梨状隐窝定位食管入口的解剖学基础

目的:为临床介入放射置入食管内支架治疗高位食管良恶性病变提供解剖学基础。方法:经福尔马林固定的成人尸体标本共31具,沿正中矢状面做头颈部正中矢切面,以第7颈椎下缘水平切面,用1／50 mm游标卡尺和精密两脚规测量梨状隐窝下极与环状软骨板下缘之间的垂直距离,梨状隐窝下极与第5颈椎下缘的距离及其相对椎体位置关系,环状软骨板下缘与第5颈椎下缘的距离及其相对椎体位置关系。结果:(1)梨状隐窝下极与环状软骨板下缘的距离为(20.5±4.2)mm、梨状隐窝下极与第5颈椎下缘的距离为(10.7±9.3)mm、环状软骨板下缘与第5颈椎下缘的距离为(-3.5±11.7)mm。(2)环状软骨板下缘有62.5％位于颈6椎体水平。结论:以梨状隐窝下极定位食管入口的方法,是高位食管内支架置入可供选择的方法。     

经上颌窦筛窦手术的应用解剖

在60个尸头(男34,女26)上观察与测量了经上颌窦筛窦手术时有关的形态结构。眶下孔至眶下缘的距离平均6.8±3.4mm;眶下孔至梨状孔缘距离13.1±4.1mm;筛上颌板长9.1±3.0mm;宽5.4±1.5mm;筛上颌板上缘至后筛板顶的高度为 22. 3±3. 7 mm。筛顶板内缘与筛板间的高度差为 0～4 mm者有 59侧(占 49.2％);4～7mm者有 52侧(占43. 3％);7 mm以上者有9侧(占7.5％)。     

国人环甲膜的调查

选用经甲醛固定的成人死体50具(男46、女4)。尸体取仰卧位,头略后仰使颈伸直,气管居正中位,显露喉部。用大头针定点,依次用游标卡尺测量喉高(喉结顶点至环状软骨弓下缘中点距离)、喉宽(环状软骨左右外缘间最大距离)、环甲膜纵径(甲状软骨下缘中点至环状软骨弓上缘中点距离)、环甲膜横径(环甲膜左右侧甲状软骨与环状软骨相交点间距离)。按环甲膜面积=1/2(环甲膜纵径×环甲膜横径),计算出环甲膜面积。并对环甲膜的横径和纵径分别与喉宽、喉高作相关回归分析及自身比例分析。结果如下:1.男性环甲膜横径平均为2.18±0.24(1.62～2.97)cm;纵径0.89±0.18(0.50～1.24)cm;面积0.98±0.25(0.49～1.46)cm~2。女性环甲膜横径平均为1.59±0.25(1.40～1.95)cm;纵径0.66±0.10(0.56～0.78)cm;面积0.53±0.16(0.43～0.76)cm~2。2.环甲膜横径与喉宽之间经相关分析为中度相关(r=0.551,P<0.0005),回归方程式为:环甲膜     

杓状软骨的定位研究及其意义

目的为杓状软骨相关手术的术中定位提供解剖数据。方法观测30例60侧正常成人喉标本杓状软骨声带突和肌突形态及其与甲状软骨板的位置关系。结果 (1)测量了顶底间距等10项杓状软骨形态指标,除了甲杓肌附着深度外,其余指标具有性别差异(P0.05)(;2)肌突距甲状软骨下角下端距离:男(13.05±1.92)mm,女(11.76±1.79)mm;距甲状软骨板后缘间距:男(8.11±1.17)mm,女(6.95±1.26)mm;距甲状软骨板内膜间距:男(3.71±1.31)mm,女(3.65±1.23)mm。(3)杓状软骨肌突投影点位于甲状软骨板斜线后下区域,该投影点距甲状软骨下缘距离:男(7.12±1.43)mm,女(5.92±1.26)mm;距后缘距离:男(7.27±1.52)mm,女(5.81±1.47)mm。结论杓状软骨相关手术可根据甲状软骨后缘、下缘、环甲关节下缘来定位肌突。肌突距甲状软骨板内面最近,若从甲状软骨板斜线后区开窗寻找肌突可以缩短手术进路距离。     

喉后外侧进路杓状软骨定位的应用解剖

目的 :为临床喉后外侧手术进路杓状软骨的定位提供解剖依据。方法 :观察 3 0例 60侧 (男 19例 ,女 11例 )喉软骨架标本杓状软骨肌突与甲状软骨板的位置关系。结果 :(1)杓状软骨肌突距甲状软骨下角下端距离 :男 (12 .5± 1.8)mm ,女 (10 .5± 1.8)mm ;距甲状软骨板后缘间距 :男 (8.0± 1.7)mm ,女 (6.7± 1.8)mm ;距甲状软骨板内面间距 :男 (3 .4± 1.7)mm ,女 (3 .5± 1.1)mm。 (2 )杓状软骨肌突投影点位于甲状软骨板斜线后区下部 ,该投影点距甲状软骨下缘距离 :男 (6.6± 0 .1)mm ,女 (4 .9± 0 .4)mm ;距后缘距离 :男 (6.8± 1.8)mm ,女 (5 .5± 1.3 )mm。结论 :经喉后外侧进路手术可从甲状软骨后缘、下缘、环甲关节下缘或去除部分甲状软骨板来定位肌突。肌突距甲状软骨板内面最近 ,若从甲状软骨板斜线后区开窗寻找肌突可以缩短手术进路距离。     

颈部血管和神经与颈椎的关系及应用解剖

目的观测颈部血管、神经与颈椎的关系,为颈椎手术提供帮助。方法在40侧成人标本上,观测颈部血管、神经的长度及起止点与相邻颈椎间的距离。结果面动脉与舌神经伴行,起点距相邻C3椎体为(18.5±7.2)mm。舌动脉与舌下神经伴行,起点距相邻C2～3椎体为(19.7±8.4)mm。甲状腺上动脉与喉上神经外支伴行,起点距相邻C3椎体为(17.0±5.7)mm,止点距相邻C5椎体为(18.2±2.5)mm。喉上动脉与喉上神经内支伴行,起点距相邻C3椎体为(15.7±6.7)mm,止点距相邻C3椎体为(19.7±5.8)mm。甲状腺下动脉起点距相邻C7椎体为(17.3±5.5)mm,止点距相邻C7椎体为(11.3±3.4)mm。结论颈上部有数支动脉起至C2～3高度,此处显露喉上神经尤为重要。颈中部尽量减少对颈内脏鞘和颈动脉鞘的牵拉。颈下部则熟悉喉返神经与甲状腺下动脉的关系。手术途径选右侧为宜,以避免胸导管的损伤。     

迷路后径路内镜下行脑桥小脑三角区手术的解剖学研究

目的 :为临床上保留迷路在内镜下行桥脑小脑三角区病变手术提供解剖学资料。方法 :在 2 0例 40侧成人尸头上模拟颞骨径路保留迷路内镜手术 ,测量乙状窦内侧至总骨脚、岩上窦下缘至外半规管在岩部后骨板延长线之间距离 ,对可操作范围进行评估 ,对内镜的导入角度进行研究。并就如何避免损伤半规管、颈静脉球、面神经、乙状窦、岩上窦等结构提出看法。结果 :岩上窦下缘至内淋巴囊上缘距离为(9 .5 3± 2 .64 )mm ,乙状窦内侧至总骨脚距离为 (13 .89± 2 .3 4)mm ,至内淋巴管距离为 (10 .62± 2 .0 9)mm ;由该三条线构成的上底为 13 .89mm ,下底为 10 .62mm ,高为 9.5 3mm的梯形为内镜操作范围。乙状窦距颞骨表面距离 (以乙状窦上膝为标准 )为 (5 .2 7± 1.60 )mm ,乙状窦宽度为 (11.97± 2 .10 )mm ,上下膝长度为 (2 4.78± 4.2 1)mm ,乙状窦与外耳道后壁距离为 (13 .5 9± 3 .0 3 )mm ,岩骨后骨板至后半规管后缘、总骨脚后缘距离分别为 (4 .0 7± 1.2 6)mm和 (5 .5 8± 1.49)mm ,内镜的导入角度应力争与岩部上嵴平行 ,这样的角度最便于观察和操作 ,且不易损伤内部重要结构。我们测得的岩部上嵴与矢状线之间角度为 (63 .87± 9.3 1)°。结论 :保留迷路所得到的操作范围完全可以满足在内镜下行脑桥小脑三角区     

经乳突内窥镜下处理岩斜坡区病变两种硬脑膜切口的应用解剖

目的 :为颞骨径路在内窥镜下行岩斜坡区病变手术时因不同的手术目的采取不同的硬脑膜切口提供解剖学依据。方法 :在 2 0例 40侧成人尸头标本上采取不同的硬脑膜切口模拟颞骨径路内窥镜手术 ,比较两种切口对手术的影响 ;并测量相关数据。结果 :岩上窦下缘至内淋巴囊上缘为 ( 9.5 3± 2 .64 )mm、岩下窦上缘之间距离为 ( 2 3 .48± 2 .48)mm ,乙状窦内侧至共脚、内淋巴管、内淋巴囊外侧之间距离分为 :( 13 .89± 2 .3 4)mm、( 10 .62± 2 .0 9)mm和 ( 3 .73± 1.66)mm。结论 :两种切口各有优缺点 ,T形切口适应证稍广 ,但易损伤周围重要结构。     

示指基节指骨与身高的性别判别分析

为探索示指基节指骨与身高的性别差异,提供判别率较高且适用于国人的性别判别式,作者随机对健康大学生202人(男100,女102人)的双手进行后前位X线片拍摄,同时测量了身高.每手测量了示指基节指骨的长与中点宽,结果(mm)为:男性分别为41.29±0.15,9.67±0.06,女性为 38.76±0.16,8.24±0.04.身高男女分别为 1717.00±4.97和 1600.78±5.26,三项均具有非常显著的性别差异.按Fisher法求出三个判别式,其判别率均高达93%以上,对人类学及法医学鉴定性别具有重要的实用意义.     

颈椎椎间隙后缘骨赘的影像学测量与临床意义

目的通过对颈椎椎间隙后缘骨赘的影像学测量,研究其临床意义。方法选取2016年9月至2017年12月收治的88例颈椎病患者(男36例,女52例),术前摄颈椎X线片,调阅PACS系统影像,以椎体下、上终板的切线(a线,b线)分别将相邻颈椎后缘骨赘分为上、下部(A上,A下,B上,B下),使用Auto CAD 2014版软件测量各部骨赘面积,计算切线上下骨赘面积与同侧骨赘总面积(A总,B总)的比值(Mean±SD)。结果本研究中后缘骨赘分为4型:Ⅰ型占61.36%,Ⅱ型5.68%,Ⅲ型10.22%,Ⅳ型22.72%。颈椎椎间隙后缘骨赘多发生于C_(5/6),占所有节段的43.18%。各节段的性别差异无统计学意义(P0.05)。上位椎体下缘a线以上存在骨赘者占总数比为32.94%,A上骨赘面积占该A总骨赘总面积的(41.18±15.45)%。下位椎体上缘b线以下存在骨赘者占总数比为28.40%,B下骨赘面积占该B总骨赘总面积的(54.69±22.49)%。结论在颈前路椎间盘切除减压融合术前通过分析颈椎后缘骨赘的影像学类型,规划术中处理后缘骨赘,可以达到更好的脊髓减压效果。     

Photoperiodicity and the function of the hypophysis and the adrenal cortex

Summary The ACTH content of the hypophysis of rats rises from a minimum in the morning to a maximum in the evening hours. These fluctuations are associated with the diurnal rhythm of light and darkness, and are abolished under conditions of continual light or darkness for 30 days. Rhythmic fluctuations of the ascorbic acid content of the adrenals are also found, with maximum values in the evening, and these are likewise abolished by maintenance under conditions of constant illumination.Presented by Active Member AMN SSSR V. V. Parin     

Characteristics of the topographic interrelation of the head of the pancreas and the duodenum and pathology of the organs of the pancreatoduodenal area

Seventy pancreatoduodenal complexes of 55 patients with chronic pancreatitis and tumours of this zone and 15 patients died from other diseases are studies histotopographically . The pieces of the pancreatic head tissue in the medial wall of the duodenum were found in 12 cases of the first group and in 4 control cases. The pancreatic tissue consisted either of all elements of this organ or cystically dilated ducts and seemed to infiltrate different layers of the duodenum wall. Three variants of the pancreatic head structure are suggested on the basis of anatomo-topographical interrelationships of the pancreatic head and duodenum. In 12 out of 14 cases chronic pancreatitis and carcinoma of organs of this zone were combined with the variants of the pancreatic head structure, in 2 cases there was a true heterotopy . Pathogenetic significance of these variants for the development of chronic pancreatitis is discussed.     

指背腱膜滑动与近侧指间关节屈曲关系及临床意义

目的:探讨指背腱膜滑动距离与近侧指间关节(PIP)屈曲关系,为临床修复提供解剖学基础。方法:男性成人新鲜尸体标本10侧30指(示、中、环指各10指),切除手指皮肤,不破坏腱鞘、屈肌支持带、伸肌支持带、内在肌及外在肌,使肌腱保持正常的生理状态,分别测量各指中央束(CS)、侧束(LB)在PIP屈曲45°和90°时的滑动距离。结果:当PIP屈曲45°时,CS滑动距离为(2.7±0.4)mm,LB滑动距离为(2.8±0.6)mm;当PIP屈曲90°时,CS滑动距离为(4.3±0.7)mm,LB滑动距离为(4.8±0.6)mm。结论:指背腱膜滑动距离减少,严重影响手指的屈曲功能。对于指背腱膜的新鲜性损伤应予以精确修复;对于陈旧性损伤的修复应确保指背腱膜的正常滑动范围。     

产后妇女全血钙和骨源性碱性磷酸酶（ABAP）活性的检测与分析

目的结合我院特点,测定来我院进行产后检查妇女的骨源性碱性磷酸酶（ABAP）活性以及全血钙。方法采用金标法测定产妇3031人骨源性碱性磷酸酶（ABAP）的活性,并从中随机选择855人采用BH-5100型多通道原子吸收光谱仪检测全血钙。结果经测定,3031名产妇中679人骨源性碱性磷酸酶（ABAP）的活性异常,异常者检出率为22.4%,其中83.5%的产妇轻度缺钙,而16.5%的产妇严重缺钙;而全血钙异常检出率为17.0%。结论ABAP活性检测方法比全血钙检测方法测定体内钙营养水平更具敏感性,可作为检测评价产妇钙营养状况的一种简易可靠的方法,为产后骨质疏松提供了一种可靠、便捷、科学合理的指标。     

Cycloversion and cyclovergence: the effects of the area and position of the visual display

Rotation of a display in the frontal plane evokes a conjugate nystagmic rotation of the eyes (cycloversion) about the visual axes, with slow phases in the direction of stimulus motion — a response known as torsional optokinetic nystagmus (TOKN). Antiphase rotation of large dichoptic displays evokes a disconjugate rotation of the eyes about the visual axes, a response known as cyclovergence. Using the scleral-coil technique for monitoring eye movements we recorded TOKN evoked by black-and-white sectored displays rotating about the visual axis at an angular velocity of 30°/s. The display was confined to central areas with diameters ranging from 5° to full field or with the central 5° to 75° occluded. A 5° central display evoked TOKN with 40% of the gain for the full-field display and gain increased as a function of the size of the display. The gain of TOKN decreased with increasing size of a central occluder. These characteristics of TOKN are similar to those of horizontal OKN. Cyclovergence was virtually absent with a 5° display but was immune to occlusion of the central 40°. Cyclovergence therefore differs from cycloversion in showing no preference for centrally placed stimuli. These effects are free from the influence of stationary edges, since these were concentric with the stimulus motion. The effects are also free from the influence of voluntary pursuit, since humans do not normally have voluntary control over torsional eye movements.     

Organization and distribution of the upper and lower esophageal motoneurons in the medulla and the spinal cord of the rat

The upper cervical esophagus is exerted on swallowing and peristalsis by somatic and visceral motoneurons, whereas the lower esophagus is exerted on only peristalsis by visceral motoneurons. We examined the origin of the esophageal motoneurons and whether there were any differences between the distributions of the upper and the lower esophageal motoneurons in the medulla and the spinal cord using cholera toxin subunit b (CTb) as the retrograde tracer. Following injection of CTb into the cervical esophagus resulted in heavy labeling of the neurons in the nucleus ambiguus including the compact (AmC), semicompact (AmS) and loose (AmL) formations, and the medial column of lamina IX at the C1-C5 levels of the cervical spinal cord corresponding to the spinal accessory nucleus. A few labeled neurons were found in the inferior salivatory nucleus, the rostral division of the dorsal motor nucleus of the vagus (DMX), the accessory facial nucleus and the lateral column of lamina IX at the C2 and C3 levels. All these labeled neurons showed ChAT immunoreactivity. When CTb was injected into the cut end of the unilateral recurrent laryngeal nerve, many labeled neurons were found in the ipsilateral AmC, the AmL, and the bilateral medial column at the C1 and C2 levels. Following injection of CTb into the subdiaphragmatic esophagus resulted in heavy labeling of the neurons only in the AmC and the DMX. When CTb was injected into the sternomastoid muscle, many labeled neurons were found in the medullary reticular formation, the facial nucleus, the medial column at the C1-C3, C5 and C6 levels, and the lateral column at the C2, C3, C5 and C6 levels. Injections of a Fluoro-Gold into the cervical esophagus and a CTb into the sternomastoid muscle or the subdiaphragmatic esophagus in the same animal showed many double labeled neurons in the medial column of the accessory nucleus at the C1 and C2 levels, but no double labeled neurons in the AmC. These results indicated that the upper cervical esophagus is innervated by the visceral medullary vagal motoneurons as well as the somatic spinal accessory motoneurons. The lower esophagus is innervated only by the visceral medullary vagal motoneurons.