ANATOMICAL STUDY OF THE STRUCTURES AT THE ROOF OF THE ORBIT WITH SPECIAL REFERENCE TO THE CHECK LIGAMENT OF THE SUPERIOR FORNIX

In an attempt to clarify the topography of the structures at the roof of the orbit we dissected the anterior cranial fossas of seven cadavers. Structures such as the periorbita, levator muscle of the upper eyelid and its aponeurosis, as well as Tenon's capsule with its continuation into the check ligament of the superior fornix were identified. The technique for correction of congenital blepharoptosis by suspension of the check ligament of the superior fornix to the tarsus was mimicked and its function clarified.     

腹腔镜腹膜内补片植入式疝修补术应用解剖研究

目的腹股沟疝是临床常见的外科疾病,主要以手术治疗为主,而腹股沟疝气的手术治疗是以对腹股沟区的解剖逐步认识而发展的,外科医生对腹股沟的解剖贡献巨大,我们通过临床手术实践发现腹股沟的另一种能很好、安全的运用于IPOM手术的解剖。     

Hemifacial spasm caused by a tortuous recurrent perforating artery: A case report

IntroductionWhen the culprit vessel in hemifacial spasm (HFS) is hard to determine, this is a challenge in microvascular decompression (MVD) surgery. In such a situation, small arteries such as perforators to the brainstem might be suspected. But small arteries are omnipresent near the facial nerve root exit/entry zone (fREZ). How to decide whether a given small artery is responsible for HFS is unclear.MethodWe report a case with a previously unreported form of neurovascular impingement, in which the culprit was found to be the recurrent perforating artery (RPA) from the anterior inferior cerebellar artery (AICA). An aberrant anatomic configuration of the RPA was found intraoperatively, which we thought was responsible for generating focal pressure on the facial nerve.Case reportA 62-year-old woman presented with a 1-year history of paroxysmal but increasingly frequent twitching in her right face. MRI showed tortuosity of the vertebral artery and apparently marked neurovascular impingement on the asymptomatic left side, while only the right AICA could be implicated as the possible culprit. Hemifacial spasm was diagnosed based on the typical clinical manifestation, and MVD was performed. The pre-meatal segment of the AICA was found not to be impinging the facial nerve at any susceptible portion near the fREZ: root exit point, attached segment, or root detachment point. The real culprit was in fact the RPA. This occult culprit vessel was tortuous, forming a coil-shaped twist which was interposed between the facial nerve and the intermediate nerve near the root detachment point. Focal pressure atrophy of the nerve was clearly observed at the compressing site. The patient achieved total spasm relief immediately after surgery, and remained spasm-free at 1-year follow-up, without any postoperative complications.ConclusionMVD is the only curative treatment for hemifacial spasm, but with a failure rate of around 10%. Mistaking the real culprit has been reported to be the most likely reason for surgical failure. Therefore, intraoperative identification of atypical occult forms of vascular compression is of importance to improve surgical outcome. In the present case, the RPA formed a coil-shaped twist, which inflicted focal vascular compression causing hemifacial spasm. We recommend careful inspection of the recurrent perforating artery during MVD for HFS, and decompressing any such neurovascular impingement.     

踝关节三角韧带损伤的诊疗进展

三角韧带是踝关节内侧柱的一部分,在维持踝关节的稳定性和力学传导上有重要作用,其发病机制主要为外旋、外展暴力,而损伤的诊断及治疗还没有统一的标准.目前诊断主要依据踝关节内侧间隙和临床检查,核磁与关节镜有助于明确诊断,却没有得到早期应用,治疗上存在保守和手术两大分歧,手术方式的选择也有所不同,国内倾向于断裂韧带的修复,国外则更加注重三角韧带的重建.本文就目前国内外有关踝关节三角韧带的研究,在解剖、生物力学、诊断和治疗上做一综述.