腰椎椎间关节滑膜皱襞的解剖学研究及成人儿童的比较

目的：研究腰椎椎间关节滑膜皱襞的解剖学组织结构，探讨其临床价值。方法：对24具成人腰椎脊柱标本和40具儿童腰椎脊柱标本的解剖，观测腰椎间关节内滑膜皱襞的结构。结果：无论成人还是儿童，各腰椎间关节均可出现滑膜皱襞。两者比较，成人滑膜皱襞的出现率为85．9％高于儿童（35．9％），且成人以大中型滑膜皱襞为主，而儿童以小型为主。成人滑膜皱襞主要出现在外上（14．6％）、外下（16．6％）及外侧（17％），而儿童主要出现在上（20_3％）、下缘（27．1％），成人与儿童的滑膜皱襞的形态均以片状为主。结论：成人腰椎椎间关节滑膜皱襞的出现率高，以大中型滑膜皱襞为主，这很可能是腰椎椎间关节滑膜皱襞嵌顿多见于成人，而儿童少见的解剖学基础，也可能是成人较儿童腰背痛多见的原因之一。     

胎儿胸椎间孔韧带的观测及意义

目的:通过胎儿胸椎间孔韧带的观测,为国人提供胎儿胸椎间孔韧带的解剖学资料。方法:选用足月胎儿尸体标本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侧胸椎标本中未发现横孔上韧带和体横韧带,T1￣T12均发现横孔下韧带,其出现率从T1￣T12分别为10.0%、10.0%、23.3%、30%、46.7%、53.3%、76.7%、80.0%、80.8%、86.7%、90.0%、86.7%;T3￣T12横孔下韧带的长度随着椎骨序数的增加而有逐渐增加的趋势。结论:胎儿胸椎间孔韧带普遍存在,其为胸椎的正常组织结构,对胸椎神经根管内的结构具有固定、支持和保护作用。     

腰椎小关节穿刺的应用解剖

目的:研究腰椎小关节穿刺的解剖入路,供临床参考应用。方法:采用新鲜成人脊柱腰段标本35(男22、女13)例,通过横断断层解剖学方法,从横断面上对L1～2～L5～S1腰椎小关节的类型、关节角、上下关节突间距以及关节面的形态等进行观测。结果:①关节类型L1～2～L5～S1主要为上凹面型(82.6%)和平面型(17.4%),其中L5～S1有51.4%为上凹面型,48.6%为平面型;②关节角从L1～2至L5～S1腰椎关节突关节角逐渐增大,分别为26°、30°、35°、40°、45(°女性平均略大3°～5°);③关节的位置在后正中线外侧,相应的上、下腰椎棘突后缘中点之间,与后正中线的距离由上到下逐渐增加,分别为14.20、15.74、18.90、24.22、27.20mm;④穿刺要经过皮肤、浅筋膜、胸腰筋膜后层、竖脊肌、关节囊后壁。结论:腰椎小关节穿刺应根据关节的类型、关节角大小选择相应腰椎间隙中点的外14.20～27.20mm(平均20.05mm)处进行。     

椎板下棘的形态学特点及其临床意义

目的：观测椎板下棘的形态特点，探讨其在显微内窥镜腰椎间盘切除术(MED)中的临床意义。方法：对42具成人干燥椎骨和10件脊柱腰骶段标本的椎板下棘进行观测，分析其对椎间管构成的影响；结合MED术式的通道和操作过程，分析其可能导致的并发症。结果：椎板下棘位于椎板下缘前外近椎弓根下切迹处。可出现于所有胸腰椎，出现率为83．3％；出现率最高在第12胸椎，为52．4％。椎板下棘分布不规则，出现在胸腰段较多。结论：椎板下棘是胸腰椎的骨性结构，有必要给予命名；椎板下棘参与构成神经根管的骨性后壁，可造成神经根受压；后路MED可引起椎板下棘断脱，造成神经根受压或损伤。     

腰椎上关节突外缘与椎弓根中心关系的解剖学观测及其临床意义

目的 :探讨腰椎上关节突外缘的形态特点及其与椎弓根中心的关系。方法 :对 10 0套成人干燥腰椎骨标本上关节突乳突的形态特点及其外缘切线与椎弓根外侧骨皮质及中心进行了观测。结果 :L110 0 % ,L2 98.1% ,L396 .4% ,L4 4 5 .8% ,L58.1%上关节突外缘切线位于椎弓根中心的外侧。上关节突外缘切线距椎弓根外侧骨皮质的距离为L1(1.8± 0 .7)mm ,L2 (1.5± 0 .5 )mm ,L3(2 .3± 1.5 )mm。结论 :上关节突外缘多位于椎弓根中心的外侧 ,以它做为椎弓根螺钉进钉的定位标志过于偏外。     

青少年胸腰椎关节突形态研究及意义

目的:为临床提供青少年关节突及椎管相关的解剖学测量数据.方法:年龄在14～19岁(平均16.5岁)25例原配完整的胸腰椎(T1～L5)标本,分别测量卜关节突内缘中点间距、下关节突内缘中点间距、下关节突根部外缘宽度、椎弓根内缘间距和椎管前后径,并与成人数据比较.结果:上、下关节突间距、椎弓根内缘间距和上关节突内缘间距/椎弓根内缘间距由上到下都旱两边高中间低的"马鞍形"变化趋势而椎孔前后径呈逐渐上升的趋势;上关节突内缘中点间距与下关节突内缘间距相关系数为0.92,下关节突内缘间距与下关节突根部外缘间宽度相关系数为0.83.结论:14～19岁青少年以上测量数据与成人数据均无显著性差异,并有一定的变化规律,为临床青少年脊柱椎管狭窄的诊断和治疗提供一定参考;上关节突内缘中点间距总是小于椎弓根内缘间距,中、下胸段椎弓根螺钉间距要小于上胸段和腰段.     

胸椎棘突末端形态与正骨诊治手法的关系

<正> 在损伤性脊柱疾患中,胸椎移位较颈、腰椎少见,一但移位亦可引起一系列症状,在用正骨手法诊治时,除检查棘上靭带有无剥离、棘突旁有无压痛外,也要检查棘突有无偏歪,常人棘突偏歪情况,尚未见报告,本文着重对胸椎棘突的偏歪情况及棘突末端形态进行了研究,并对上关节突面的朝向作了观察。     

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...     

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。     

10～12岁儿童胸椎关节突关节角三维数字化研究及临床意义

目的通过薄层CT扫描和三维重建后测量,探索10~12岁儿童胸椎关节突关节角的形态特征和增龄变化规律,为临床胸椎关节相关疾病的早期诊治和预防提供理论依据。方法选取无骨质破坏、畸形、骨折、肿瘤等椎骨形态结构未发生改变及既往未行脊柱相关手术的10~12岁儿童30例,行多排螺旋CT薄层扫描(0.625~1.25 mm),范围T_1~T_(12),将原始数据以DICOM格式导入三维重建软件进行相关指标测量及统计分析。结果关节突矢状位角在侧别间相差均在10°以内,上关节突矢状位角在T_1、T_(11)、T_(12)间、下关节突矢状位角在T_3、T_4、T_9、T_(10)和T_(12)间差异均无统计学意义(P0.05)外,余差异均有统计学意义(P0.05)。关节突冠状位角在侧别间差异比较均无统计学意义(P0.05),上下关节突冠状位角总体呈"尖峰状"趋势,最大值位于T7~T9。上关节突水平位角侧别间仅在T2、T_4、T8、T_10和T_(12)间、下关节突水平位角则在T_7间差异有统计学意义(P0.05),上关节突水平位角无论左右侧,其在上胸段走势平稳,下胸段则呈递减趋势,下关节突水平位角侧别间除个别椎序外,也总体呈递减趋势,二者均在T_(11)和T_(12)中出现负角。结论 10~12岁儿童胸椎关节突关节角(冠状位角、矢状位角和水平位角)可直观地反映胸椎关节突随年龄增长的发育规律,验证了胸椎关节突关节角从颈椎的近水平位逐渐到胸椎的近冠状位,再到腰椎的近矢状位这一发育规律,且关节突关节角左右侧基本对称,其角度差值均小于10°。     

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     

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.     

Anatomic considerations and the relationship between the piriformis muscle and the sciatic nerve

Stating background  The piriformis syndrome is one of the non-discogenics causes of sciatica. It results from the compression of the sciatic nerve (SN) by the piriformis muscle (PM) in the neutral and piriformis stretch test position. The evidence of the increase in pain in the test position requires a detailed anatomical study addressing the changes that occurred in the SN and PM anatomy during the test position. The aim of this study is to examine this relationship morphometrically. Materials and methods  A total of 20 right and left lower limbs of ten adult cadavers were examined. The SN and the PM were made visible. The location of the SN was evaluated with respect to the consistent bony landmarks, including the greater and the lesser trochanter of the femur, the ischial tuberosity, the ischial spine of the hip bone, the posterior inferior iliac spine of the hip bone and the posterior superior iliac spine of the hip bone. The study was done in both neutral and test positions (i.e., 30° adduction 60° flexion and approximately 10° medial rotation position of the hip joint). Results  The width of the greater sciatic notch was 63.09 ± 13.59 mm. The length of the lower edge of the PM was 95.49 ± 6.21 mm, and whereas the diameter of the SN where it emerged from the infrapiriforme was 17.00 ± 3.70 mm, the diameter decreased to 11.03 ± 2.52 mm at the level of the lesser trochanter of the femur. The SN intersected the PM most commonly in its medial second quarter anatomically. The vertical distance between the medial edge of the SN–PM intersection point and the ischial tuberosity was 85.62 ± 17.23 and 72.28 ± 7.56 mm (P < 0.05); the angle between the SN and the transverse plane was 66.36° ± 6.68° and 71.90 ± 8.48° (P < 0.05); and the vertical distance between the medial edge of the SN and the apex of the ischial spine of the hip bone was 17.33 ± 4.89 and 15.84 ± 4.63 mm (P > 0.05), before and after the test position, respectively. Conclusion  This study provides helpful information regarding the course and the location of the SN. The presented morphometric data also revealed that after stretch test position, the infrapiriforme foramen becomes narrower; the SN becomes closer to the ischial spine of the hip bone, and the angle between the SN and the transverse plane increases. This study confirmed that the SN is prone to be trapped in the test position, and diagnosis of this situation requires dynamic MR and MR neurography study.     

空肠和回肠直动脉及器官表面动脉的观测

目的　通过对空、回肠直动脉分支类型的观察、测量不同类型直动脉管径、间距以及器官表面动脉吻合网面密度 ,探讨空、回肠血供形态的异同 ,为临床空、回肠疾病手术、器官移植、介入治疗提供形态学依据。方法　选取 15具成人及 2～ 6岁小儿 10具进行股动脉插管、乳胶灌注后解剖剥离直动脉 ,将空回肠均分 5段观测相关指标。结果　成人空肠 (1、2段 )及回肠 (3～ 5段 )直动脉起始处外管径 (mm)分别为 0 6 8± 0 18、0 72± 0 0 1、0 6 1± 0 0 2、0 5 3± 0 0 3和 0 5 1± 0 0 1,相邻分支间距 (mm)分别为 2 89± 1 72、2 79± 2 0 6、2 2 1± 1 6 4、2 17± 1 17及 2 85± 0 4 6 ;空、回肠直动脉长、短干型分支供血能力不同 ;空肠器官表面动脉吻合网面密度大于回肠。结论　直动脉分支类型、管径、间距及器官表面动脉吻合网面密度对空、回肠血供影响较大。