用进行了探讨。     

Intense vascular sprouting from rat femoral vein induced by prostaglandins E1 and E2

The formation of new capillaries from the rat femoral vein was specifically explored to assess whether venous vessels of this caliber may participate in the process of angiogenesis. Prostaglandins of the E series (PGE1 and PGE2) were administered into the soft connective tissue surrounding the rat femoral vessels as angiogenic inducers. In these conditions, between 2 and 7 days, a great number of new capillaries were observed in the media of the femoral vein, arising from the endothelial cells (EC) in the intima. The events of the capillary growth from the femoral vein included EC activation, local degradation of the basal membrane followed by migration and proliferation of EC, solid sprout formation with posterior canalization, development of a new basal membrane, and appearance of pericytes around the new capillary. Although numerous vascular buds were also observed arising from the small venules and capillaries in the periadventitial tissues, they were separated at first from those in the media of the femoral vein by the venous adventitia. Later, connections were observed between both newly formed microcirculations. The present study shows the capacity of PGE1 and PGE2 in the extravascular position of inducing capillary sprouting from veins. Furthermore, the observations provide greater evidence that vessels with characteristics similar to those of the rat femoral vein may contribute to angiogenesis, on occasion with an intense neovascularization. This fact may be of interest for the establishment of a functional circulation after angiogenesis by anastomoses of the new capillaries with those arising from pre-existing vessels of greater caliber than the venules. © 1994 Wiley-Liss, Inc.     

A case of right partial and double internal jugular veins

We present a very rare case of right partial and double internal jugular veins, found in an 86-year-old Japanese female cadaver during a student dissection practice session in 2002 at Osaka Dental University. In this case, the right internal jugular vein separated into medial and lateral branches at a level with the middle of the fifth cervical vertebra. Both branches had the same thickness as an internal jugular vein and poured into the right subclavian vein. A slender venous space slit was formed by these two branches and the right subclavian vein. The inferior belly of the right omohyoid muscle and the inferior root of the right ansa cervicalis passed through the superior region in this venous space. To our knowledge, this case has never been reported previously. Therefore, we attempted to investigate the incidence based on existing references for similar cases and speculated on the development based on our findings. We considered the medial branch was the right internal jugular vein and the lateral branch was the communicating branch between the external and internal jugular veins.     

Duplicate testicular veins accompanied by anomalies of the testicular arteries.

Duplicate testicular veins associated with other anomalies of the testicular arteries were observed during dissection of the posterior abdominal wall in a 90-year-old Japanese male cadaver. The right testicular vein was composed of the medial and lateral testicular veins. The medial testicular vein drained into the inferior vena cava, whereas the lateral testicular vein drained into the confluence of the inferior vena cava and right renal vein. Several anastomosing branches were seen between the medial and lateral testicular veins. The left testicular vein was formed after the medial and lateral venous trunks joined and drained into the ipsilateral renal vein. The right testicular artery originated from the anterior surface of the abdominal aorta at the level of the left renal artery, passed posterior to the inferior vena cava, and accompanied the right lateral testicular vein running downwards. The left testicular artery arose from the abdominal aorta at a level of 5 cm below the origin of the right testicular artery, and then ran downwards accompanied by the medial trunk of the left testicular vein.     

大白鼠大脑大静脉及其侧副循环的研究

用脑血管树脂铸型技术，结合手术显微镜及扫描电镜观察研究了大白鼠脑静脉系，特别是大脑内静脉、大脑大静脉及其侧副循环，发现大白鼠双侧大脑内静脉与岩上窦和窦汇之间各有一静脉管道相连，扫描电镜下可见丰富的毛细血管注入大脑内静脉的小集合静脉；一些小静脉互相平行、盘绕，某些部位呈袢状；大脑大静脉的远位与近位属支间有重叠现象，两者间存在共同引流区，这些发现提示大脑内静脉具有极大的运载能力，当大脑大静脉阻塞后，在