A comparison of modified Larson and ‘anatomic’ posterolateral corner reconstructions in knees with combined PCL and posterolateral corner deficiency

Different methods to reconstruct damaged posterolateral structures are available, but there has been little work studying their relative performance in combined PCL plus posterolateral corner (PLC) deficiency. We hypothesized that an ‘anatomic’ reconstruction with three graft bundles crossing the joint line would restore knee laxity closer to normal than a modified two-bundle Larson reconstruction. In a controlled laboratory study, the kinematics of cadaveric knees were measured electromagnetically with posterior drawer, external rotation, or varus rotation loads applied, with the knee at sequential stages: intact, PCL-deficient; PCL plus PLC-deficient; modified Larson reconstruction; anatomic PLC reconstruction. The graft bundles were tensioned sequentially to restore specific degrees of freedom to intact values of laxity at specific angles of knee flexion. A significant difference was not found between the two reconstructions. Both reconstructions restored external rotation and varus laxity to normal. Both restored posterior drawer to that caused by isolated PCL deficiency, but did not restore posterior laxity to normal. It was concluded that, with appropriate graft tensioning, both PLC reconstructions could restore both external rotation and varus laxity to normal, but not posterior drawer. The three-stranded anatomical reconstruction did not perform better than the modified two-strand Larson technique. Both of these isolated PLC reconstructions in knees with combined PCL plus PLC deficiency restored the knees to the laxity condition of an isolated PCL-deficiency, they could not reduce posterior drawer to normal.     

副神经与颈丛交通支的解剖学观测

目的:解剖观测副神经与颈丛交通支,为副神经的临床应用提供解剖学依据.方法:利用显微解剖方法,观测交通支的数量、来源、交通部位及副神经相关数据.结果:(1)91.94%的副神经存在交通支,以2支型为主;胸锁乳突肌深面、枕三角内和斜方肌深面交通支的数量分别占45.90%、10.66%和43.44%,分别以C3、C3和C4来源为主;(2)双侧交通支的数量和来源差异均无显著性(P＞0.05);(3)斜方肌深面汇入副神经的交通支,其汇入点均在副神经入肌点远端;(4)交通支汇入后副神经的外径和神经束数目的增加均具有显著性(P＜0.05);(5)仅观察到4.84%的副神经存在交通支汇入其胸锁乳突肌支.结论:交通支的汇入是副神经神经纤维的重要组成部分,对胸锁乳突肌,特别是斜方肌可能具有一定支配作用,故在颈部手术时应尽量加以保护;切取副神经作为神经移植供体时,应在交通支汇入前或完全汇入后切取.     

Tort reform: the pathologists' perspective

Physicians who become ensnarled in malpractice litigation often feel that the tort system has treated them unfairly. This negative perception has fueled physician efforts to enact "reforms" intended to mitigate the damage that allegations of medical negligence currently have on both individual physicians and on the practice of medicine itself. Although physicians are generally enthusiastic about "reform," there is currently no definition that allows tort "reform" to be separated from related initiatives. Some physicians largely restrict the term to defendant-friendly changes in the rules and procedures governing the workings of the tort system, whereas others take a somewhat broader view. In the present paper, we have favored the broader approach to the topic, leading to a discussion of 30 measures that have been presented in the context of tort "reform." Although most of these measures involve changes in the complex rules governing the malpractice tort system itself (eg, capping jury awarded damages), our broader view of "reform" also includes attempts to exert influence on the tort system from the outside (eg, peer review of expert testimony) and measures designed to keep patient dissatisfaction out of the tort system (eg, apology for error). Some would argue for an even broader view of tort "reform" that would including measures for reducing the pool of dissatisfied patients. For example, trial lawyers have claimed that physicians have put far too much effort into "reforms" that reduce the legal consequences of committing medical errors, and not enough effort into "reforms" that would reduce the errors themselves. The latter point may or may not have some validity, but there is a natural demarcation between measures designed to align medical outcomes with patient expectations (eg, error reduction, better diagnostic technology) and others designed to improve the processes that resolve patient dissatisfaction. Only the latter meet our definition of tort "reform."     

Anatomic variations in the course of the hypoglossal nerve: A case report

To achieve a successful surgical anatomy a detailed knowledge of regional anatomy and anatomical variations is an important fundamental. The extra cranial hypoglossal nerve has a well described course as it traverses the neck, and is frequently identified during neck dissection. This serves a guide to the surgeon of such atypical variations in anatomy to avoid injury to important structures during dissection. We are presenting a case report which demonstrates the extra cranial variation of Hypoglossal nerve.     

Site-specific distribution of large-bowel adenomatous polyps

The anatomic distribution of adenomatous polyps occurring in the large intestine of 98 consecutive patients was studied. Fifty-two of the patients were black and 46 were white. Seventy-nine percent of lesions in whites were found in the distal colon and rectum, whereas in blacks this occurred in only 47 percent. The difference was significant (P<.01). Black patients also displayed a greater frequency of synchronous polyps and had a higher incidence of previous colorectal polyps. The findings suggest that the total colonic surveillance is essential in black patients to adequately screen for large-bowel neoplasia.     

肋间神经移位肩胛上神经的解剖学研究

目的探讨第3～6肋间神经移位肩胛上神经重建肩关节外展功能的可行性。方法取15具30侧成人躯干标本,解剖测量第3～6肋间神经自腋中线至锁骨中线可切取长度以及自腋中线至锁骨中点(拟定神经吻合点)的移位距离,并进行统计学比较。结果 30侧标本中,第3、4肋间神经均可切取自腋中线至锁骨中线范围内的全段神经,且可切取长度均较移位距离长(P<0.01)。6侧第5肋间神经及16侧第6肋间神经在未到达锁骨中线时被肋软骨覆盖,其中第5肋间神经可切取长度与移位距离相似(P>0.01),第6肋间神经可切取长度较移位距离短(P<0.01)。肩胛上神经通过游离切断,可翻转至锁骨中点下方2 cm以上。第5肋间神经切取长度与肩胛上神经翻转长度(2 cm)之和,可超过移位距离(P<0.01),但第6肋间神经总长度仍较移位距离短(P<0.01)。结论第3～5肋间神经可直接移位肩胛上神经重建肩关节外展功能,而第6肋间神经需增加游离切取长度范围或采用神经移植修复。     

解剖法与非解剖法肝切除在肝胆管结石治疗中的应用与近期效果分析

目的:比较解剖法与非解剖法肝切除治疗肝胆管结石的手术效果。方法:采用前瞻性病例对照研究,其中解剖法肝切除31例,非解剖法肝切除30例,比较两组患者的手术时间、术中出血量、术后并发症发生率、谷草转氨酶(AST)、引流量、排气时间、术后住院时间和结石残留率。结果:两组患者一般情况、脏器功能、结石分布、解剖变异和切肝范围均无统计学差异(均P>0.05),具有可比性。与非解剖法肝切除组比较,解剖法肝切除组术中出血量、术后并发症发生率、引流量均明显降低(均P<0.05),手术时间延长(P<0.05);术后排气时间、术后住院时间和结石残留率两组间差异无统计学意义(均P>0.05)。结论:解剖法肝切除具有手术打击小,术后渗出及并发症少等优点,虽然手术时间较长,但仍有改进潜力,值得推广。     

Appendicitis in double cecal appendix: Case report

Double cecal appendix is a rare anatomical variation. Approximately 100 cases have been reported worldwide. It is usually diagnosed incidentally during emergency appendectomies due to inflammatory processes in the cecal appendix. Case presentation: male, white, 36 years old, obese, presenting with pain in the lower abdomen for 24 h followed by nausea, vomiting and mild fever. He was subjected to additional tests, with the leukogram showing leukocytosis and abdominal ultrasonography depicting cecal appendix with thickened wall, locally associated with small quantities of liquid and intestinal loop obstruction. He underwent laparotomy, revealing acute appendicitis. Another intestinal loop obstruction was identified next to the ileum, leading to recognizing another cecal appendix after local dissection. Double appendectomy and segmental iliectomy were performed although not needed. Results of the anatomopathological examination of the surgical samples showed acute inflammation in the two cecal appendices. So, performing a routine retroperitoneal release and a complete cecum evaluation during such surgical procedures is recommended and suggested due to the possibility of not identifying a second cecal appendix.     

上胸椎椎板螺钉内固定的解剖学研究

目的 测量成人上胸椎T1~T6椎板解剖学参数,探讨上胸椎椎板螺钉内固定的可行性。方法 取21具成人T1~T6的干燥标本（不分男女）,用游标卡尺和量角器测量其椎板的解剖学数据,包括椎板高度（H）、厚度（T）、宽度（W）、钉道长度（L）、外倾角（angle A）。结果 21具成人尸体T1~T6节段椎板高度、厚度、宽度分别为16.48~21.20mm、6.33~6.90mm、6.68~10.18mm,椎板外倾角为51.7°~55.9°,钉道长度为36.00mm~26.60mm。解剖学左右侧对比,差异无统计学意义。结论 上胸椎椎板螺钉具有解剖学可行性,有可能作为上胸椎后路固定的一种替代或者补救方法。     

“肿眼泡”的解剖学基础和手术处理

探讨单纯性上睑肥厚的解剖学原因，寻求一种对“肿眼泡”较满意的手术方法。复习了上睑有关局部解剖学，设计一种手术方法，重点是剪除眶脂肪中的腱膜前脂肪，将眶隔向后上方移位，并缝合在ｗｈｉｔｎａｌ韧带下的提上睑肌腱膜上。对１３例２６只眼施行了上睑成形术，获得了较满意的效果，但手术后病人的眼睑恢复自然的时间较长，一般需要３～６个月。俗称“肿眼泡”的单纯性上睑肥厚的形成与眼睑的皮下组织和纤维脂肪组织并无密切的关系，其解剖学原因是眶隔膜与提上睑肌腱膜融合的位置过低，眶脂肪中的腱膜前脂肪向前下方突出，致使组织堆积在睑缘部的睑板前面，形成眼睑臃肿肥厚。手术的重点是剪除腱膜前脂肪，将眶隔向后上方移位