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。     

1例全麻插管致杓状软骨脱位的护理及启示

杓状软骨脱位是临床麻醉中较少见的一种并发症,患者会有不同程度的声音嘶哑、进食水呛咳等症状,应当予以重视。分析全麻气管插管致杓状软骨脱位的可能原因,并提出护理对策,脱位原因包括：带胃管的老年患者、高龄、体瘦,保留气管导管时间长,拔气管导管的方法欠佳,掌握拔管时机不妥等因素。笔者认为通过正确的拔管方法,掌握拔管指征,观察患者呼吸发音吞咽状况等护理措施,可以降低因气管插管导致杓状软骨脱位的并发症。我科去年1例肾癌患者行全麻下腹腔镜下肾部分切除术后出现了声音嘶哑,术后第7d确诊为杓状软骨脱位,经过精心护理后好转出院,现报道如下。     

环杓后肌神经的显微外科解剖

本文借助SXP-Ⅰ型手术显微镜观察了30例成人喉返神经终末支支配环杓后肌的分支,并用改良的karnovsky-Roots AchE染色方法鉴定了喉返神经终末分支的性质。结果表明,喉返神经以前、后二终支入喉,前支是运动支,后支为感觉支;环杓后肌神经来自前支和前支的分支——杓间肌支,支数多,长度短。组织学研究表明,前支内,环杓后肌神经纤维和其它神经纤维随机分布在一起,未形成一个独立的神经束。     

神经肌蒂移植至环杓后肌的应用解剖

在21具成尸标本上,针对喉返神经损伤后的有关问题观察了支配舌骨下肌群和环甲肌的神经.从解剖学角度认为神经肌蒂移植时首选肩胛舌骨肌上腹肌支、胸骨舌骨肌上肌支或环甲肌肌支。暴露环(?)后肌的手术层次是咽下缩肌、咽肌、梨状隐窝和环(?)后肌筋膜。     

甲状软骨、环状软骨和关节软骨的钙化

关节软骨和喉软骨随年龄增长,部分软骨经历了软骨内钙化,其确切的自然过程、衰老程度和衰老模式一直备受临床关注.在此过程中可能发生了喉软骨组织替代变化.然而年龄和喉结构组织变化之间缺乏高关联暗示其他不知因素影响关节软骨的变化,如病理因素、营养、激素和物理应力或遗传因素,都可能参与了软骨变化的进程.诸多因素的影响导致了在年龄...     

实验犬环杓后肌功能重建的组织化学研究及图像分析

为了确定并比较犬两种不同术式：Ⅰ。颈袢胸骨舌骨肌支蒂移植术；Ⅱ．副神经胸锁乳突肌支肌蒂移植术，治疗声带麻痹的效果。建立单侧联合性声带麻痹动模型，分别用Ⅰ、Ⅱ两种术式移植神经肌蒂于失神经的环杓后肌。术后４个月取各组ＰＣＡＭ做同结构检查，并做光镜组织化学：乙酰胆碱酯酶、琥珀酸脱氢酶、三磷酸苷酶、糖原反应。用图像定量并测示肌纤维直径。结果发现两种术式都能使ＰＣＡＭ恢复功能，第Ⅱ种术式组织化学结构优于第Ⅰ     

中国人喉的研究：喉软骨的度量

应用福尔马林常规固定的成人喉软骨40例(男29例、女11例),进行了大体的测量,结果如下: 一、甲状软骨(mm)     

下颌持续前导作用下髁状突软骨改建的超微结构变化

背景：以往的动物实验证明,前导下颌可以导致年轻SD大鼠的颞下颌关节组织发生改建,主要表现为髁状突组织的生长速度加快,下颌骨发生继发性生长。但其髁突软骨细胞的超微结构改建研究仍是研究的关键所在。 目的：观察生长期大鼠在下颌持续前导作用下髁状突软骨生长和改建的组织学和超微结构的变化。 方法：将4周龄SD大鼠随机分为对照组和实验组,实验组24 h佩戴下颌前导矫治器,分别在干预3,7,14,21,30 d麻醉处死动物并取材,光学显微镜和透射电镜观察大鼠髁突软骨的组织学和超微结构的变化。 结果与结论：从干预14 d开始,实验组髁突软骨厚度在观察周期中出现先增加后变薄的现象,髁状突中后部软骨厚度变化显著(P < 0.01)。从干预7 d开始髁突软骨细胞的超微结构发生改建,包括细胞内细胞核固缩,粗面内质网腔隙肿胀,脂滴变小甚至消失,核周微丝变少且不规则,细胞外基质增宽变多以及出现大片空白等。结果证实,在下颌前导作用下,大鼠髁突软骨会随着承受力的时间增厚或变薄,软骨细胞基质合成能力也会显著增强。 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程     

中央前、后回在矢状断面上的定位

目的：在矢状面上利用髓突对成人端脑的中央前、后回进行准确定位。方法：取30例成人头部标本，MR扫描获得层厚6mm的颅脑矢状面MRI图象，然后切制成相应的连续脑切片，二者结合并以钟表盘为参照对髓突进行观察、测量与统计。结果：在旁正中矢状面上，“兔尾征”是中央后回定位的特征性标志。各层面以钟表盘为参照，12点左右是集中辨认中央前回的位置，12点半左右是集中辨认中央后回的位置，且随着层面外移，髓突方向呈现一定的规律：中央前回髓突基本对应12点位，至脑岛外侧份层面时，12点位正好是中央沟，其前后髓突支分别是中央前、后回。再向外切时，中央沟基本保持该方向不变。结论：在矢状面上利用髓突可准确定位中央前、后回。     

The incidence of the foramen thyroideum in Turkish population

This study was undertaken to investigate the incidence and characteristics of the foramen thyroideum (FT) in Turkish population. A total of 50 cadaver specimens were dissected which were a randomly selected sample of population from the criminal laboratory of the Republic of Turkey’s Ministry of Justice (Istanbul). Larynges were dissected with a surgical SMZ 10 Nikon stereomicroscope. Six of the 50 specimens dissected had distinctly identifiable foramina with neurovascular component. One specimen had bilateral foramina, five specimens had unilateral foramina, and two had it in the left side, three in the right. One specimen had a double foramen in the left side. All of them were male and contained neurovascular components. Our data showed 12% incidence of FT in Turkish population.     

The morphology and topography of the superior laryngeal artery

The aim of this study was to investigate and correlate the anatomical parameters of the superior laryngeal artery (SLA). For the study, 50 adult, human specimens were used; laryngeal pieces were drawn from 16 cadavers and the arteries were dissected intralaryngeally. In 68%, the SLA originated from the superior thyroid artery and in 32%, directly from the external carotid artery. In five sides, an aberrant superior laryngeal artery (ASLA) was entering the larynx through a foramen thyroideum. The normal superior laryngeal artery (NSLA) had a short extralaryngeal part and continued intralaryngeally, with two segments and a point of inflexion; the first segment ran along the superior border of the thyroid cartilage, the point of inflexion of the NSLA was at a minimal distance of 1.1 cm anterior to the superior horn of the thyroid cartilage and from this point the NSLA continued in the paraglottic space. The ASLA had a constant origin from the superior thyroid artery; it then traversed the foramen thyroideum and reached the paraglottic space–at the superior border of the lateral cricoarytenoid muscle, it ended in two terminal branches. We constantly evidenced the following collateral branches of the NSLA: superior, anterior and postero-medial. The terminal branches are the antero-inferior branches that constantly anastomose with the cricothyroid artery and the postero-inferior branch anastomosed with the inferior laryngeal artery. Occasionally, additional branches of the NSLA were found. In conclusion, the intralaryngeal branching patterns of the NSLA and the ASLA are similar, the differences being given by the entry point into the larynx that will make the superior and anterior branches of the ASLA longer, will eliminate the transversal segment of the NSLA, and will shorten the descending segment in the paraglottic space in the case of ASLA. The base of the upper horn of the thyroid cartilage, the oblique line and its tubercles, the cricothyroid membrane and the cricothyroid joint are constant landmarks that allow a precise intralaryngeal identification of the SLA. These findings can improve performances during surgical manipulations of the larynx and laryngeal transplants.     

婴幼儿胫骨软骨管的形态特征及临床意义

用血管灌注方法对40侧出生到3岁婴幼儿胫骨骺内的软骨管进行了研究。软骨管起源于软骨骺骨膜动脉,主要经骺的前、后面进入骺内。关节软骨内无软骨管。近侧骺生长板内偶有血管穿过。对软骨管的形态特征与临床关系进行了讨论。     

喉的应用解剖与临床意义

目的：为功能性喉手术提供解剖形态学数据。方法：对50例结构完整的喉标本进行解剖观察和测量。结果：提供了喉重建术相关的甲状软骨、环状软骨、甲状舌骨膜、环甲韧带、弹性圆锥和方形膜等共75项按性别分组的测量数据。结论：为临床功能性喉手术以及喉功能重建提供了形态学参考数据。     

Temporal and spatial localization of type I and II collagens in human thyroid cartilage

Thyroid cartilages of various ages were investigated by immunofluorescence staining for localization of the fibrillar collagen types I and II in order to understand the tissue remodeling occurring during the mineralization and ossification of thyroid cartilage. In fetal and juvenile thyroid cartilages, type I collagen was restricted to the inner and outer perichondrium, while type II collagen was localized in the matrix of hyaline cartilage. However, in advanced ages, type I collagen was also localized in the pericellular and in the interterritorial matrix of intermediate and central chondrocytes of thyroid cartilage. The matrix of peripheral chondrocytes was negative for type I collagen. This suggests that some chondrocytes in thyroid cartilage undergo a differentiation to type I collagen-producing chondrocytes. At the beginning of ossification, bone-related type I collagen was chiefly detected in the central cartilage layer, but was never deposited first from the perichondrium in the direction to the subperichondrial cartilage. This observation confirmed previous findings showing that osteogenesis mainly follows an endochondral ossification pattern. Interterritorial matrix failed to react with the type II collagen antibody in men from the beginning of the third decade, and later still in women, even after treatment with hyaluronidase. These observations indicate that major matrix changes occur faster in male than in female thyroid cartilage.Dedicated to Professor Dr. W. Kühnel on the occasion of his 60th birthday     

鼻翼软骨环状结构的特点及临床意义

目的：探索鼻翼软骨环状结构特点与外鼻形态的解剖关系,寻找唇裂鼻畸形可能的病理机制及手术修复方法。方法：２０具成人尸体标本,１具单侧唇裂胎儿标本,采用大体解剖方法。结果：外鼻下端存在两个环状解剖结构。①由鼻翼软骨内、外脚及穹窿部,鼻中隔,小翼软骨和连结小翼软骨与前鼻棘的纤维组织组成的鼻翼软骨纤维环;②由鼻翼软骨的内、外脚及穹窿部与鼻肌的两束肌纤维连结而成的鼻翼软骨肌肉环。唇裂侧鼻翼软骨环状结构发育不良。结论：鼻翼软骨环状结构对外鼻形态的维持起重要作用;鼻翼软骨环状结构发育不良是唇裂鼻畸形发生的重要因素;鼻翼软骨环状结构的修复与重建对唇裂鼻畸形的手术矫正具有重要意义。     

结缔组织生长因子在幼年兔关节软骨全层缺损修复中的表达及意义

目的:探讨结缔组织生长因子(CTGF)在幼年兔膝关节软骨全层缺损修复过程中的表达及意义。方法:采用兔膝关节股骨关节面全层软骨缺损自我修复模型,25只幼年新西兰白兔,随机分为5组(每组5只):对照组、损伤24 h组、1周组、4周组、8周组。应用RT-PCR技术和免疫组化技术分别检测CTGF mRNA和蛋白在修复过程中的表达。结果:幼年兔关节软骨全层损伤后自我修复良好。各组检测均见CTGF mRNA表达,损伤后各组表达水平显著高于对照组(P0.05)。免疫组化显示各组软骨细胞均有CTGF蛋白表达,阳性表达主要集中在软骨的中间带及深层带。结论:幼年兔关节软骨全层缺损自我修复过程伴有显著的CTGF表达上调,CTGF可能在关节软骨修复中发挥重要作用。     

Localization of knee joint cartilage pathology by multichannel vibroarthrography

This paper proposes non-invasive techniques to localize sound or vibroarthrographic (VAG) signal sources in human knee joints. VAG signals from normal subjects, patients who subsequently underwent arthroscopy, and cadavers with arthroscopically-created lesions, obtained by stimulation with a finger tap over the mid-patella and swinging movement of the leg, were analyzed for time delays using cross-correlation functions for source localization. Correct results were obtained for 13 of the 14 subjects tested by finger stimulation, and for 11 of the 12 subjects whose VAG signals during swinging movement were analyzed. The techniques could be valuable in the diagnosis and treatment of knee pathology before and after joint surgery or drug therapy.     

Localization of type I and II collagen during development of human first rib cartilage

The localization of fibrillar type I and II collagen was investigated by immunofluorescence staining with specific antibodies in order to obtain a better understanding of tissue remodelling during the development of first rib cartilage. In childhood and early adolescence type I collagen was found to be restricted to the perichondrium of first rib cartilage, while type II collagen was localized in the matrix of hyaline cartilage. However, in advanced age type I collagen was also found in the territorial matrix of intermediate and central chondrocytes of first rib cartilage. The matrix of subperichondrial chondrocytes was negative for type I collagen. This suggests that some chondrocytes in first rib cartilage undergo a modulation to type I collagen-producing cells. The first bone formation was observed in rib cartilages of 20- to 25-year-old adults. Interestingly, the ossification began peripherally, adjacent to the innermost layer of the perichondrium where areas of fibrocartilage had developed. The newly formed bone matrix showed strong immunostaining for type I collagen. Fibrocartilage bordering peripherally on bone matrix revealed only a faint staining for type I collagen, but strong immunoreactivity to type II collagen. The interterritorial matrix of the central chondrocytes failed to react with the type II collagen antibody, in both men and women, from the end of the second decade. These observations indicate that major matrix changes occur at the same time in male and female first rib cartilages. Thus, our findings indicate that ossification in human first rib cartilage does not follow the same pattern as that observed in endochondral ossification of epiphyseal discs or sternal cartilage.