肾上腺的断层标本与CT、MR图像对照研究

目的：为肾上腺病变的横断层影像诊断和外科治疗提供实用的断层解剖学依据。方法：采用22例成人上腹部连续横断层标本、10例健康成人MR横断层图像及20例无肾上腺病变的临床病人MSCT横断层图像,连续追踪观测了肾上腺在横断面上的形态、位置、毗邻和大小。结果：在连续横断面上,左、右肾上极层面是寻找双侧肾上腺的可靠层面。下腔静脉后壁是识别右肾上腺前界的标志;脾动、静脉则是识别左肾上腺前界的标志。肾上腺在横断面上的形态变化较大,可分为四种类型。肾上腺前方的毗邻结构复杂,尤其是左肾上腺。故肾上腺病变向前生长时有不同的优势途径。结论：断层影像解剖可很好地显示肾上腺的形态与毗邻。     

膝关节半月板的三维断面解剖学研究

目的    观测膝关节半月板的断面形态特征和变化规律,为诊断膝部病变提供更为详尽的形态学资料。  方法    正常成人尸体膝关节片厚5 mm的连续断面标本27例,其中矢状断面标本9例,冠状断面标本12例,横断面标本6例。通过三维断面标本,观察膝关节半月板的断面形态特征。  结果    内侧半月板矢径（40.36±4.73）mm,横径（33.99±3.77）mm;外侧半月板矢径（34.51±2.18）mm,横径（34.51±　3.25）mm。内、外侧半月板前、后角厚度分别为（4.98±1.83）mm和（4.45±1.44）mm、（3.54±1.24）mm和（6.15±1.43）mm。半月板后角高度外侧大于内侧,外侧半月板后角高度大于前角。内侧半月板后角宽度大于前角。板股韧带出现率为75%。  结论    ①半月板前、后角部在矢状面上,体部在冠状面上显示最好,横断面可见半月板全貌。②由于内侧半月板与关节囊紧密相连,且后角宽度大于前角,致使其易受损伤。③外侧半月板后角高度大于内侧半月板后角及同侧前角,可能是导致外侧半月板后角较易受损的因素之一。     

国人经股骨上髁轴的磁共振测量

目的 在MRI上研究股骨远端上髁解剖,为全膝置换术中定位外科经股骨上髁轴(STEA)及股骨假体大小设计提供可靠依据。 方法 对78侧正常成人膝关节行磁共振扫描,测量STEA宽度、STEA的骨性标志与膝关节后侧及远端关节线的距离,股骨远端内外上髁的前后径大小及股骨后髁角。 结果 STEA宽度在男性中为(79.55±4.90)mm,在女性中为(71.18±4.22)mm,股骨内上髁沟最低点、外上髁最凸点与膝关节后方关节线及远端关节线的距离与STEA宽度具相关性,股骨远端内外上髁的前后径大小与STEA宽度也具相关性,股骨后髁角为(4.22±2.07)°。 结论 国人股骨远端上髁解剖大小明显小于欧美国家人群,股骨远端内外上髁的前后径与STEA宽度成一定比例,STEA的骨性标志与膝关节后侧及远端关节线的距离可为定位STEA提供一定帮助,通过术中触摸或PCL定位STEA的可靠性差。     

Comparison of medial and lateral posterior femoral condyle articular cartilage wear patterns

Background

While degenerative changes to the articular cartilage of the anterior and distal portions of the femoral condyles have been well studied in the literature, the changes that occur on the posterior femoral condyle are not as clear. The purpose of this study was to assess the difference in articular cartilage thickness between the medial and lateral posterior femoral condyles in knees undergoing unicompartmental knee arthroplasty.

家猪心脏二尖瓣复合体的形态学观测

目的　观测家猪心脏二尖瓣复合体 ,为家猪心脏研究和心脏移植积累资料。方法　甲醛固定的家猪心脏 3 5例 ,解剖并观测二尖瓣复合体。结果　家猪心脏二尖瓣复合体由瓣环、瓣膜、腱索和乳突肌构成 ,瓣环周长为 73 0 0± 9 71mm ;前瓣、后瓣、前外侧连合、后外侧连合的高度分别为 17 45± 1 99mm、16 3 3±2 2 2mm、5 68± 1 3 7mm、5 3 5± 1 11mm ,前外侧连合、后内侧连合的宽度分别为 4 3 1± 0 80mm、4 40±0 63mm ,前乳头肌起始 ,腱索附着于前瓣、后瓣和后内侧连合的条数为 4 0 0± 1 3 0、5 2 1± 1 84、2 44±1 16,后乳头肌起始 ,腱索附着于前瓣、后瓣和前外侧连合的条数为 3 76± 1 78、5 3 8± 2 2 0、2 12± 0 91。结论　家猪心脏二尖瓣复合体中各结构与人类相似 ,但大小有一定差异     

Duplicate testicular veins accompanied by anomalies of the testicular arteries.

Duplicate testicular veins associated with other anomalies of the testicular arteries were observed during dissection of the posterior abdominal wall in a 90-year-old Japanese male cadaver. The right testicular vein was composed of the medial and lateral testicular veins. The medial testicular vein drained into the inferior vena cava, whereas the lateral testicular vein drained into the confluence of the inferior vena cava and right renal vein. Several anastomosing branches were seen between the medial and lateral testicular veins. The left testicular vein was formed after the medial and lateral venous trunks joined and drained into the ipsilateral renal vein. The right testicular artery originated from the anterior surface of the abdominal aorta at the level of the left renal artery, passed posterior to the inferior vena cava, and accompanied the right lateral testicular vein running downwards. The left testicular artery arose from the abdominal aorta at a level of 5 cm below the origin of the right testicular artery, and then ran downwards accompanied by the medial trunk of the left testicular vein.     

Surgical anatomy of the radial nerve at the elbow

An anatomical study of the brachial portion of the radial nerve with surgical implications is proposed. Thirty specimens of arm from 20 fresh cadavers (11 male, 9 female) were used to examine the topographical relations of the radial nerve with reference to the following anatomical landmarks: acromion angle, medial and lateral epicondyles, point of division between the lateral and long heads of the triceps brachii, lateral intermuscular septum, site of division of the radial nerve into its superficial and posterior interosseous branches and entry and exit point of the posterior interosseous branch into the supinator muscle. The mean distances between the acromion angle and the medial and lateral levels of crossing the posterior aspect of the humerus were 109 (±11) and 157 (±11) mm, respectively. The mean length and calibre of the nerve in the groove were 59 (±4) and 6 (±1) mm, respectively. The division of the lateral and long heads of the triceps was found at a mean distance of 126 (±13) mm from the acromion angle. The mean distances between the lateral point of crossing the posterior aspect of the humerus and the medial and lateral epicondyles were 125 (±13) and 121 (±13) mm, respectively. The mean distance between the lateral point of crossing the posterior aspect of the humerus and the entry point in the lateral intermuscular septum (LIS) was 29 (±6) mm. The mean distances between the entry point of the nerve in the LIS and the medial and lateral epicondyles were 133 (±14) and 110 (±23) mm, respectively. Our study provides reliable and objective data of surgical anatomy of the radial nerve which should be always kept in mind by surgeons approaching to the surgery of the arm, in order to avoid iatrogenic injuries.     

Variations of the bilateral testicular veins: embryological and clinical considerations

Variations of the bilateral testicular veins were observed during routine dissection of the posterior abdominal wall in a 77-year-old male Japanese cadaver. The right testicular vein consisted of the lateral and medial testicular veins. The right lateral testicular vein drained into the right renal vein. The right medial testicular vein accompanied the right testicular artery to ascend obliquely and drained into the left aspect of the inferior vena cava. The left testicular vein was composed of the lateral, middle and medial testicular veins. Three left testicular veins accompanied the left testicular artery to course cranially and then finally drained into the left renal vein.     

足底腱膜的解剖

目的观察足底腱膜的形态结构,为临床应用提供相关的解剖学资料。方法解剖50只10%甲醛固定的足,观察足底腱膜浅层的形态结构;测量足底腱膜中间部(跖腱膜)止于跖骨头处内、外侧纤维束的厚度与长度;跖腱膜中间部的厚度。结果足底腱膜浅层的纤维结构主要参与前外侧部足底脂肪垫的构成,并形成与足底皮纹相似的螺旋纤维板状结构,足跟部足底腱膜浅层的纤维结构较为稀疏。中间部的厚度为(2.168±0.1139)mm;跖腱膜于第1跖骨头处内、外侧纤维束的厚度分别为(1.33±0.08)mm、(1.46±0.07)mm,明显大于止于2~5跖骨头处的内、外侧纤维厚度,P0.05;第5跖骨头处的内、外侧纤维厚度分别为(0.29±0.02)mm、(0.37±0.04)mm,明显小于1~4跖骨头处的内、外侧纤维厚度,P0.05。结论足底腱膜浅层主要参与足前外侧脂肪垫的构成,足底腱膜深层对维持足部纵弓的稳定起着非常重要的作用,在足部受力时有效地避免足前部趾足底总神经、趾足底总血管受压。     

Tibial insertion of the anterior cruciate ligament and anterior horn of the lateral meniscus share the lateral slope of the medial intercondylar ridge: A computed tomography study in a young,healthy population

BackgroundThe central intercondylar ridge (CIR) is an anatomical bony landmark that bisects the slope of the medial intercondylar ridge (MIR) between the tibial insertion of the anterior cruciate ligament (ACL) and anterior horn of lateral meniscus (AHLM) and was recently revealed by computed tomography (CT) evaluation corresponding to histologic slices of cadaveric knees. The purpose of this study was to clarify the shape and size of ACL and AHLM tibial insertion in young, healthy knees using the new bony landmark (CIR) and previously reported landmarks.MethodsThe contralateral healthy knees in 34 ACL-reconstructed patients (18 male patients, 16 female patients, mean age: 24.0 years) were scanned by CT. In the reconstructed coronal/sagittal images, bony landmarks of ACL (anterior: anterior ridge, posterior: blood vessel in tubercle fossa, medial: MIR, lateral: CIR) and AHLM (medial: CIR, lateral: bottom of the slope) were plotted for evaluation. The length of sagittal slices and the width in five coronal slices of the insertion were measured.ResultsThe ACL insertion consistently showed a boot-like-shape adjacent to the square shape of AHLM on three-dimensional imaging. The mean ACL sagittal length was 14.5 ± 1.9 mm, while the mean ACL widths (in mm) from anterior to posterior were 12.7 ± 2.7, 8.1 ± 1.9, 7.9 ± 2.0, 7.5 ± 1.5, and 7.2 ± 1.6, which was highly correlated with the tibial plateau size.ConclusionsThe boot-like-shape of the ACL tibial footprint insertion shared the slope of MIR with the rectangular shape of AHLM in young, healthy knees. This study may provide useful information for safe tibial tunnel creation at the time of ACL reconstruction.     

颞下间隙的矢状和冠状断层解剖及临床意义

目的为颞下间隙疾病的影像诊断提供解剖学资料。方法选用成尸头颈部40例制成连续矢、冠状断面,观察颞下间隙及邻近结构的解剖学关系,利用游标卡尺及求积仪分别测量其径线和面积。结果颞下间隙的矢、冠状断面呈不规则形,经茎突等层面的面积分别为:(450.6±4.62)mm2(左)、(452.2±4.71)mm2(右),(625.3±6.05)mm2(左)、(627.7±6.13)mm2(右),(153.8±3.41)mm2(左)、(155.3±3.52)mm2(右),(350.9±4.58)mm2(左)、(352.8±4.49)mm2(右),两侧颞下间隙及邻近结构呈对称性,长径、横径和面积的差异均无统计学意义(P>0.05)。冠状面上自翼内肌上缘至卵圆孔内侧壁的连线可区分颞下间隙与咽旁间隙。翼外肌、茎突和翼突是CT等影像诊断的重要解剖学标志。结论颞下间隙的矢、冠状断层解剖对疾病的影像诊断具有重要意义。     

经左颈静脉插管肝内门-体静脉分流术的应用解剖

为给临床经左颈静脉插管行肝内门 -体静脉支架分流术提供解剖学依据 ,在 4 8例成人尸体上解剖并观测了双侧颈内静脉、头臂静脉、上腔静脉、右心房、下腔静脉上段的长度、外径、以及各有关静脉间的角度。结果为左颈内静脉长度 :10 6.9± 18.3 m m,外径 :13 .6± 3 .4 mm ;左头臂静脉长度 :66.3± 10 .8mm ,外径 :15 .9± 4 .1mm;上腔静脉长度 :4 8.5± 9.8mm,外径 :2 1.4± 8.4 mm;右心房长度 :68.7± 17.4 m m,上口外径 :2 0 .2± 4 .7mm,下口外径 :2 3 .9± 6.0 m m;下腔静脉上段长度 :2 1.5± 6.5 m m;左颈内静脉延长线与左头臂静脉间的角度 :4 5 .5°± 10 .3°,左头臂静脉延长线与上腔静脉间的角度 :5 8.3°± 12 .7°;5 8.3°± 12 .7°;左颈内静穿刺点至肝静脉口的总长 :2 4 3 .2± 2 3 .6m m。结论 :在经左颈内静脉行肝内门 -体静脉分流术时只要掌握了插管静脉的角度和深度仍具备和右侧穿刺途径一样多的优点     

胃裸区的冠状断层解剖学研究

目的：为给胃底部和食管腹段疾病的现代影像学诊断和外科治疗提供实用的形态学依据。方法：用成人躯干部连续冠状断层标本30例,研究了胃裸区在连续冠状断层上的典型表现及胃裸区内的结构。结果：（1）胃膈韧带右层与小网膜的后层相续,左层与膈脾韧带右层及胃脾韧带后层相续,向下左、右层靠拢而续为胃胰襞左部。在冠状断层上寻找胃裸区的最佳层面在A11（下腔静脉前份层面（和A12（下腔静脉中份层）。（2）胃裸区居胃膈韧带的左、右层之间,其存在率为100％。胃裸区内除有迷走神经后干,血管、淋巴结外,左肾上腺、左肾上极及胰体上份亦可进入其内。结论：（1）胃为腹膜间位器官。（2）国膈韧带很短且两层间的距离较宽,加上胃裸区较大,胃底后壁的活动度较小,在施行胃底和食管腹段手术构解胃底后壁时,对胃裸区内的结构应给与足够的重视。     

肾上腺静脉MSCT影像解剖研究

目的　利用MSCT准确显示肾上腺静脉正常解剖结构及变异,为临床提供影像解剖数据。 方法　回顾分析上腹部CTA患者108例。薄层MIP/MPR评估测量肾上腺静脉管径、长度及走行路径。 结果　①右侧：显示率64.81%（70/108）,变异5.71%(4/70);汇入下腔静脉7点至8点间占优势42.42%;其管径Rr (2.19±0.56) mm,腺外段长度RD1 (5.02±1.82) mm,汇入下腔静脉距右肾静脉汇入距离RD2 (40.69±12.96) mm,汇入口开口向下角度RA (60.25±17.85)°。②左侧：显示率97.22%（105/108）;变异14.29%（15/105）;肾上腺静脉管径Lr (2.39±0.56) mm,腺外段长度LD1 (7.28±4.01) mm,膈-肾上腺静脉干管径LR (3.65±0.93) mm,膈-肾上腺静脉的共干段长度LD2 (14.07±6.77) mm,膈-肾上腺静脉汇入左肾静脉点至下腔静脉左侧缘距离LD3 (32.89±4.85) mm,膈-肾上腺静脉汇入左肾静脉开口向内的角度LA1 (118.06±18.49)°,肾上腺静脉与膈静脉共干段开口向下的角度LA2 (156.15±13.81)°。 结论　MSCT可显示大部分右侧肾上腺静脉及绝大部分左侧肾上腺静脉正常走行及变异,测量相关影像解剖数据,为AVS等手术方案提供影像数据。     

内镜引导下经后路上颈椎螺钉内固定的应用解剖

目的探讨内镜引导下经后路上颈椎螺钉内固定的应用解剖,为临床经后路C2/3椎弓根螺钉固定术提供解剖学资料。方法选用干骨28套(C1-7),对其滋养孔的位置、椎弓根等相关数据进行了观察和测量。结果C2/3的滋养孔距后正中线分别为(17.26±7.36)和(16.05±7.95)mm;椎弓根的长、高、宽(mm)分别为6.18±1.36、8.87±2.22、11.54±3.21和4.95±3.5、7.00±0.97、10.50±4.11;椎弓根的中轴线与正中矢状切面所构成的夹角分别为(43.83±3.09)°和(41.53±3.29)°。结论临床经后路C2/3椎弓根螺钉内固定手术,进螺点可选定在C2/3侧块距其外侧缘5mm、距下关节突下缘8mm处,螺钉进入的延长线与正中矢状切面的夹角应为40°～45°,并向头侧倾斜10°为宜,螺钉的长度为24～30mm,覬为5mm为佳。     

介入治疗股骨头缺血性坏死的应用解剖

目的 介入治疗股骨头缺血性坏死提供解剖学基础.方法 选用经乳胶灌注防腐成人下肢标本20侧及新鲜成人下肢标本2侧,观察股深动脉的起点方位及分支类型,测量股深动脉及各分支长度和外径以及各分支起始部的角度.结果 股深动脉主要从股动脉后方(36.4％)和后外侧方(36.4％)发出,旋股内侧动脉从股深动脉发出(72.7％),从股动脉发出(27.3％).各主要血管的长度为:股深动脉(19.22±10.19) mm,其根部距腹股沟韧带的距离为(38±11.78)mm;旋股内侧动脉(12.56±6.17) mm;旋股外侧动脉(13.93±11.04) mm.各主要血管的外径为:股深动脉(5.20±1.57)mm,旋股内侧动脉(3.64±0.99) mm,其升支(2.66±0.99)mm;旋股外侧动脉(4.48±1.19) mm,其升支(2.12±0.59) mm.旋股内侧动脉升支以与主干成接近90°的夹角;旋股外侧动脉与其升支间约呈115.82°夹角.结论 熟悉股动脉应用解剖,有利于完善这种治疗方法.     

Duplication of the inferior vena cava associated with other variations

Multiple vascular variations, including duplication of the inferior vena cava, double renal arteries and anomalies of the testicular blood vessels, were observed during dissection of the retroperitoneal region of a cadaver of an 87-year-old Japanese man. The right inferior vena cava arose from the union of right common iliac veins and a thinner interiliac vein. This interiliac vein ascended obliquely from right to left and joined the left common iliac veins to form the left inferior vena cava. The right and left inferior venae cavae were of approximately equal width. The right testicular vein consisted of medial and lateral venous trunks. The two venous trunks coalesced to form a single vein, which drained into the confluence of the right inferior vena cava and right renal vein. The left testicular vein was composed of the medial and lateral testicular veins, which drained into the left renal vein. Double renal arteries were seen bilaterally, which originated from the lateral aspects of the abdominal aorta. The right testicular artery arose from the right inferior renal artery and accompanied the lateral trunk of the right testicular vein running downwards. The left testicular artery arose from the ipsilateral inferior renal artery and ran downwards accompanied by the left lateral testicular vein. In addition, the bilateral kidneys showed multicystic changes.     

距跟骨间韧带断层解剖及磁共振成像的对照研究及临床意义

目的 为临床MRI诊断距跟骨间韧带的损伤提供断层解剖学依据. 方法 选取12例成年男尸右足踝标本,于自然松弛位(即跖曲20°)经低温冷冻后制成断层标本,其中冠状位4例、矢状位4例、横断位4例,并与该区的MRI图像对比. 结果 在矢状面过距骨颈外侧缘内侧(19.2±2.8)mm范围,在冠状面过距骨体中部(17.9±5.2)mm范围内可见距跟骨间韧带.在过距骨体中部的矢状位断面距跟骨间韧带显示最清晰,平均长17.2mm,矢状径平均宽11.9mm.过距骨体中部的冠状位断面距跟骨间韧带显示最清晰,平均长13.1mm,横径平均宽14.1mm.水平面对于显示距跟骨间韧带效果不佳. 结论在MRI上能清楚显示距跟骨间韧带,为诊断距跟骨间韧带损伤提供了依据.