盆环原发恶性肿瘤的切除与生物学重建

目的:探讨骨盆环恶性肿瘤的切除、重建方式与并发症的处理 .方法:手术治疗骨盆环原发恶性或低度恶性肿瘤5例,其中骶骨恶性畸胎瘤2例、脊索瘤1例,髂骨骨肉瘤1例、恶性骨软骨瘤1例.所有患者术前未行动脉栓塞、结扎髂内血管.髂骨翼肿瘤采用自体髂骨、髋臼肿瘤采用异体骨重建骨盆环、自体股骨头重建髋臼骨床 人工全髋关节置换术.结果:5例肿瘤均行根治性切除,3例骶骨肿瘤术中出血量150～800 mL,术后出血300～1 000 mL,1例切口感染,1例术后出现失血性休克.髂骨翼肿瘤和髋臼周围肿瘤术中出血量分别为1 000 mL和4 000 mL,术后分别为800 mL和1 100 mL.髂骨肿瘤切除与重建患者2月后恢复关节功能,髋臼肿瘤切除与重建患者6月后恢复功能,4例患者术后随访4～24个月,生存良好.结论:骨盆环恶性肿瘤的外科手术治疗关键是完整的手术切除,包膜外切除可以减少出血、预防复发,影响骨盆环稳定时应考虑重建,自体、异体骨移植能够恢复髋臼周围骨量、维持骨盆环生物学稳定.     

Microsurgical anatomy of VII and VIII cranial nerves and related arteries in the cerebellopontine angle

Summary The relationships of VII and VIII cranial nerves and related arteries are reviewed in 26 preparations by microdissection techniques. These vessels may be grouped in large (AICA, PICA), medium (LA, SA, CSA, RPI) and small calibre (vasa nervorum, radicullar and medullar branches). The importance of these structures in acoustic neuroma surgery, vestibular neurectomy and cross-compression syndromes is discussed. Vascular loops and elongated arteries are normal structures present at birth.This work was supported by a grant from the AJ Roemmers Foundation     

Responses of sacral visceral afferents from the lower urinary tract,colon and anus to mechanical stimulation

The discharge characteristics of sacral visceral afferents supplying the urinary bladder, urethra, colon and anus to mechanical stimuli were analyzed in the anaesthetized cat. The stimuli used were passive distension (urinary bladder, colon), isovolumetric contraction (urinary bladder), movements of the urethral catheter and mechanical shearing stimuli (mucosal skin of the anal canal). (1) In total 245 afferent units which projected in the pelvic nerve were isolated from the sacral dorsal roots. From one of the following organs, urinary bladder, colon, urethra and anus 117 afferent units were activated. By these stimuli from the bladder, urethra and anus 122 afferent units could not be activated, and as far as tested also not from the colon; in 6 afferent units the classification was unclear. (2) Afferent units from the urinary bladder and the colon responded consistently to passive distension of the respective organ. The units from the urinary bladder showed graded responses at intraluminal pressures of about 10–70 mm Hg and responded also to isovolumetric contractions of the organ. The thresholds of the units from the bladder to passive distension and contraction varied from about 5 to 20 mm Hg intravesical pressure. (3) The afferent units from the urethra and the anus did not react or showed some weak phasic and irregular responses to distension and contraction applied to the urinary bladder or to distension of the colon. They were consistently excited by low threshold mechanical stimulation of the urethra and anus, respectively. (4) The axons from the bladder, urethra and anus were presumably myelinated (conduction velocity above 2 m/s) and conducted at 10.3±6.1 m/s (n=34, mean±SD), 26.3±9.3 m/s (n=13) and 9.5±5.1 m/s (n=37), respectively. The axons from the colon conducted at about 0.5 to 16 m/s (n=20), 13 of them conducting at less than 2 m/s. About 75% of the axons which could not be activated by mechanical stimulation of the visceral organs were presumably unmyelinated (conduction velocity below 2 m/s). (5) Some ongoing activity was found in 9 out of 26 afferent units from the anus but, with one exception, the afferent units from the bladder, urethra and colon were silent. (6) It is concluded that the pelvic afferent units from the urinary bladder, urethra, colon and anus consist of distinct populations with characteristic response patterns. There is no indication from this investigation that the urinary bladder is supplied by sacral afferents which are only recruited at high intravesical pressures during passive distension and isovolumetric contractions and which are possibly associated with pain.Supported by the Deutsche Forschungsgemeinschaft     

Study of the carrying angle of the human elbow joint in full extension: a morphometric analysis

This study measured the carrying angle of the elbow joint in full extension in 600 students, using the supplementary angle to that between the longitudinal axis of the arm and that of the forearm. The mean carrying angle was 12.88°±5.92: 10.97°±4.27 in men and 15.07°±4.95 in women. The carrying angle changes with skeletal growth and maturity. The angle is always greater on the side of the dominant hand. We confirmed the inverse relationship between the carrying angle and the intertrochanteric diameter. Also, the type of constitution influences the value of the carrying angle, especially in women.     

A randomized controlled trial of goserelin and medroxyprogesterone acetate in the treatment of pelvic congestion

Following identification of the proportion of pelvic congestion among symptomatic patients complaining of chronic pelvic pain, and in a totally asymptomatic group of patients requesting tubal ligation, the efficiency of goserelin acetate versus medroxyprogesterone acetate was compared objectively using pelvic venogram scores, and subjectively by symptom resolution, improvement of psychological status and sexual functioning in a prospective randomized trial in 47 patients with pure pelvic congestion syndrome. Patients received either goserelin acetate (3.6 mg/month for 6 months) or medroxyprogesterone acetate (MPA; 30 mg/day for 6 months). Among patients with chronic pelvic pain, those with pure pelvic congestion were mostly parous, had the most severe pelvic signs and symptom scores, lowest rates of sexual functioning, and higher states of anxiety and depression as compared with others. At 1 year after treatment, goserelin remained superior to MPA in terms of pelvic venographic improvement as an objective measure. In alleviation of signs and symptomatology, improvement of sexual functioning and reduction of anxiety and depressive states as subjective measures, goserelin acetate achieved a statistically significant advantage (P = 0.0001) compared with MPA.     

Laparoscopic presacral neurolysis for endometriosis-related pelvic pain

BACKGROUND: Some patients with endometriosis are candidates for sympathectomy of the superior hypogastric plexus. The objective of this paper is to describe our technique of laparoscopic presacral neurolysis for sympathectomy and to report 1 year results of the first 15 cases. METHODS: To achieve this objective in a prospective observational study of 1 year follow-up; we performed laparoscopic presacral chemical neurolysis with phenol in 15 patients with pelvic pain and minimal-moderate endometriosis. The main outcome measures were: the impact of treatment on pelvic symptom resolution, non-opioid analgesic consumption during menses, sexual performance and observed complications and side effects during 1 year follow-up. RESULTS: We noted a significant reduction in total pelvic symptom score as compared with baseline mean (SD) of 9.04 (1.2). The mean difference [95% confidence interval (CI)] of reduction was 5.7 (4.9-6.5), 5.8 (5.0-6.6) and 5.8 (4.9-6.6) from the baseline at the 3rd, 6th and 12th postoperative month (P < 0.001). We observed a significant improvement in Sabbatberg Sexual Rating Scale as compared with baseline mean (SD) of 30.9 (4.3). The mean difference (95% CI) of increase was 33.4 (30.3-36.4), 33.2 (30.1-36.2) and 33.2 (30.1-36.3) from the baseline at the 3rd, 6th and 12th postoperative month. We observed a significant reduction in analgesic consumption during menses in terms of total naproxen sodium tablets as compared with baseline mean (SD) of 8.9 (1.1). The mean difference (95% CI) of reduction in the total number of naproxen sodium 250 mg tablets was 6.5 (5.5-7.5), 6.7 (5.7-7.7) and 6.6 (5.6-7.6) from the baseline at the 3rd, 6th and 12th postoperative month. The most common side effect was constipation. CONCLUSION: Laparoscopic presacral neurolysis is feasible and simple. More data is needed to support its efficacy and safety.     

Length and moment arm of human leg muscles as a function of knee and hip-joint angles

Summary Lengths of muscle tendon complexes of the quadriceps femoris muscle and some of its heads, biceps femoris and gastrocnemius muscles, were measured for six limbs of human cadavers as a function of knee and hip-joint angles. Length-angle curves were fitted using second degree polynomials. Using these polynomials the relationships between knee and hip-joint angles and moment arms were calculated. The effect of changing the hip angle on the biceps femoris muscle length is much larger than that of changing the knee angle. For the rectus femoris muscle the reverse was found. The moment arm of the biceps femoris muscle was found to remain constant throughout the whole range of knee flexion as was the case for the medial part of the vastus medialis muscle. Changes in the length of the lateral part of the vastus medialis muscle as well as the medial part of the vastus lateralis muscle are very similar to those of vastus intermedius muscle to which they are adjacent, while those changes in the length of the medial part of the vastus medialis muscle and the lateral part of the vastus lateralis muscle, which are similar to each other, differ substantially from those of the vastus intermedius muscle. Application of the results to jumping showed that bi-articular rectus femoris and biceps femoris muscles, which are antagonists, both contract eccentrically early in the push off phase and concentrically in last part of this phase.     

女性盆底可视化研究

目的：建立中国人体女性盆底部局部可视化数字模型。方法：应用中国女性数字化可视人体数据集，采用体绘制及面绘制重建方法，分别在P4微机和SGI工作站上对盆底部结构进行计算机三维重建及立体显示。结果：在P4微机上实现女性盆底部交互式三维可视化，在SGI工作站上重建了女性盆底部三维数字模型，三维重建图像能够清晰显示盆底部肌肉与骨性结构、膀胱、子宫及直肠等的三维解剖关系。结论：中国女性数字化可视人体数据集能够提供完整精确的断面数据，女性盆底三维交互可视化及数字模型准确反映该区域复杂的解剖结构及其空间毗邻关系，可为该区疾病的影像诊断及外科手术治疗提供形态学依据。     

髂前下棘的解剖及其在骨盆骨折外固定中的应用

目的:对髂前下棘进行应用解剖学研究,为骨盆外固定钉直径的选择和微创置钉技术提供参考依据.方法:对22例44侧骨盆的髂前下棘进行观察测量,获取髂前下棘横、矢径,以及体表投影等数据,按性别分组进行统计学处理.所得数据应用于26例骨盆骨折外同定手术.结果:男性髂前下棘横、矢径分别为(12.23±1.91)mm和(20.09±2.43)mm;女性分别为(11.05±1.56)mm和(19.25±1.85)mm.男性髂前下棘在髂前上棘下方(29.49±7.66)mm,内侧(21.79±6.48)mm;在耻骨结节上方(51.70±9.31)mm,外侧(67.74±5.36)mm.女性髂前下棘在髂前上棘下方(23.74±8.89)mm,内侧(16.86±8.92)mm;在耻骨结节上方(43.93±9.04)mm,外侧(70.16±6.39)mm.依据本研究数据对26例骨盆骨折髋臼上方行外固定手术.有效的减少术中放射学暴露和手术时间.结论:根据解剖学测量数据进行固定钉选择和术中定位,使得髋臼上置钉外固定支架可迅速准确实施,适应骨盆骨折急诊处理的需要.     

骨盆骨折出血动脉栓塞的解剖学基础

目的：了解骨盆动脉侧枝吻合特点，探讨骨盆骨折损伤血管的动脉栓塞的方法。方法：20具新鲜成人骨盆，采用前后双侧入路解剖，观察髂内外血管的走行特点、各动脉间的侧枝吻合情况。结果：骨盆动脉起点口径小于3mm的血管有闭孔动脉、髂腰动脉、骶外侧动脉。骨盆动脉起点口径3～5mm的血管有臀上动脉、臀下动脉、阴部内动脉。骨盆动脉起点口径大于5mm的血管有髂总动脉、髂内动脉、髂外动脉。距骨壁距离大于10mm的血管有髂总动脉、髂内动脉、髂外动脉。距骨壁距离小于10mm的血管有闭孔动脉、髂腰动脉、骶外侧动脉、臀上动脉、臀下动脉。骨盆动脉分支间有广泛的吻合支。结论：骨盆骨折动脉损伤应栓塞损伤的动脉及其主要的侧枝循环。