腹壁下动脉穿支皮瓣及腹壁浅动脉皮瓣的血供解剖研究

目的　针对下腹部皮瓣及皮下组织的血供分区尚存在争议,对血供分区、血管及其相互间的吻合情况进行综合分析,为穿支皮瓣的应用提供解剖学基础。 方法　使用改良的一次性全身动脉造影技术,灌注10具新鲜尸体标本。经螺旋CT扫描后,应用交互式医学影像控制系统（Mimics）对腹壁下动脉及其穿支和腹壁浅动脉进行3D可视化研究,并对下腹壁区域皮肤及皮下组织等进行层次解剖与X线摄像。 结果　腹壁下动脉有3种分支形式,当其分为2支或3支时,发出相对应的内、外两排穿支。腹壁浅动脉的解剖变异度较大,但均与腹壁下动脉穿支间有丰富的吻合。 结论　腹壁血供传统分区的争议与术中选择内排或外排穿支有关。当术前确认腹壁浅动脉管径较大,且所需组织量不超过半腹部时,腹壁浅动脉皮瓣是一种很好的术式选择。     

臀腰部皮穿支及其相互关系的数字化模型

目的　建立臀腰部穿支血管数字化模型,为临床上臀腰部跨区穿支皮瓣的设计与安全截取提供形态学基础。 方法　3例新鲜男尸行动脉血管聚乙烯醇-氧化铈造影灌注,1例新鲜女尸行动脉血管明胶-氧化铅一次性全身整体造影灌注。64排螺旋CT无间距扫描采集数据集,利用Mimics软件对臀腰部穿支血管进行渲染、提取、定位、配准与数字化构建。 结果　臀上、下动脉,腰动脉,肋间后动脉主干及其分支X线摄影图像清晰,血管显影密度均匀。构建的臀腰部皮穿支血管3D可视化模型形象逼真,空间立体感强;穿支血管蒂、血管体及各穿支吻合区清晰可见。 结论　在臀腰部可设计截取多种形式的跨区穿支皮瓣。     

小腿后部穿支的3D可视化研究与皮瓣设计

目的：运用血管造影及其数字化模型探讨小腿后部各区穿支间的关系,为穿支皮瓣的临床应用提供解剖学依据。方法：（1）8具新鲜成人整尸,采用改良的氧化铅配方行一次性全身动脉造影。其中2具行连续螺旋CT扫描,对小腿进行三维重建。（2）将小腿后部分为上、中、下3区,层次解剖并配合x线摄影,观测各区穿支的定位、直径、走行、分支及其相互之间的吻合状况。结果：小腿后部共有外径≥0．5mm穿支（13±2．3）支,平均外径（0．8±0．2）mm,平均供血面积（38±9．0）cm2。上区的胭动脉穿支位置恒定且较粗大,向下与中区的胫后动脉、腓动脉之穿支形成不减少口径的真性吻合,其单穿支供血面积高达（55±20）cm2;下区穿支较细,沿跟腱两侧呈链状分布,向上与中区的穿支吻合。结论：小腿后部为良好的穿支皮瓣供区,中区可切取穿支皮瓣游离移植,上区与下区可分别切取近端蒂与远端蒂穿支皮瓣。     

三维重建技术在穿支血管解剖中的应用*

供养人体皮肤的每一条穿支血管均有一个明确的分布范围,即穿支皮瓣的解剖学供区,也称之为穿支体区[1].每一条穿支体区借助周边的穿支血管吻合互相连接[2],紧邻解剖学供区的被称之为动力学供区,若再继续向远邻的供区延伸则称之为潜力供区[3].因此,如欲切取"跨区穿支皮瓣"则必须了解其周边连接血管的特性[4].对尸体标本或活体进行CT血管造影后,应用"后处理软件"可清晰显示全身各部位穿支血管的解剖学细节.使用交互式医学影像控制系统(Materialise Interactive Medical Image Control System, Mimics 17.0,Materialise, Leuven, Belgium),可快速方便地显示皮下血管网、穿支血管及其源动脉的三维分布状况与毗邻结构,包括浅层肌、肌间隔等,不仅有利于基础研究工作者进行系统的解剖学研究,亦可辅助临床工作者进行穿支皮瓣的术前设计与术中导航.     

两种穿支血管的定位方法

目的 为常见穿支的定位与皮瓣设计提供形态学依据。方法 选用新鲜成人整尸标本2具,采用氧化铋-聚乙烯醇填充剂灌注技术,行一次
性全身动脉造影,螺旋CT扫描。将数据导入Mimics图像工作站,以常见穿支皮瓣为例,分别应用快速直接体绘制(VR）和动态重建方法（DR）,
对穿支血管定位并模拟皮瓣设计。结果 两种方法均能够对常见穿支皮瓣的穿支血管定位。快速体绘制对穿支血管定位较快,但显示层次毗邻效果
不好;调节阈值动态重建方法不仅可对穿支进行定位与皮瓣设计,而且显示层次清楚。结论 应用快速直接体绘制方法可快速、粗略地显示出各
部位主要穿支的位置与源动脉;采用改变CT值的动态重建方法可以多彩色形式显示多种结构的层次与毗邻关系;两种方法结合可对穿支进行精
确定位,模拟皮瓣设计,为皮瓣的安全切取提供形态学依据。     

尺动脉穿支皮瓣的应用解剖学研究

目的　为尺动脉穿支皮瓣的临床应用提供解剖学依据。 方法　观察10具动脉铸型标本。取新鲜成人尸体25具(50侧),行一次性全身动脉造影。通过直接层次解剖,应用图像分析和测量系统Scion image,对前臂内侧区穿支进行定性、定量分析;螺旋CT扫描数据以Dicom 格式输入Mimics 图像工作站,对尺动脉穿支皮瓣进行三维重建。 结果　该区共有外径≥0.5mm 的穿支(7.0±2.0)支,外径(0.6±　0.2) mm,蒂长(2.7±1.4)cm,单穿支的供血面积(26.0±7.0)cm2。尺动脉除在远端发出粗大的尺动脉腕上皮支,在肱骨内上髁以下8～10cm处也有较粗、恒定的穿支,尺动脉多个穿支相互吻合形成前臂内侧血管链。 结论　可以尺动脉近端穿支为基础设计游离皮瓣,以内侧血管链为基础设计长而窄的增压穿支皮瓣也是切实可行的。     

数字化前臂穿支皮瓣模型构建与解剖学研究

目的　利用计算机三维重建技术构建前臂数字化模型,探讨前臂动脉穿支特点,虚拟仿真临床个性化皮瓣设计。 方法　选用新鲜男尸体无器质性损伤前臂标本4只,常温下灌注显影剂,经CT扫描后,将数据导入医学图像处理软件Mimics13.1中,分别对骨骼、血管及软组织进行三维构建。测量前臂穿支血管数目、蒂长、管径,距尺、桡骨茎突距离,为穿支皮瓣切取提供依据。根据穿支血管支配区域,对图像进行多次分割,构建数字化穿支皮瓣。 结果　数字化前臂三维构建的图像仿真高,可立体显示前臂各穿支血管及其穿支皮瓣。桡动脉、尺动脉、骨间后动脉穿支血管数是12～17、10～15、5～11支,与实体解剖学数据基本一致。 结论　通过构建数字化前臂模型,测量数据表明各标本动脉起源、行程及其穿支较恒定,可根据尺桡动脉及骨间后动脉穿支血管的分布情况,设计皮瓣的范围,对临床穿支皮瓣的切取具有较重要的意义。     

腓浅动脉穿支皮瓣的应用解剖学研究

目的 为腓浅动脉穿支皮瓣的临床应用提供解剖学依据。 方法 新鲜成人尸体20具(40侧),行一次性全身乳胶灌注5具,全身动脉造影15具。通过直接层次解剖,应用图像分析和测量系统Scion image,对小腿前外侧区穿支进行定性、定量分析;螺旋CT扫描数据以DICOM格式输入Mimics图像工作站,对腓浅动脉穿支皮瓣进行三维重建。 结果 该区共有外径≥0.5mm的穿支(7.0±3.0)支,外径(0.7±0.2) mm,蒂长(3.3±1.7)cm,穿支的供血面积(33.0±8.0)cm2。腓浅动脉起始外径(1.2±0.3) mm,干长(5.6±1.8) cm,与中、下1/3处腓浅下外侧动脉及腓动脉终末穿支吻合构成一条几乎不减少口径的血管链。 结论 腓浅动脉与腓浅下外侧动脉及腓动脉终末穿支相吻合构成的血管链供养小腿前外侧区皮肤,由此设计腓浅动脉穿支皮瓣是切实可行的。     

腹部区穿支体形态学及其血供分区

目的探讨下腹壁皮肤的血供及神经支配规律,为下腹部皮瓣的窃取提供解剖学依据。方法新鲜成人标本10具,8具灌注明胶氧化铅,2具做红色乳胶灌注。灌注氧化铅的8具标本行螺旋CT扫描,后将数据导入Mimics图像工作站,集中对下腹壁的血管进行三维重建。之后行分层解剖及X光摄像,重点观察下腹壁的血供模式及神经支配情况。结果腹壁下动脉发出内外排两列穿支。其中,内侧列穿支走行无明显的偏向性,有分支跨越中线与对侧腹壁下动脉内排穿支吻合;外侧列穿支走行向外侧走行较长距离,与腹壁浅动脉及肋间后(下)动脉吻合。腹壁浅动脉属于腹壁浅动脉系统,分支与走行方式有3种。腹壁下动脉穿支皮瓣相关的腹壁区域主要由T10～T12神经支配。T10、T11、T12神经本干在腹壁下动脉两分支前方与血管交叉,交叉位分别位于脐上(1.11±1.62)cm,脐下(1.84±1.93)cm及脐下(6.11±1.42)cm。结论内外排穿支的形态学不同,以它们为蒂的皮瓣的偏向性也不同。T10、T11、T12神经本干在腹壁下动脉两分支前方与血管交叉,分离血管蒂时应注意保护,避免损伤。腹壁下动脉穿支皮瓣有其优点,是一良好的皮瓣供区。     

股前内侧穿支皮瓣的应用解剖学研究

目的　为股前内侧穿支皮瓣的临床应用提供解剖学基础。 方法　新鲜成人尸体20具(40侧),行一次性全身乳胶灌注5具,全身动脉造影15具。通过直接层次解剖,应用图像分析和测量系统　Scion image,对股前内侧穿支进行定性、定量分析;螺旋CT扫描数据以Dicom格式输入Mimics图像工作站对该区穿支皮瓣进行三维重建。 结果　股前内侧区共有外径≥0.5mm的穿支(21.0±4.0)支,外径　(0.8±0.1)mm,蒂长(4.5±2.1)cm,穿支的平均供血面积(44±4.8)cm2。将股前内侧区分为上、中、下3区,发现三个区域均有穿支供应相应区域皮肤,中1/3区是穿支分布最集中的区域,多为肌皮穿支,主要由股动脉主干,旋股外侧动脉起始部,以及膝降动脉的穿支供血。 结论　股前内侧区穿支丰富,穿支蒂的来源因解剖部位而不同,在中1/3区穿支出现率较为恒定,设计股前内侧穿支皮瓣是切实可行的。     

选择性食管动脉插管的应用解剖

为提供与选择性食管动脉插管有关的应用解剖学资料,在31具成人尸体上,对食管动脉的支数、起始、位置,外径和角度进行了观测,并讨论了与临床应用的有关问题。     

空回肠入壁动脉走行及表面动脉形态的解剖学观察

目的 探讨人空回肠入壁动脉走行及表面动脉形态，为空回肠的器官移植提供巨微解剖学资料。方法新鲜胎儿尸体30例，新鲜成人尸体3例通过墨汁灌注、组织切片、薄层透明、微血管铸型及扫描电镜观察，进行观测其走行及其表面动脉形态。结果获得人空回肠入壁动脉走行及表面动脉形态的形态学资料。结论空回肠入壁动脉在各层都有分支，表面动脉由直动脉的长支和短支发出。     

Anatomical study of the arrangement and attachments of the human medial pterygoid muscle

The authors have studied the medial pterygoid muscle on 179 fresh cadavers using anatomical dissection and magnetic resonance imaging (MRI). The aim of this study was to define the general morphology and architectural organisation of the human medial pterygoid. Plane by plane dissection, anatomical sections in different spatial planes on half heads and isolated blocks demonstrated that the medial pterygoid has different architectural disposition and insertional zones from those which are normally described. The study has shown that the muscle has a typical penniform structure made up of seven alternating muscular/aponeurotic layers and that the tendinous intramuscular sheets were particularly well developed. This allows supporting a future functional study.     

From cradle to grave via the dissection room: the role of foetal and infant bodies in anatomical education from the late 1700s to early 1900s

The preponderance of men in the narrative of anatomical education during the 1800s has skewed the historical perception of medical cadavers in favour of adult men, and stifled the conversation about the less portrayed individuals, especially children. Although underrepresented in both the historical literature and skeletal remains from archaeological contexts dated to the 1800s, these sources nevertheless illustrate that foetal and infant cadavers were a prized source of knowledge. In the late 1700s and 1800s foetal and infant cadavers were acquired by anatomists following body snatching from graveyards, from the child's death in a charitable hospital, death from infectious disease in large poor families, or following infanticide by desperate unwed mothers. Study of foetal and infant remains from the 1800s in the anatomical collection at the University of Cambridge shows that their bodies were treated differently to adults by anatomists. In contrast to adults it was extremely rare for foetal and infant cadavers to undergo craniotomy, and thoracotomy seems to have been performed through costal cartilages of the chest rather than the ribs themselves. However, many infants and foetuses do show evidence for knife marks on the cranium indicating surgical removal of the scalp by anatomists. These bodies were much more likely to be curated long term in anatomical collections and museums than were adult males who had undergone dissection. They were prized both for demonstrating normal anatomical development, but also congenital abnormalities that led to an early death. The current findings show that the dissection of foetal and infant cadavers was more widespread than previous research on anatomical education suggests. This research details the important role of the youngest members of society in anatomical education during the long 19th century, and how the social identity of individuals in this subgroup affected their acquisition, treatment and disposal by elite medical men of the time.     

Functional anatomy of the human lateral pterygoid muscle

The authors studied the lateral pterygoid muscle of 179 fresh cadavers by both anatomical dissection and magnetic resonance imaging. The aim was to define the general morphology and the architectural organisation of the lateral pterygoid muscle. Dissection plane by plane, anatomical sections in different planes of space and dissections via multiple approaches on harvested blocks allowed the demonstration that the lateral pterygoid shows an architectural arrangement different from that which is usually described but similar to that, from its typically penniform structure of the masseter and the medial pterygoid. The anatomical situation of this muscle gives rise to numerous differences in opinion much to its morphology as to its functional examination. This study has shown that one part of the muscle has a typical penniform structure made up of alternating musculo-aponeurotic layers and by the absence of individual muscle bellies. In addition the particular shape of this muscle makes it useless to insert intramuscular electrodes in its only accessible portion, which makes the results of electromyographic studies debatable.     

颈深筋膜及筋膜间隙的薄层断面解剖及三维重建

目的　明确颈深筋膜的分层及筋膜间隙的位置、毗邻 ,为颈深筋膜间隙的影像识别与分析提供参考 ,为临床诊治感染蔓延、肿瘤侵润提供解剖学依据。　方法　采用低温冰冻和生物塑化技术用 17例标本 ,制作了颈部连续薄层横断面 ,对颈深筋膜及筋膜间隙进行了观测。从颈部薄层塑化断面标本上 ,用双线提取间隙轮廓的方法 ,在SGI工作站上对颈深筋膜间隙进行三维重建。　结果　 1.颈深筋膜应分为四层 ,颈深筋膜深层分为翼筋膜和椎前筋膜 ,颈深筋膜各层均参与颈动脉鞘的形成。 2 .颈动脉间隙是一开放的间隙 ,其后外侧与颈后间隙相通 ;证实了危险间隙的存在。 3.重建出咽后间隙、颈动脉间隙和内脏间隙的三维图像 ,并能同时显示间隙内的主要结构。结论　得出了颈深筋膜和筋膜间隙的模式图 ,并为筋膜间隙的三维重建提供了一种新的方法。     

Acknowledging the use of human cadaveric tissues in research papers: Recommendations from anatomical journal editors

Research within the anatomical sciences often relies on human cadaveric tissues. Without the good will of these donors who allow us to use their bodies to push forward our anatomical knowledge, most human anatomical research would come to a standstill. However, many research papers omit an acknowledgement to the donor cadavers or, as no current standardized versions exist, use language that is extremely varied. To remedy this problem, 20 editors‐in‐chiefs from 17 anatomical journals joined together to put together official recommendations that can be used by authors when acknowledging the donor cadavers used in their studies. The goal of these recommendations is to standardize the writing approach by which donors are acknowledged in anatomical studies that use human cadaveric tissues. Such sections in anatomical papers will not only rightfully thank those who made the donation but might also encourage, motivate, and inspire future individuals to make such gifts for the betterment of the anatomical sciences and patient care.