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。     

喉上神经外支在环甲间隙的应用解剖学研究

目的为甲状腺手术中保护喉上神经外支提供解剖学基础。方法成人尸体32具(64侧),解剖观察喉上神经外支在环甲间隙的解剖学特点,观察该神经与间隙内其他解剖结构的关系。结果3侧喉上神经存在袢状结构;发现所有标本中均存在环甲肌支,71.8%(46侧)存在咽支;按Friedman分型方法进行分型:Ⅰ型占28.1%(18侧)、Ⅱ型占54.7%(35侧)、Ⅲ型占17.2%(11侧)。喉上神经外支入咽下缩肌点位置均位于胸骨甲状肌深面,斜线下方。喉上神经外支入咽下缩肌点至斜线的垂直距离为(3.60±0.30)mm,距胸骨甲状肌内侧缘的垂直距离(8.27±1.72)mm,距环状软骨中点的距离是(27.09±1.46)mm。结论甲状腺手术中,从环甲间隙入路多数情况下可以显露保护喉上神经外支环甲肌支;大于17.2%的情况下不能显露,但也不会损伤。     

乳突根治术中乙状窦沟的解剖学观测

目的测量乙状窦沟到周边结构的距离,为乳突根治术提供解剖学依据。方法模拟乳突根治术耳后入路进行解剖,测量乙状窦前板到外耳道后上棘的距离,乙状窦前板到砧骨短脚中点的距离,乙状窦前板到外半规管隆凸的距离,乙状窦上膝距外耳道后上棘的距离,乙状窦下膝距外耳道后上棘的距离。结果 (1)乙状窦前板到外耳道后上棘的距离(13.19±2.37)mm;(2)乙状窦前板到砧骨短脚中点的距离(18.25±1.97)mm;(3)乙状窦前板到外半规管隆凸的距离(14.58±1.66)mm。(4)乙状窦上膝距外耳道后上棘的距离(16.95±2.06)mm;(5)乙状窦下膝距外耳道后上棘的距离(19.59±2.24)bmm。结论测量乙状突窦沟距其与周边结构间的距离,为手术安全提供了解剖学基础。     

喉返神经喉外分支的显微解剖及临床意义

目的探讨甲状腺手术区域喉返神经(RLN)的解剖特点和方法。方法运用大体解剖的方法,对48例成人标本甲状腺手术区域的RLN及其周围毗邻结构进行了观测。结果 48例96侧成人标本中,29%RLN主干穿过环咽肌肌束至致密结缔组织膜下缘,71%RLN主干走行在环咽肌深面。69%RLN在距离甲状软骨下角尖端(15.2±5.5)mm处分为前、后两支,前支多于环状软骨侧方下缘距离甲状软骨下角尖端(5.9±1.8)mm处穿过结缔组织膜,后支入喉点距甲状软骨下角尖端(4.8±2.1)mm;31%RLN未见分支。结缔组织膜下缘RLN与甲状腺下动脉(ITA)分支的关系为:66%(63/96)RLN位于ITA前方,27%(32/96)位于ITA后方。结论大多数RLN具有喉外分支,在以甲状软骨下角作为标志寻找RLN时,要同时找寻RLN及喉外分支的入喉点。ITA与RLN的关系复杂多变,ITA不作为RLN定位的首选。     

环状软骨板-椎体间距的影像解剖学观测及意义

目的探讨环状软骨板-椎体间距的正常值.方法取60例(男、女各30例)成人无骨赘头颈部正中矢状断面标本,用游标卡尺测量环状软骨板至颈椎体的距离.随机选取60例(男、女各30例)在校正常大学生的头颈部侧位X线片进行环状软骨板-椎体间隙的X线测量.结果尸体标本上环状软骨板与颈椎体之间的距离环状软骨板上缘男(6.66±0.81)mm,女(5.74±0.37)mm;环状软骨板中部男(5.57±0.93)mm,女(4.64±0.61)mm;环状软骨板下缘男(7.70±1.02)mm,女(6.71±0.76)mm;性别差异t=2.10～5.64,P＜0.05.在颈椎侧位X线片上环状软骨板与颈椎体之间的距离为环状软骨板上缘男(7.34±1.12)mm,女(6.78±1.01)mm;环状软骨板中部男(6.28±1.160)mm,女(5.68±1.12)mm;环状软骨板下缘男(8.32±1.00)mm,女(7.52±1.52)mm;性别差异t=2.07～5.64,P＜0.05.结论环状软骨板中部与颈椎(C5或C6)间的距离最小.     

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。     

正常女性下颌角区多层螺旋CT解剖学研究

目的测量下颌骨后缘、下颌角、下颌骨下缘骨皮质的厚度,为下颌角缩小术提供解剖学依据。方法应用多层螺旋CT扫描60例正常青年女性的下颌骨,MPR重建后测量双侧下颌骨后缘、下颌角、下颌骨下缘三段内外板及边缘骨皮质厚度。所得到的结果应用SPSS13.0软件进行分析。结果左侧下颌骨后缘内外板及边缘骨质厚度分别为(2.13±0.29)mm,(2.89±0.35)mm,(4.40±0.66)mm;左侧下颌角内外板及边缘骨质厚度分别为(2.15±0.35)mm,(2.91±0.36)mm,(5.80±1.23)mm;左侧下颌骨下缘内外板及边缘骨质厚度分别为(2.20±0.41)mm,(3.02±0.42)mm,(4.31±0.68)mm。右侧下颌骨后缘内外板及边缘骨质厚度分别为(2.14±0.25)mm,(2.73±0.29)mm,(4.17±0.59)mm;右侧下颌角内外板及边缘骨质厚度分别为(2.25±0.25)mm,(2.76±0.32)mm,(5.60±1.06)mm;右侧下颌骨下缘内外板及边缘骨质厚度分别为(2.40±0.39)mm,(2.99±0.41)mm,(4.15±0.65)mm。双侧下颌骨后缘外板、下颌角外板及下颌骨下缘内板差异具有统计学意义(P0.05),其余两侧各段骨皮质厚度差异无统计学意义。结论多层螺旋CT对下颌骨后缘、下颌角、下颌骨下缘骨皮质厚度的测量对下颌角缩小术有重要的临床意义,可确保手术精确实施、降低手术难度、减少手术的并发症。     

喉上神经喉内支的分支分布及其临床意义

目的 :明确喉上神经喉内支的分支及分布情况。方法 :对 2 5例 (5 0侧 )成人新鲜正常喉的喉上神经在 10～ 2 0倍显微镜下进行解剖观测和组织染色。结果 :第 1段 (从发出至甲状舌骨膜 )长 (2 4.2± 4.2 )mm ;第 2段 (位于甲状舌骨膜内 )长 (7.0± 1.2 )mm ;第 3段 (出甲状舌骨膜至喉 )长 (13 .4± 1.6 )mm。喉内支穿甲状舌骨膜后分为内上支、中间支、后下支 3支 ,并反复分支达会厌软骨、杓会厌襞、杓状软骨粘膜、声带后 2 /3区、杓间区及环状软骨板后区粘膜。结论 :喉内支第 1段无分支且位置浅 ,可作为神经吻合的最佳部位 ,并提出了喉内支在喉内分布较详细的分布模式。     

颈椎前路减压及内固定的解剖学问题

目的 :探讨颈椎前路减压安全界限的解剖标志及适合国人的颈椎前路钢板螺钉设计参数。方法 :采用 17例完整成人颈部标本 (含C3～C7) ,对颈椎前路减压及钢板螺钉内固定设计的有关解剖学参数进行测量 ,包括颈长肌间距、横突孔间距、椎体矢状径及钩突与横突孔间距等。结果 :在C3～C7相应椎体 ,颈长肌内侧与横突孔之间有 7～ 9mm的距离 ;钩突内侧缘距横突孔 5mm ,钩突前脚距横突孔 4mm。从C3～C7,钩突前脚间距从 15 .4mm增大到 2 3 .2mm ,椎体矢状径为 14 .8～ 16 .3mm ,钩突前后径约 11mm。结论 :颈椎前路减压的安全区域可以双侧钩突前角为解剖标志 ,在此之间手术比较安全。适合国人的颈椎前路钢板设计以宽度 16～ 17mm ,螺钉长度 12mm为合适。     

喉上神经外支变异1例

笔者对41例标本,共82侧喉上神经外支进行解剖时发现1例成年男性尸体左侧喉上神经外支变异,现报道如下:左侧喉上神经位于第2颈椎横突,发自迷走神经,在舌骨大角处分为较大的内支和细小的外支.内支与喉上动脉伴行,经甲状软骨上缘和舌骨之间穿甲状舌骨膜入喉;外支沿甲状软骨下缘行走,伴行甲状腺上动脉,并分出3支:第1支位于甲状软骨上缘发出进入甲状舌骨肌;第2支由甲状软骨下缘发出,进入咽缩肌;第3支在甲状腺侧叶与咽缩肌和气管之间下行,于环状软骨下缘与喉返神经一起进入环甲关节后缘,沿途喉上神经外支与甲状腺侧叶实质紧贴,肉眼不易与甲状腺周围的筋膜区别(图1).     

The attachments of the conus elasticus to the laryngeal skeleton: Physiologic and clinical implications

The attachments of the inferior and dorsal extensions of the lateral parts of the conus elasticus (CE) are not fully understood. A re-investigation was done in plastinated serial sections of 20 adult human larynges. The CE consists of a coherent sheet of connective tissue fibers dividing into two layers toward the inferior anchorage to the cricoid arch, and the posterior anchorage to the cricoid lamina. Caudally, the medial fiber layer is continuous with the submucous fibro-elastic membrane of the trachea and is not connected to the cricoid cartilage. The lateral caudal fiber layer is attached to the superior rim of the cricoid arch. Dorsally, both layers of the CE are fixed to the cricoid lamina, the lateral sheet to the lateral edge of the cartilage, the medial sheet to its anterior perichondrium near the midline. Towards the cricoarytenoid joint, the dorsal extension of the CE divides into a caudal and a cranial sheet including a fold of adipose tissue at the base of the arytenoid cartilage. The cranial layer extends towards the vocal process, the caudal layer radiates into the joint capsule and may therefore influence the complicated joint mechanics. The firm attachments of the CE to the cricoid cartilage probably counteract deformations of the CE during phonation. An insufficient fixation of the CE may contribute to an obstruction of the airways causing sleep apnea. © 1996 Wiley-Liss, Inc.     

髋臼上区域置钉安全范围的影像学研究

目的　探究髋臼上区域螺钉的进钉位置、角度以及安全范围。 方法　收集男女骨盆CT数据各50例,利用Mimics软件重建髋臼上置钉区域三维模型（髂前下棘至髂后上棘方向）。同一横断面上,通道狭窄处中点连线方向确定为螺钉方向,沿该方向每2.5 mm为一层,逐层测量安全范围相关指标。在1/2高度层面放置中心钉,测量中心钉进钉点与髂前下棘的位置关系及螺钉方向,在水平面和矢状面上移动钉尖,测量安全倾角范围。 结果　髋臼上骨通道存在前、后两狭窄点,不同层面其宽度不同,从下至上,前狭窄由窄变宽再变窄,后狭窄逐层增宽。螺钉通道中间层较宽,上下层较窄;中心通道宽度90%的男、女性分别大于7 mm和6 mm;进钉约50 mm至前狭窄,70 mm至坐骨大切迹顶上方,100 mm至后狭窄,全程长约130 mm;螺钉为内倾、头倾方向,与矢状面和横断面的夹角均约为30°;97%的进钉点位于髂前下棘中心外侧,其中外下方占71%。 结论　髋臼上螺钉的进钉点主要位于髂前下棘外方,内倾、头倾方向,与矢状面和横断面的夹角均约为30°。     

喉组织切片与喉CT图像的对照研究及三维重建

目的对喉部MSCT和组织切片图像及其三维重建的比较研究。方法 30例(21男,9女)结构完整的喉标本,全喉连续大切片,HE染色,专业微距照相系统拍照,专业图像分析;30名(12男,18女)健康志愿者经64排高分辨率薄层MSCT扫描,得到喉部CT图像。在用3D-Doctor软件进行MSCT三维重建。测量组织切片和MSCT三维重建喉甲状软骨、环状软骨和6个切面会厌前间隙和声门旁间隙的面积,进行两组独立样本的t检验。结果 MSCT图像中甲状软骨、会厌软骨和环状软骨能清晰显示,但杓状软骨显示不全。会厌前间隙和声门旁间隙内容结构无法显示,而组织切片清晰显示间隙内容。组织切片和MSCT甲状软骨、环状软骨的测量结果无显著性差异(P0.05)。除了甲状软骨声带附着处至上、下切迹距离等四项数据无性别差异(P0.05)以外,其他数据均有性别差异(P0.05)。MSCT切割平面与组织切片会厌前间隙和声门旁间隙面积的测量结果无显著性差异(P0.05)。结论 MSCT对超过其分辨率的细微结构显示欠佳,其三维重建的细节效果不如组织切片完整清晰。组织切片能对MSCT起到良好的补充作用,使得MSCT及其三维重建作为临床医疗诊断和影像学检查的辅助工具,更适合于临床应用。     

An anatomical study of the recurrent laryngeal nerve: its branching patterns and relationship to the inferior thyroid artery

Abstract: The aim of this study was to provide information about the morphology and topography of the recurrent laryngeal nerve (RLN), its external features and branches, as well as its relationship to the inferior thyroid artery, the inferior horn of the thyroid cartilage and the thyroid gland. The RLNs in 50 adult cadavers (100 sides) were dissected and analyzed. A communicating loop connecting one branch of the RLN to another or a twig originating from the cervical sympathetic trunk was present in 13 of 100 sides. A double left RLN appeared in 2 sides; a right non-recurrent inferior laryngeal nerve appeared in one side. All of the RLNs, including looped ones, bifurcated into laryngeal branches and extralaryngeal branches, with most of the former further dividing into the anterior and posterior branches entering the larynx. The relations of the RLN to the inferior thyroid artery, the inferior horn of the thyroid cartilage and the thyroid gland were inconstant. The information gained from this study will be of value in thyroid surgery.     

骶髂关节未经影像学引导下穿刺的解剖学基础

目的　为临床骶髂关节未经影像学引导下穿刺的可行性和安全性提供解剖学基础。 方法　对3例已固定好的骶髂关节断层标本,4例干燥骨盆(男女各2例),4例防腐骨盆（男3例,女1例）和62例强直性脊柱炎患者（男32例,女30例）骶髂关节CT平扫图及三维重建进行解剖观察和测量,以髂后上棘下的骶髂关节矢状滑膜部为穿刺目标。 结果　男女矢状滑膜部矢状长度分别为（18.40±3.40）mm 和（17.32±3.60）mm（P>0.05）;男女矢状滑膜部到后正中线的距离分别为（41.00±3.30)mm和（42.74±4.00)mm（P<0.05）;男女矢状滑膜部中点与髂后上棘距离分别为（27.66±3.10)mm和（28.76±3.50)mm（P>0.05）。 结论　根据性别,脂肪厚度等不同情况在距离后正中线（41.00±3.50）mm的范围,髂后上棘下（28.00±3.20）　mm这一区域进行未经引导下穿刺可使穿刺较容易进入骶髂关节,使得穿刺成功率提高。     

Anatomical considerations on arytenoid cartilage dislocation

The cricoarytenoid joints of 12 human adult male and female larynges were studied with regard to the anatomical reasons for arytenoid cartilage dislocation. The specimens were impregnated with curable polymers as a whole and then cut into 600–800 μm sections along different planes. The articulating surface at the upper border of the cricoid lamina revealed a striking extension backward and occasionally even slightly distalward. This may allow the arytenoid cartilage to glide in a posterior direction until it partially looses its contact to the cricoid facet. In physiologic conditions, the arytenoid position is balanced along a sagittal plane between the posterior cricoarytenoid ligament dorsally and the thyroarytenoid muscle ventrally. If one of these structures is damaged, i.e., by medical disease or trauma, the arytenoid cartilage may be pushed easily in the opposite direction. Arytenoid dislocation mainly in a posterior direction is described in literature as a possible complication of endotracheal intubation. Preparatory pharmacological muscle relaxation leads to paralysis of the thyroarytenoid muscle and its ventrally directed traction on the arytenoid cartilage. As the shape of the articulating surfaces, especially the peculiarities of the cricoid facet, even facilitates a dorsally directed movement of the Arytenoid cartilage, it may be easily displaced in a posterior direction during the procedure of endotracheal intubation. © 1994 Wiley-Liss, Inc.     

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.     

改良经眶入路翼腭窝穿刺解剖学观测

目的　为眶入路法行翼腭窝穿刺提供新的进针路径。 方法　对77个（154侧）成人颅的眶和翼腭窝进行相关的观察和测量。 结果　眶外缘点至眶外下缘点、圆孔外口下缘、眶上裂后端、眶下裂前端的距离分别为：左（4.93±1.80）mm,右(4.02±2.05）mm;左（43.74±2.75）mm,右(43.80±2.89）mm;左（47.83±2.47）mm,右(47.74±2.53）mm;左（17.74±2.18）mm,右(17.43±1.97）mm。穿刺针（直针）由眶外缘点进入翼腭窝的成功率为：左侧96.10%;右侧93.51%。对穿刺针（直针）进入翼腭窝失败者改用弯针穿刺,直针和弯针由眶外缘点进入翼腭窝的总成功率为：左、右均达98.70%。 结论　经眶外缘点行眶入路翼腭窝穿刺可明显提高穿刺成功率。     

上、下项线间相关距离测量及临床应用研究

目的　测量完整人颅骨的上、下项线及枕骨大孔间的距离,为临床应用提供数据。 方法　在113例中国成年人正常、干燥颅骨标本上,取枕外隆突最高点、上项线上枕外隆突最高点左、右两侧旁开1 cm、2 cm各取一点,颅骨后正中线上枕外嵴中点及其左、右两侧旁开1 cm点各取一点,从上、下项线所取测量点向枕骨大孔方向作与颅骨后正中线平行的直线,用游标卡尺测量枕骨上、下项线间及上、下项线分别与枕骨大孔间的弧面、直线、垂直及水平距离。 结果　在后正中线上,上、下项线间的距离最小,直线距离为（18.11±2.99）mm、弧面距离为（19.18±2.83）mm、垂直距离为（11.11±3.44）mm、水平距离为（14.65±3.19）mm,向左、右旁开后除水平距离变小,其余各距离指标变大;枕外嵴中点到枕骨大孔后缘间两点的距离最小,直线距离为（21.73±3.35）mm、弧面距离为（22.74±3.47）mm、垂直距离为（10.69±3.44）mm、水平距离为（19.10±3.35）mm,向左、右旁开后,各距离指标变大。 结论　下项线准确定位是临床操作安全和有效的关键,以枕外隆突和上项线可以确定下项线位置,在后正中线上,下项线距上项线的垂直距离最小,为（11.11±3.44）mm。