腰部椎间孔韧带的观测

用胎儿，儿童及成人脊柱标本，共２０例，研究腰部椎间孔韧带，在上述标本中均发现椎间孔韧带，共１９５条，其中横孔上韧带２０条，横孔下韧带１１９条，体横上韧带３１条，本横下韧２５条。横孔上，下韧带带主要分布于上腰部椎间孔内，尤以Ｌ１椎间孔内多见。     

Age changes in the lumbar intervertebral disc studied with magnetic resonance and cryomicrotomy

This is an original evaluation made on the correlation between sagittal gross and histologic cryomicrotome sections and magnetic resonance (MR) images of the lumbar intervertebral discs according to age groups. Age-related structural changes were recognized in the anatomic sections and MR images of the discs in cadavers from birth to 73 years of age. In T2-weighted MR images, the nucleus and fibrocartilaginous inner anulus have a bright signal while the peripheral annular fibers have a low signal intensity. With aging the discs become progressively more fibrous: the peripheral anulus widens and becomes densely fibrous and the inner anulus extends centrally to encroach upon the nucleus, sometimes producing a bilobed nucleus. In the newborn the components of the disc are sharply demarcated with a large, centrally located nucleus pulposus and a relatively narrow anulus fibrosus. In the adult, the nucleus and inner anulus continue to have a relatively bright signal in MR images and characteristically contain a dark band of low signal intensity which does not correspond to clefts or tears of the disc but to increased fibrous tissue content. The thickened peripheral annular fibers have a very low signal intensity. By the eighth decade of life the discs have a very high fibrous content throughout, indicated in MR images by a decreased signal intensity with no sharp distinction between nucleus and anulus in the anatomic sections. The dark band in the central portion of the disc remains as a characteristic feature in MR images of the adult disc. Degenerative changes in the discs are identified in MR images by contrasting signal intensities.     

腰椎椎弓峡部裂三维有限元模型的建立与验证

目的建立腰椎椎弓峡部裂三维有限元模型,通过生物力学实验进行有效性验证。方法利用临床1例腰椎椎弓峡部裂病例影像学资料,采用Simpleware建模软件分别模拟下腰椎骨性结构、椎间盘组织,并在Ansys软件附加腰椎相关韧带和关节囊,建立L5双侧椎弓峡部裂三维有限元模型,并通过体外力学实验结果验证模型有效性。结果重建模型构建了椎体皮质骨、松质骨、腰椎关节突关节、椎弓根、椎板、横突、棘突等骨性结构,还构建了纤维环、髓核、上下终板组织,并成功附加了前纵、后纵韧带、黄韧带、棘上、棘间韧带以及关节突的关节囊。模型共计有281261个节点和661150个单元。腰椎椎弓峡部裂重建成功。通过与体外生物力学在不同工况下L4下关节突、L5上、下关节突、S1上关节突应力/应变趋势以及L4下关节突内外侧力学应力/应变趋势比较,验证了模型的有效性。结论建立了下腰椎椎弓峡部裂的三维有限元模型,此模型可以用来进一步实施有关峡部裂治疗的力学研究。     

Transforaminal ligament may play a role in lumbar nerve root compression of foraminal stenosis

Lumbar foraminal stenosis is a common pathological change, and lumbar nerve root compression in stenotic foramina was recently considered as one of the main causes of low back pain and leg pain. However, the exact mechanism of lumbar nerve root compression in foramina is still not clear. Previous studies indicated that loss of the intervertebral disc height could reduce the cross-sectional area of lumbar foramina, while lumbar nerve root compression by boundaries of foramina has not been observed in experimental reduction of the intervertebral disc height. Given the close anatomic relationship between transforaminal ligaments and lumbar nerve roots, we hypothesize that transforaminal ligament can be the leading cause of lumbar nerve root compression in foraminal stenosis. We also propose that there are two possible mechanisms of lumbar nerve root compression by transforaminal ligaments: (1) nerve roots are compressed by the transforaminal ligament which moves downward with the loss of the intervertebral disc height; (2) pathological transforaminal ligaments increase the risk of nerve root compression in foramina.     

Innervation of the canine thoracolumbar vertebral column

The pattern of innervation of the caudal thoracic and cranial lumbar vertebral column of the dog is described. Frozen sections stained with Schofield's silver impregnation method show that the dorsal longitudinal ligament is profusely innervated, while the anulus fibrosus contains a few nerves limited to its outermost layers; no nerves are present in the nucleus pulposus. Following injection of horseradish peroxidase (HRP) into the anulus fibrosus of the thoracolumbar intervertebral disc and subsequent removal and staining of dorsal root ganglia, the reaction product is found in ganglia as far as two segments cranially as well as caudally, demonstrating that the disc is innervated by nerves arising from several spinal cord segments. A meningeal ramus, which innervates the discs of man, could not be found by gross dissection. Dissections show each vertebral articular facet innervated by the medial branches of two contiguous spinal nerves, a pattern further confirmed by injections of HRP into facet joints with subsequent staining of dorsal root ganglia. The dorsal rami of spinal nerves often divide into medial, intermediate, and lateral branches rather than the traditionally described division into only medial and lateral branches.     

颈椎椎间孔外口区韧带的解剖学观测

目的　对颈椎C_2~7椎间孔外口区域的韧带进行解剖学描述并探讨其临床意义。 方法　对10具成人尸体标本的 100个椎间孔进行解剖观测。鉴别所有出现的韧带,观察并记录C2~7椎间孔外口区域椎间孔外韧带的数量、形态、分布和起止位置。并用游标卡尺分别测量每条韧带的长度、宽度和厚度。 结果　在100个椎间孔外口区域共发现252个椎间孔外韧带。椎间孔外韧带可以分为放射型韧带236 个(93.7 %)和横跨型韧带16个(6.3 %)两种。放射型韧带将神经根连接到周围结构,可分为上方韧带（25.0%）,下方韧带（60.2%）,前方韧带（6.3%）和后方韧带（8.5%）;横跨型韧带与神经根相垂直并横跨于神经根上,其中,横跨型韧带在C4~5节段最为常见,在C4~5节段的平均长度为横跨型韧带长度为(8.12±1.38) mm(6.28~9.93 mm),厚度最厚可达1.04 mm,每个颈椎椎间孔最多只有一条横跨型韧带。 结论　椎间孔外韧带是椎间孔正常的生理结构,可能与颈椎减压术后C5神经麻痹的发生有关。在颈椎减压术后,横跨型韧带可能是造成神经根卡压而引起神经损伤的潜在原因之一。而放射型韧带可以限制脊神经移位,可能因此牵拉神经引起损伤。     

胸椎椎间孔外韧带的解剖学观测

目的　对T1~12椎间孔外口区域的韧带进行解剖学研究并探讨其临床意义。 方法　对10具成人尸体标本的240个T1~12椎间孔进行解剖观测。鉴别所有出现的韧带，观察并记录T1~12椎间孔外口区域椎间孔外韧带的数量、形态、分布、起止位置和毗邻，并用游标卡尺分别测量每条韧带的长度、宽度和厚度。 结果　在229个胸椎椎间孔外口区域共发现564个椎间孔韧带，另11个椎间孔外口区域未发现韧带，椎间孔外韧带的出现率为95.42%。韧带有2种类型，放射型占24.11%（136个），横跨型占75.89%（428个）。放射型韧带在T1及T9~12节段较为常见，而在T2~8节段则相对较少。其中有43.44%（245个）韧带分布于椎间孔外口区域的前部，39.89%（225个）分布于后部，11.35%（64个）分布于上部，5.32%（30个）分布于下部。 结论　胸椎椎间孔外口区域存在2种类型的韧带；其中放射型韧带可能是一种脊神经抗牵拉的结构，对脊神经起到固定和保护作用，横跨型韧带可能是胸椎压缩性骨折后肋间神经痛的潜在原因之一。     

关节突植骨融合联合竖脊肌离断建立邻近椎间盘退行性变动物模型的初步研究

目的研究关节突植骨融合联合竖脊肌离断的方法建立邻近椎间盘退行性变动物模型可行性。方法选用日本大耳白兔24只,3个月龄,雌雄不限,体质量（2．5±0．5）kg,随机平均分成2组。实验组切除L3-4、L4-5、L5-6。双侧关节突并原位进行植骨,同时横断L1水平双侧竖脊肌;对照组只切开皮肤即缝合。术后2个月和6个月,从形态学和影像学（三维CT重建和MRI、观察腰椎融合情况和邻近椎间盘退行性变情况。结果实验组术后2个月时,L3-6。椎体关节突处骨赘增生．腰椎活动受限,腰椎后结构发生融合;6个月时,L2-3,椎间盘高度降低,含水量减少,组织学提示纤维环排列不规整并出现裂隙．发生退行性改变.对照组未见明显变化。结论应用破坏腰椎关节突并植骨联合切断双侧竖脊肌的方法,可以建立腰椎后结构融合导致邻近椎间盘退行性变的实验动物模型．为研究邻近椎间盘退行性变的发生机制奠定研究基础。     

髂腰韧带CT三维显示及其在腰椎节段定位中的作用

目的:研究髂腰韧带能否在CT上显示以及髂腰韧带在腰椎节段定位中的作用。方法:128例腰椎患者进行了CT容积扫描检查,采用横断、矢状、冠状多平面重建图像分析髂腰韧带的结构特点。128例患者中有11例为移行椎患者,均经X线片证实。结果:117例腰骶正常节段的患者髂腰韧带均起自L5横突。83%的髂腰韧带前、后束之间间隔脂肪组织,前、后束可分辨,横断位上前束较扁,向外侧走行止于髂棘后1/3内侧缘,后束较短而厚,向外后侧走行止于髂后上棘内侧骨面,冠状位上髂腰韧带前、后束均呈类三角形改变,尖端指向髂棘,底边与L5横突相连,矢状位上髂腰韧带前束呈薄条带状或小点状,后束呈宽厚条带状或结节状。17%的髂腰韧带前、后束之间缺乏脂肪组织,前、后束不能分辨,横断位上韧带呈宽厚条带状或扇形向外后方行走,止于髂棘,冠状位上韧带呈类三角形改变,矢状位上韧带呈结节状或不规则条带状改变。以髂腰韧带作为L5椎体水平的定位标记,11例移行椎均准确定位。结论:CT三维多平面重建可准确显示髂腰韧带的形态和走行特点。髂腰韧带起自L5横突,根据这一特点能对腰椎节段进行准确的定位,特别是在合并有腰骶部移行椎的患者。     

The radioscapholunate ligament: A gross and histologic description

The anatomic relationships of the carpal radioscapholunate ligament to its contiguous structures were analyzed by studying (1) 12 grossly dissected fresh adult wrists, and (2) multiple histologic sections from six adult wrists. Observations indicate that the radioscapholunate ligament originates from the prominence between the scaphoid and lunate articular facets on the distal articular surface of the radius, and from the palmar margin of the distal radius, deep and medial to the origin of the radiotriquetral and radiocapitate ligaments. The primary insertion of the radioscapholunate ligament is the medial margin of the proximal pole of the scaphoid. The ligament secondarily inserts into the lateral margin of the lunate and significantly contributes to the proximal portion of the scapholunate interosseous ligament. The radioscapholunate ligament is distinguished morphologically from the other palmar radiocarpal ligaments by its loosely organized collagen fibers and relatively high degree of vascularity. The radiotriquetral and radiocapitate ligaments are composed of densely fasciculated collagen fibers surrounded by perpendicularly oriented perifascicular and epiligamentous fibers. A fibrous capsular layer covers the most superficial aspect of each carpal ligament. On the deep surfaces of these ligaments, a condensation of epiligamentous fibers forms a synovial capsular layer. The palmar radiocarpal ligaments are truly intracapsular structures, as they are interposed between the fibrous and synovial capsular layers. No histologic evidence of elastin is present within the substance of these ligaments.     

Regional variations in the density and arrangement of elastic fibres in the anulus fibrosus of the human lumbar disc

Elastic fibres are critical components of the extracellular matrix in dynamic biological structures that undergo extension and recoil. Their presence has been demonstrated in the anulus fibrosus of the human lumbar intervertebral disc; however, a detailed regional analysis of their density and arrangement has not been undertaken, limiting our understanding of their structural and functional roles. In this investigation we have quantitatively described regional variations in elastic fibre density in the anulus fibrosus of the human L3-L4 intervertebral disc using histochemistry and light microscopy. Additionally, a multiplanar comparison of patterns of elastic fibre distribution in the intralamellar and interlamellar zones was undertaken. Novel imaging techniques were developed to facilitate the visualization of elastic fibres otherwise masked by dense surrounding matrix. Elastic fibre density was found to be significantly higher in the lamellae of the posterolateral region of the anulus than the anterolateral, and significantly higher in the outer regions than the inner, suggesting that elastic fibre density in each region of the anulus is commensurate with the magnitude of the tensile deformations experienced in bending and torsion. Elastic fibre arrangments in intralamellar and interlamellar zones were shown to be architecturally distinct, suggesting that they perform multiple functional roles within the anulus matrix structural hierarchy.     

A neurosensory hypothesis of ligament function

Ligaments are generally viewed as passive structural elements. Virtually all treatments for torn ligaments are based upon a structural paradigm. However, there is considerable evidence to suggest that ligaments function as neural sensors to facilitate supportive reflex contractions of muscles. It is hypothesized that injury to ligaments disrupts the neural apparatus as well as the structural support. Dysfunction following injury may result as much from neural injury as from structural instability. In some patients, "neural adaptation" likely occurs, while in others it does not. Since current treatments for ligament injuries (all of which are based on structure) are not uniformly successful, we need to develop methods to distinguish the neurally impaired patient from the structurally impaired, and to develop methods to treat the former.     

腰4、5间盘纤维环结构形态的细微观察

观测成人腰椎间盘纤维环纤维层水平的细微解剖结构。用显微外科技术将腰间盘纤维环分离,每层纤维均分为8个观测点,测量纤维走向与水平面的夹角等数值。结果表明:各测点处的纤维走向角α,在水平面,沿径向由外向内,随层数的增加不断变大,最小纤维走向角发生在前正中处,其值为25°~30°;在同一层,纤维走向角由前向后不断变大,在椎间盘正后方为70°~90°,即此部分纤维走向与后纵韧带走向基本一致;用归一化方程,归一化直线可以非常方便地求出任一层、任一点处的纤维走向角α;腰椎间盘纤维环的前方、左右两侧皆有交织现象发生,左右两侧交织区域多些,仅后方正中附近未发现相临两层的交织现象。由此可见,腰椎间盘纤维环纤维具有特殊的细微结构,与其功能相适应。     

The anococcygeal ligaments: Cadaveric study with application to our understanding of incontinence in the elderly

The term “anococcygeal ligament (ACL)” has been used to refer to two distinct structures: a superficial fibrous band originating from the myosepta of the external anal sphincter (EAS) and running upwards to the coccyx (the superficial ACL); and a deep fibrous band originating from the periosteum of the coccyx, merging with the thick presacral fascia and attaching to the superior end of the EAS (the deep ACL). In the present work, elastic fiber histology and muscle immunohistochemistry of sagittal sections obtained from 15 donated elderly male cadavers showed that superficial ACL, corresponding to a superficial fascia or skin ligament, was composed of very tortuous elastic fibers, with a fine elastic fiber mesh at their coccygeal attachment; whereas the deep ACL was composed of almost straight collagen and elastic fibers, intermingled with the coccygeal periosteum. Due to the weak insertion into the coccyx and the wavy course, the superficial ACL is unlikely to provide, even in association with contraction of the longitudinal anal muscle, a stable mechanical support to maintain the configuration of the EAS. Being similar to the suspensory ligament of breast, tissue repair of the skin ligament would not have a mechanical role. In contrast, the deep ACL, in association with the thick presacral fascia, likely plays a role in maintaining a suitable positioning of the anorectum to the coccyx. However, their relative lack of smooth muscles compared with rich elastic fibers indicates that both ACLs may become permanently overextended under conditions of long‐term mechanical stress. Clin. Anat. 28:1039–1047, 2015. © 2015 Wiley Periodicals, Inc.     

一种新型脊柱动态内固定系统的理论验证

背景：传统的腰椎融合固定后存在许多不可避免的缺陷,可造成邻近节段的退行性变或加剧已存在的脊柱退行性变。目前动态内固定系统的初步临床效果令人鼓舞,但进一步的临床应用却呈现出现有棘突间内固定器设计上的诸多不足,出现一些与器械直接相关的并发症。目的：研发一种新型脊柱动态内固定系统。方法：自行设计一种新型脊柱动态内固定系统,既能适应脊柱的万向活动,又能保留棘上韧带。从设计理念而言,更能满足人体脊柱的正常活动。结果与结论：腰椎棘突间动态固定在不牺牲脊柱即刻稳定性的前提下将其动态固定,置入后可分散坚固内固定的负荷传导,避免应力遮挡,还可增大椎管容积,增加椎间孔的大小,恢复椎间隙高度,卸载后方纤维环的负荷,减少相应节段小关节载荷。但由于现有腰椎棘突间动态稳定器的设计缺陷和昂贵价格,使临床应用受限。自主研发的一种棘间万向动态稳定器,可安于棘突根部,实现棘间、棘-板间弹性承载并能万向活动,从而有望克服现有技术的诸多不足并降低其价格。中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程全文链接：     

Three-dimensional morphology of the pericellular matrix of intervertebral disc cells in the rat

Intervertebral disc cells are surrounded by a pericellular matrix that is biochemically and morphologically distinct from other extracellular matrix regions. Although the function of the pericellular matrix is not fully understood, prior studies of pericellular matrix-chondrocyte regions in articular cartilage (termed 'chondrons') suggest that the size, shape, and mechanical properties of the pericellular matrix significantly influence the micromechanical environment of the contained cells. A first step in understanding the role of the pericellular matrix in the intervertebral disc is to quantify the three-dimensional morphology and zonal variations of these regions across the disc. In this study, three-dimensional reconstructions and morphometric measurements of pericellular matrix-cell regions were obtained in situ using fluorescence confocal microscopy of en bloc sections of nucleus pulposus and anulus fibrosus of the rat disc immunolabeled for type VI collagen. The morphology of the pericellular matrix and cells varied significantly across regions, with distinct pericellular matrix aspect ratios (largest/smallest diameter) showing shapes that were generally large and rounded in the nucleus pulposus (average of 1.9), and ellipsoidal and discoidal in the inner (2.4) and outer anulus fibrosus (2.8). The average pericellular matrix volume per cell was found to be significantly larger in the nucleus (6424 microm(3)) than that of inner (1903 microm(3)) and outer (1433 microm(3)) anulus. Pericellular matrix regions containing 1 or 2 cells were the dominant subgroup in the rat intervertebral disc at both 1 and 12 months of age. Multicellular pericellular matrix regions were present more often in the younger nucleus pulposus and outer anulus fibrosus. The orientation of the pericellular matrix regions further varied significantly across the disc, reflecting local collagen matrix architecture. These studies provide new information on the organization and shape of intervertebral disc cells and their surrounding pericellular matrix, which may provide new insights into the mechanisms that regulate cell-matrix interactions.     

成人胸椎间孔韧带的解剖学观测

目的 通过解剖观测成人胸椎间孔韧带.为国人提供胸椎间孔韧带的解剖学资料并探讨其临床意义.方法 选用成人尸体标本15具,解剖观察胸椎间孔韧带.用游标卡尺进行相关测量.结果 在30侧成人胸椎标本中未发现横孔上韧带和体横韧带.T1椎间孔内未发现横孔下韧带,T2～T12椎间孔内均发现横孔下韧带,其出现率从T2～T12呈逐渐增加...     

Three ligaments reinforce the lower eyelid

This study was performed to elucidate the ligamentous structures in the lower eyelid other than the Lockwood ligament. Ten lower eyelids (right 5, left 5) of 5 Oriental post-mortems were dissected. The orbital septum was incised along the orbital rim, and then turned over toward the eyelid margin. The orbital fat was exposed and removed as much as possible without injuring the ligamentous structures. The ligamentous structures in the lower eyelid were then investigated macroscopically. There were two other ligaments in the lower eyelid in addition to the Lockwood ligament. All three ligaments originated from the posterior lacrimal crest, but went in different directions. The superior ligament ran on the junction of the orbital septum and the capsulopalpebral fascia, and in the lateral area, it ran on the posterior aspect of the orbital septum and attached to the periosteum of the lateral orbital rim. The inferior ligament went toward the posterior aspect of the inferior oblique muscle after separating from the Lockwood ligament. Ligaments other than the Lockwood ligament were revealed in the lower eyelid. These ligaments are thought to reinforce the fragility of the lower eyelid.     

拇指腕掌关节周围韧带的解剖学分析

目的　解剖拇指腕掌关节周围各条韧带及观察其组织形态学特征,探讨其在拇指腕掌关节稳定性中的作用。 方法　采用大体解剖学方法对10例新鲜冰冻手标本进行解剖,识别拇指腕掌关节周围韧带的连接部位与方向性,对韧带的宽度、长度、厚度进行形态学对比分析。并组织学观察拇指腕掌关节背侧和掌侧韧带细胞数。 结果　确定拇指腕掌关节周围存在7条主要韧带：即由3条背侧韧带（桡背侧韧带、背侧中央韧带、后斜韧带）组成的复合体,厚度分别为(1.24±0.12)、(1.91±0.15)、(1.61±0.12) mm。2条掌侧韧带（前斜韧带、尺侧副韧带）,厚度分别为(0.78±0.11) mm、 (1.03±0.11) mm。2条尺侧韧带（大多角骨-第1掌骨背侧韧带,第1、2掌骨间韧带）,厚度分别为(0.78±0.19) mm、(0.89±0.19) mm。背侧韧带明显厚于掌侧韧带（P<0.01）,桡背侧韧带、背侧中央韧带、后斜韧带的细胞数多于前斜韧带,后斜韧带的细胞数也多于尺侧副韧带,均有统计学差异（P<0.05）。 结论　3条背侧韧带组成粗厚坚韧的复合体,在拇指腕掌关节的稳定中,前斜韧带起着更大的作用。