用CT-HRP法研究家兔胸锁乳突肌和斜方肌运动神经元的中枢定位

将CT-HRP分别注入家兔的胸锁乳突肌和斜方肌内,以研究脊髓内标记神经元的节段分布。实验结果表明,胸锁乳突肌和斜方肌运动神经元位于脊髓颈段前角内,并分为两个独立的细胞柱。胸锁乳突肌运动神经元位于C_1和C_2节段的前角背内侧区,主要分布于C_1节段的尾侧半和C_2节段的吻侧半;神经元胞体平均直径为36.7μm。斜方肌运动神经元位于C_2～C_3节段的前角腹外侧区,主要分布于C_3和C_4节段;神经元胞体平均直径为29.3μm,比胸锁乳突肌神经元略小。胸锁乳突肌和斜方肌运动神经元的树突向四周伸展,广布于灰质后角的基底部、中间带和前角内,并延伸到白质的侧索内。其中最显而易见的是胸锁乳突肌神经元树突伸向中央管周灰质和白质前索,此结果为讨论胸锁乳突肌和斜方肌的不同功能作用提供了形态学基础。     

Unilateral pallidal stimulation for segmental cervical and truncal dystonia: Which side?

We present a 24-year-old man with idiopathic segmental cervical and truncal dystonia of juvenile onset. His condition improved after unilateral stimulation of the internal globus pallidus ipsilateral to the contracting sternocleidomastoid muscle.     

单头胸锁乳突肌肌皮瓣在口腔颌面部的应用研究

目的：从肌皮动脉“缘支”同样也是肌皮瓣血供主要来源这一观点出发，在手术设计上将肌皮瓣的肌蒂改为复合组织蒂，并提出保护“缘支”的手术方法，安全地扩大了应用皮瓣的面肌。方法：通过对50具（100例）成人尸体进行解剖学观察与测量。为临床设计胸锁乳突肌胸骨头肌皮瓣提供解剖学依据。结果：根据胸锁乳突肌两个头的可分离性，要中安全切取单头胸锁乳突肌皮瓣，修复口腔颌面部组织缺损获得成功。结论：本术式可保留胸锁乳突肌锁骨头的生理功能，防止术后出现“歪颈”，而且有的病例采用胸骨头代替嚼肌，通过保留其运动神经，感觉神经，使已缺损的嚼肌、舌肌的生理功能得到恢复。     

胸锁乳突肌的血管构筑

目的：为临床上应用胸锁乳突肌提供解剖学依据。方法：对１７例成人尸体进行巨微解剖学观察与测量结果：胸锁乳突肌主要有三段血液来源，上段为枕动，中段主要为颈外动脉的直接肌支。下段主要为甲状腺上动脉。结论：进行整形修复时，胸锁乳突肌肌瓣以用甲状腺上动脉为蒂最佳。亦可作单头转移。     

Influence of masticatory muscle pain on electromyographic activities of cervical muscles in patients with myogenous temporomandibular disorders

The present study tested the hypothesis that the resting electromyographic (EMG) activities of sternocleidomastoid and trapezius muscles of myogenous temporomandibular disorder (TMD) patients would be significantly greater than healthy individuals. Eight masticatory muscle pain patients without disc interference disorders (DID) and 30 patients with DID along with 41 matched control subjects were included in the study. The resting EMG activities of sternocleidomastoid and trapezius muscles were recorded with a portable EMG machine. Pain intensities described over the muscles were recorded with a 100 mm visual analogue scale. The two groups of patients had significantly higher resting activities compared with control subjects. Patients (in both groups) who had pain in sternocleidomastoid and trapezius muscles reported significantly higher resting activities in the respective muscles than patients who were free of pain and the controls. The presence of pain over the examined muscles showed significant association with the myogenous TMDs without DID. The observed association of the cervical muscles with myogenous TMDs is expected to be a result of functional link between masticatory and cervical muscles. The present findings suggest that the myogenous TMDs without DID could be a distinct sub-group that can be a part of broader regional or generalized diseased entity.     

胸锁乳突肌肌皮瓣修复舌根癌术后组织缺损

目的:介绍应用胸锁乳突肌肌皮瓣修复舌根癌术后组织缺损的临床经验。方法:对7例应用胸锁乳突肌肌皮瓣修复舌根癌术后组织缺损的病例进行回顾性研究,分析胸锁乳突肌肌皮瓣的设计、制作、皮瓣存活情况及术中和术后并发症的发生情况。结果:7例患者中男性5例,女性2例,年龄42～75岁,修复范围约4.0cm×4.0cm～6.0cm×6.5cm,除1例皮瓣二期愈合,1例颈部创口二期愈合外,余肌皮瓣均愈合良好。患者无严重的术后并发症,外形和功能在术后短期内均得到基本恢复。术后1～2月追加放疗,未见有皮瓣坏死。结论:应用胸锁乳突肌肌皮瓣修复舌根癌术后组织缺损安全可靠,成功率高,且利于改善患者术后的功能和外形,值的推广使用。     

不同日龄新生小鼠视网膜组织学观察

目的 通过对不同日龄新生小鼠视网膜组织学观察,了解小鼠出生后视网膜进一步发育的情况。 方法 对出生后1～20天小鼠的视网膜进行光镜检查,同时对出生后1～3天小鼠视网膜进行放射自显影检查。 结果 新生小鼠(小于3天)视网膜组织只有色素上皮细胞层、神经母细胞层和神经节细胞层,随着日龄的增加,视网膜逐渐发育分化,至20天时视网膜组织才发育完善。 结论 20天前新生小鼠的视网膜是一种发育不完善的组织,可考虑用作移植供体。 (中华眼底病杂志, 1999, 15: 174-176)     

胸锁乳突肌肌瓣与美容切口在腮腺肿瘤术中的应用

目的 探究胸锁乳突肌肌瓣与美容切口在腮腺肿瘤术中的手术效果,以及患者满意度的情况。 方法 研究对象选取为2015年1月~2017年6月我院收治的74例腮腺肿瘤患者,采用数字表法随机分为观察组和对照组各37例,两组患者均沿耳屏缘内侧向下做美容切口并切除肿瘤,观察组在切除肿瘤后将胸锁乳突肌肌瓣修复术区缺损,对照组不做任何修复处理,对比两组患者的术中出血量、手术时间、住院时间等手术指标,对比两组患者的术后并发症情况,并采用满意度问卷调查两组患者的手术满意度。结果 两组患者的术中出血量、手术时间、住院时间对比无显著差异（P＞0.05）;两组患者术后暂时性面瘫、涎瘘、耳垂麻木发生率对比无显著差异（P＞0.05）,观察组术区凹陷畸形、Frey综合征发生率显著低于对照组（P＜0.05）;观察组患者满意度为94.6%（34/37）,显著高于对照组的67.6%（25/37）,差异具有统计学意义（P＜0.05）。结论 胸锁乳突肌肌瓣修复腮腺肿瘤术后缺损不会影响手术时间及术中出血量,同时可有效减少术后并发症的发生,提高患者的手术满意度,值得在临床上应用和推广。     

Sternocleidomastoid size and upper trapezius muscle thickness in congenital torticollis patients: A retrospective observational study

The purpose of this study was to investigate the upper trapezius muscle thickness (UTMT) in congenital muscular torticollis (CMT) patients and determine the correlation among sternocleidomastoid muscle thickness (SCMT), accessory nerve (AN) cross-sectional area (CSA), and UTMT in CMT.This retrospective study consisted of 2 participant groups: Group 1 (SCM mass CMT, n = 20) and Group 2 (Postural CMT, n = 22). For both groups, B-mode ultrasound was performed by a physiatrist to measure the SCMT and UTMT and calculate the CSA of the AN. The correlation among SCMT, CSA of the AN, and UTMT in both groups was evaluated.The between-group comparison revealed that Group 1 had significantly greater SCMT, UTMT, and CSA of the AN on the affected side than Group 2 (P < .05). The intragroup comparison between the affected and unaffected sides also revealed that, in Group 1, the SCMT, UTMT, and CSA of the AN were significantly higher on the affected side than on the unaffected side (P < .05), whereas no significant differences were observed in Group 2. In Group 1, a positive correlation (r = 0.55) was observed between the UTMT and CSA of the AN on the affected side, but not observed between the SCMT and CSA of the AN.The findings of the study indicate that sternocleidomastoid muscle size may impact the thickness of the upper trapezius muscle via the accessory nerve in patients with congenital torticollis.     

经胸锁乳突肌肌间入路行甲状腺手术对颈前区功能保护研究

目的 探讨经胸锁乳突肌肌间入路（SMIA）行甲状腺切除的可行性及其在颈前区功能的保护作用。方法 回顾性分析2019年5-8月浙江大学医学院附属第一医院甲状腺疾病诊治中心收治的采取SMIA手术治疗的60例单侧甲状腺癌病人的临床资料（SMIA组），以同期采取低领弧形切口颈白线入路（LACA）手术治疗的60例单侧甲状腺癌病人作为对照（LACA组）。比较两组间临床病理特征、手术相关结果及术后颈前区功能的差异。采用EQ-5D-5L量表评估颈前区功能的主观感受，采用Hollander伤口评估量表评定切口愈合的临床效果。结果 两组病人在年龄、性别、肿瘤大小、手术时间、术中出血、淋巴结清扫数目、术后甲状旁腺激素水平、引流量等方面差异均无统计学意义（P>0.05）。术后随访1个月，两组在保护颈前区功能和减少术后颈部不适感觉方面差异有统计学意义（P<0.001），且SMIA组均优于LACA组；在切口愈合及临床效果方面，SMIA组Hollander伤口评估量表得分优于LACA组，差异有统计学意义（P<0.05）。结论 经SMIA行甲状腺切除不增加并发症的发生风险，且对甲状腺手术颈前区功能保护的作用优势明显，是安全可行的手术入路。