食管纵行肌上附着点的巨微解剖

目的:探讨吞咽过程中咽壁缩短的机制。方法:运用大体解剖技术和断层解剖技术相结合的方法,对66具成人咽食管段纵行肌进行了观测。结果:食管纵行肌不仅止于环状软骨板后正中嵴,食管侧壁的大部分纵行肌纤维向上穿过环咽侧三角,与腭咽肌直接相续,小部分纵行肌纤维止于环状软骨弓侧缘。结论:咽壁的缩短是咽肌和食管纵行肌共同收缩的结果,是主动性的过程。     

CT图像和重组技术在骶椎临床影像解剖学研究中的应用

目的 观察骶椎的解剖形态及其与耻骨联合的位置关系,为骶椎正位X线摄影体位的优化设计提供解剖学依据。 方法 回顾性随机收集1000例患者骨盆腔CT影像,借助CT图像重组技术观测骶椎的解剖形态及其与耻骨联合的相对位置关系。 结果 骶椎均为前面凹陷、底朝上、尖向下后方走行,骶椎上下端中点连线M与人躯体长轴之间的夹角A均为锐角,耻骨联合位于骶椎的前正中偏下位置,其与骶椎下缘的连线N和躯体长轴垂线间夹角B>0 °（即耻骨联合上缘低于骶椎下缘的位置）占89.7%（897/1000);青少年组（14~45岁）角A为（35.86±6.88）°,明显低于中年组（46~69岁）（37.82±6.34）°和老年组（>69岁）（37.60±6.65）°（P<0.05）,青少年组角B为（10.27±7.02）°,明显高于中年组（8.88±7.23）°和老年组（7.83±6.93）°（P<0.05）,而中年组和老年组间差异均无统计学意义;男性角A（36.12±0.27）°和角B（6.27±0.25）°,均明显低于女性（38.03±0.33）°和（12.79±0.33）°（P<0.05）。 结论 CT图像重组技术可用于观察和分析骶椎的解剖形态及其与耻骨联合的位置关系,不同年龄段和不同性别者骶椎与耻骨联合的相对位置情况差异显著,可为骶椎正位X线摄影检查体位的优化设计提供可靠的解剖学依据。     

脐中襞和脐内侧襞形态特点及其在腹腔镜疝修补术中的意义

目的　应用腹腔镜技术研究国人脐中襞及脐内侧襞与脐环会合的类型,并测量分析脐中/内侧襞宽度分布规律。 方法　自2006 年1 月～2009年12月, 收集了腹腔镜腹股沟疝修补术中463例患者脐正中/内侧襞与脐部会合类型,测量了脐正中襞和脐内侧襞于盆壁附着处宽度,对比分析不同年龄组和男女两性之间脐内侧襞宽度。 结果　脐正中襞和脐内侧襞与脐部会合方式分4型,双侧脐内侧襞与脐正中襞分别独立会入脐环为Ⅰ型22.2％（103例）,脐正中襞与一侧脐内侧襞回合后再与另一侧脐内侧襞分别汇入脐环为Ⅱ型43.6％（202例）,双侧脐内侧襞与脐正中襞三者会合一起后再汇入脐环为Ⅲ型20.7％（96例）,未见脐中襞者为Ⅳ型13.5％（62例）,与国外报道相似。在儿童组、青少年组、中青年组和老年组之间,脐正中襞宽度没有差别,但老年组脐内侧襞宽度大于2.0cm以上比例（46.6%）显著低于儿童组（73.9%）。男女两性别之间,脐正中襞宽度也没有差别,但男性脐内侧襞宽度大于2.0cm以上比例（61.6%）显著高于女性（41.4%）。 结论　腹腔镜下国人脐正中襞及脐内侧襞与脐部会合方式可分4型,脐内侧襞宽度在不同年龄、性别之间有显著差异,为腹腔镜腹股沟疝修补术中切取自身材料提供参考。     

腹腔镜前路L5～S1椎间盘手术的血管解剖观察

目的:阐明髂间三角区内血管的分布规律,为腹腔镜前路L5～S1椎间盘手术提供安全靶区。方法:31例经动脉灌注红色乳胶的成人防腐固定腰椎标本,年龄58.2岁。观测并分析髂间三角内与腹腔镜前路L5～S1椎间盘手术相关的血管解剖数据。结果:L5～S1椎间盘的高度、宽度分别为(1.87±0.21)cm、(5.07±0.60)cm;主动脉杈(AB)与髂总静脉汇合处(CCIV)分别位于L5～S1椎间盘上缘(3.97±1.24)cm、(2.75±1.46)cm处;夹角分别为(52.4±12.0)°、(78.4±22.1)°;骶正中动脉(MSA)存在于所有的标本中,在L5～S1椎间盘上、下缘处的外径分别为(0.16±0.04)cm、(0.14±0.05)cm;上、下缘水平到右髂动脉(RIA)的距离分别为(2.02±0.81)cm、(2.74±0.83)cm。左髂静脉(LIV)到右髂动脉的平均距离为3.60cm,占椎间盘宽度的71.3%(32.3%～124.4%)。结论:髂间三角内的血管解剖能满足腹腔镜前路L5～S1椎间盘手术要求,可作为手术治疗椎间盘疾患的选择靶区。     

骶结节韧带和骶棘韧带的解剖学测量及其意义

目的　测量骶结节韧带和骶棘韧带的解剖学数据,为临床应用提供形态学基础。 方法 20例（男、女性各10例20侧）正常成人防腐骨盆标本,用游标卡尺、圆规和直尺测量骶结节韧带和骶棘韧带的起点宽度、附着点宽度、韧带上缘、中部和下缘长度、韧带中点宽度和厚度。 结果　男、女性骶结节韧带上缘、中部和下缘长度分别为（12.19±0.49）cm和（11.20±0.39）cm 、（8.02±0.80）cm和（7.22±0.90）cm、（6.67±0.24）cm和（6.76±0.15）cm,两者比较除韧带起始部宽度和上缘长度存在差异(P<0.05)外,其余无统计学差异;男、女性骶棘韧带上、中、下平均长度分别为（4.45±0.14）cm和（4.56±0.32）cm、（4.27±0.17）cm和（4.54±0.67）cm、（4.44±0.33）cm和（4.67±0.42）cm,韧带起始部宽度、韧带中点宽度和厚度男、女性差异有统计学意义(P<0.05),其余无统计学差异。 结论　骶结节韧带和骶棘韧带与临床骨盆骨折和妇产科疾病的治疗联系紧密,本研究为临床相关研究和治疗提供了解剖学依据。     

下颌神经管的解剖结构

背景:在下颌后牙种植术中,由于下颌神经管走行于下颌骨体内,有时可损伤下齿槽神经,因而制约了牙种植术的应用。 因此,牙种植术的应用需详细了解下颌神经管的解剖结构。 目的：观察下颌神经管在下颌骨内的走行及管内的解剖结构。 方法：共纳入15具成人牙下颌骨标本与4具新鲜下颌骨动脉灌注标本。纳入对象均牙列完整,后牙无缺失,牙槽骨无吸收。测量15具成人牙下颌骨标本下颌管走行及其管腔各径长度,包括下颌管横径与纵径,下颌管至上下内外缘距离。观察4具新鲜下颌骨动脉灌注标本管内下颌神经管内神经、血管位置关系。 结果与结论：下颌管内缘至舌侧骨板的距离比下颌管外缘至颊侧骨板距离短(P < 0.01);下颌管上缘至牙槽嵴顶的距离较下颌管下缘至下颌骨下缘的距离大(P < 0.01)。表明下颌管在下颌骨体部走行中偏舌侧、偏下颌骨下缘。下颌神经管在下颌骨体部的部分横径小于纵径(P < 0.05),亦即下颌管截面形态为上下径略长的椭圆形。神经管横纵径于前后牙位区差异无显著性意义。实验还发现在暴露的下颌管腔中下牙槽神经及伴随血管有一层被膜包绕成神经血管束,血管位于神经上方,而且位置恒定,并发出小分支包绕神经。结果提示,下牙槽血管神经束在下颌管内走行中血管位于神经之上。     

舟月骨间韧带分级切断对舟月间距的影响

目的了解舟月骨间韧带(SLIL)分级切断与舟月间距之间的关系,对SLIL各亚区在维持正常舟月骨位置关系中所起的作用进行评价,为临床上舟月骨分离的诊断提供参考。方法取新鲜冰冻上肢标本12具,以亚区为单位对SLIL进行分级切断,标本分为正常组、断SLIL近侧组、断SLIL近+背侧组、断SLIL近+掌侧组、SLIL全断组;分别在腕关节处于应力位及非应力位、中立位与尺偏位时拍摄腕部X线片,测量各组标本舟月间隙宽度的变化。结果在各种拍摄条件下,切断SLIL近侧亚区对舟月间隙均未产生明显的影响;切断SLIL近+背侧亚区组、切断SLIL近+掌侧亚区组舟月间隙有所增宽,但没有统计学差异;在SLIL全切断组,舟月间隙增宽较为明显(P<0.05)。在切断SLIL近+背侧亚区组、切断SLIL近+掌侧亚区组及SLIL全切断组,对腕关节施以轴向100N的压力会使舟月间隙增宽更为明显,其中以SLIL全切断组增宽最为明显(P<0.01);与中立位比较,腕处于尺偏位时可使舟月间隙更宽,但并没有明显的差异(P>0.05)。结论SLIL近侧部分在维持正常舟月间距上不起关键作用;SLIL切断范围较大时,在腕部处于应力位时拍摄的X线片上可以更容易发现舟月间隙的异常,对舟月骨分离的诊断有一定的应用价值。     

成人颞骨骨迷路的解剖学研究及其临床意义

目的:对成人颞骨骨迷路进行解剖观察和测量,为临床提供解剖学基础。方法:制作26侧成人颞骨骨迷路标本进行观察和测量。结果:(1)半规管长度以后半规管最长,前半规管次之,外半规管最短。(2)半规管横断面呈椭圆形,其弓顶处管腔纵径大于横径。(3)壶腹端、单脚端、总脚端均近似圆形。后、前、外半规管壶腹端的纵径分别为:1.94mm,1.95mm,1.92mm。外半规管单脚端纵径为1.20mm,前、后半规管总脚端纵径为1.60mm。(4)三个半规管弓除外半规管弓在同一平面上外,前、后半规管弓均不在同一平面上,而呈不同程度的扭曲。(5)同侧三半规管之间并非相互垂直。(6)26侧中前半规管位于弓状隆突下的有16侧(61.54％),余10侧(38.46％)与弓状隆突不相重叠。结论:本研究结果为骨迷路结构研究增添了新的内容,为临床内耳手术的开展提供解削学基础和参考数据。     

不同入路对老年患者腰段腰硬联合麻醉的临床观察

目的 探讨不同硬膜外腔穿刺入路时老年患者腰段腰硬联合麻醉(CSEA)穿刺成功率和术后腰背痛的影响.方法 将210例行前列腺电切术患者随机分为3组:直入法组(A组)、旁正中法组(B组)、侧入法组(C组),每组各70例.2组患者左侧膝胸卧位,选择L3-4间隙穿刺,穿刺针口平面与黄韧带纤维走向平行方向进针.A组采用常规硬膜外穿刺,后正中线两棘炙中点穿刺进针.B组棘突中点向左侧旁开0.5～1cm处穿刺进针.C组棘突中点向左侧旁开1～1.5cm处穿刺进针.阻力消失法试验(+),旋转穿刺针尾使针口斜面与黄韧带垂直,行蛛网膜下腔穿刺.结果 3组术后头痛、神经根和血管损伤差异无统计学意义(P>0.05);A组术后腰背痛明显高于B组(P<0.01)和C组(P<0.05);A组一次穿刺成功率明显低于B组(P<0.01)和C组(P<0.05),B组明显高于C组(P<0.05).结论 侧入法穿刺成功率明显增加,有效减少腰段椎管内麻醉术后穿刺点疼痛.     

三维数字化测量肾结石的解剖学病因及临床意义

文题释义：肾结石：是泌尿系统最常见的疾病,与饮食中的钙含量和酸性物质增高有关,严重者常需要进行手术治疗,肾结石手术几乎占了泌尿外科手术数量的一半。 三维数字化：利用医学工程软件把人体脏器的实体模型进行虚拟创建,之后进行修改、模拟、设计等一些操作。 背景：肾结石发生病因有很多,但对于肾脏解剖形态学研究是否影响结石的产生还未有明确答案。 目的：重建肾脏的三维立体模型;测量与肾结石病因的相关解剖结构数据进行分析。 方法：随机选取2017年12月至2019年2月在北京房山区良乡医院就诊的30例肾结石患者作为肾结石组,对照组是同期进行体检的正常人30例。两组受试者采集肾脏CT的扫描数据后,利用Mimics 16.0.软件通过图像分割和融合来重建肾脏的三维立体模型;测量肾脏长度、肾脏宽度、肾窦长径、肾窦宽径、肾盂与输尿管连接处直径、肾上缘至棘突纵线距离、肾下缘至棘突纵线距离、肾门至棘突纵线距离;并对肾结石患者肾脏解剖学指标进行多参数Logistics回归分析。结果与结论：①肾结石患者与正常人的肾在肾脏长度、肾脏宽度、肾窦长径、肾窦宽径、肾盂与输尿管连接处直径、肾上缘至棘突纵线距离、肾下缘至棘突纵线距离、肾门至棘突纵线距离方面的三维数字化测量结果差异无统计学意义(P > 0.05)。②肾结石患者肾脏解剖学多参数Logistics回归分析结果表明,肾结石患者的肾脏长度、肾脏宽度、肾窦长径、肾窦宽径、肾盂与输尿管连接处直径、肾上缘至棘突纵线距离、肾下缘至棘突纵线距离、肾门至棘突纵线距离等与肾结石的形成无明显相关性(P > 0.05)。提示肾脏形态学的不同与结石形成无关。ORCID: 0000-0001-6850-7615(武利兵);0000-0001-5877-8358(许阳阳) 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     

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。     

Morphology of the Upper Esophageal Sphincter or Cricopharyngeus Muscle Revisited

Histological examination of specimens from 22 donated elderly cadavers and 15 human fetuses revealed that the cricopharyngeus muscle (CPM) provided (1) posterior circular muscle fibers adjacent to the external aspect of the uppermost esophageal circular muscle and (2) a thin anterior sling connecting to that same muscle. Another thick lateral bundle of longitudinal muscle originated independently from a fascia covering the posterior cricoarytenoideus muscle, extended laterally and posteriorly, and occupied a space after the CPM had disappeared at the anterolateral angle of the esophagus below the cricoid. The thick fascia contained abundant elastic fibers along the internal surface of the pharyngeal constrictors (posteromedial elastic lamina), but was interrupted or discontinued near the cricoid origin of the CPM. As no submucosal smooth muscles or elastic fibers were connected to it, the CPM did not accompany a specific elastic structure at the interface between the pharyngeal and esophageal muscles. In fetuses, the medial half of the CPM was inserted into the cricoid while the lateral half continued to the sternothyroideus muscle or ended at a fascia covering the cricothyroideus. These anterolateral ends provided a mechanical load for longitudinal growth of the pharyngeal constrictors. Consequently, the CPM was unlikely to develop and grow to form the upper esophageal sphincter, and the muscle bundle crossing the lateral aspect of the pharyngo-esophageal junction appeared to have a secondary passive role as a sphincter. This situation contrasts with that of another sphincter in the human body formed from striated muscle. Clin. Anat., 33:782–794, 2020. © 2019 Wiley Periodicals, Inc.     

A reassessment of cervical surface anatomy via CT scan in an adult population

Surface landmarks in the neck are important for orientations of cervical glands, arteries, veins, nerves, and vertebrae. Recent research suggests some orientations are not correct. What are the cervical landmark orientations in the Chinese population? In this study, two essential cervical anatomy planes, the thyroid cartilage and C7 planes, were assessed in living adult Chinese subjects using computed tomography (CT), and the hyoid, carotid bifurcation, cricoid cartilage, thyroid arteries, and vertebral artery were simultaneously positioned. After excluding patients with distorting pathology, a total of 108 cervical CT scans were examined. The thyroid cartilage plane commonly passed through the C5 (in males) or C4 (in females) vertebral level. The carotid artery bifurcated most commonly at C3 (left) or C4 (right), more than 10 mm above the thyroid cartilage plane bilaterally in most cases. Orientation of the carotid bifurcation according to the body or greater horn of the hyoid was more accurate. The superior thyroid artery was found a finger‐breadth below the thyroid cartilage plane, and the inferior thyroid artery in the C7 plane. The inferior border of the cricoid cartilage was most often at C7 (in males) or C6 (in females). The vertebral artery entered the C6 transverse foramen in more than 80% of scans. This reassessment of cervical surface anatomy using modern imaging tools in vivo provides both qualitative and quantitative information for surgeons in clinical practice. Clin. Anat. 30:330–335, 2017. © 2017 Wiley Periodicals, Inc.     

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.     

Anatomical aspects of postintubational subglottic stenosis

The subglottic regions of 54 human adult male and female larynges were studied with regard to anatomical aspects of postintubational stenosis. Fourteen specimens were impregnated with curable polymers and cut into 600–800 μm sections along different planes. Forty formalin-fixed hemilarynges were dissected. Measurements of the upper cricoid lamina and the thickness of the endocricoid soft tissues were taken for statistical analysis. Immediately beneath the glottis, the upper part of the cricoid lamina consists of two lateral plates with an average angle of 110°. Distally, the cricoid adopts a more and more rounded lumen. At the level of the cricothyroid joint, the definite airway lumen is always laterally narrowed by a prominent thickening of the endocricoid soft tissue. Large amounts of loose connective tissue facilitate the development of edema in case of injury in this region. Dorsally, the submucous stratum is smaller and consists mainly of dense connective tissue. The blood vessels are fixed to the cricoid perichondrium by collagenous fibers. Any pressure applied from the airway lumen will force the vessels against the nonresilient cartilage, resulting in occlusion and ischemia. These pathophysiologic mechanisms are important for the development of early laryngeal damage during endotracheal intubation, possibly resulting in posterior stenosis due to scarring later on. © 1995 WiIey-Liss, Inc.     

Osteoblastoma of the larynx: a case report

We describe a unique case of an osteoblastoma in the cricoid cartilage of a 50-year-old man who presented with hoarseness and progressive dyspnea. Panendoscopic examination revealed a reddish tumor at the left side of the cricoid cartilage. Computed tomography (CT) imaging showed a sclerotic lesion involving the cricoid cartilage, protruding in the airway lumen. The tumor was removed via an external procedure. Histology confirmed the diagnosis of osteoblastoma.     

Congenital laryngeal atresia: two autopsy cases, one describing the use of computed tomography

Two autopsy cases of congenital laryngeal atresia (CLA) were studied. In the first case (a boy delivered at 37 weeks of gestation) the subglottic lumen was almost totally occupied by a dome shaped cricoid cartilage with a pharyngotracheal duct (PTD). No tracheoesophageal fistula (TEF) was found. In the second case (a girl born at 41 weeks of gestation) histology showed that the subglottic lumen was almost occluded by an epithelial lamina and a dome-shaped cricoid cartilage. Again no TEF was found. Both cases had PTD and showed normal development of the lungs. These deformities coincided with Smith & Bain's type II subglottic atresia. The anatomy of the lesion was confirmed by postmortem three-dimensional reconstruction CT, the use of which has not previously been reported.     

Interrelationships between the innervations from the laryngeal nerves and the pharyngeal plexus to the inferior pharyngeal constrictor

Purpose

The inferior constrictor is innervated by the pharyngeal plexus and the external and recurrent laryngeal nerves. The communication between these nerves may influence the innervations. However, the relations of their anastomoses with the innervations have been unclear. This gross anatomical study re-examined the configuration of the inferior constrictor and investigated the variations of the anastomoses and the innervations of the constrictor to clarify their interrelationships.

Methods

The inferior constrictor and the branches of the superior and recurrent laryngeal nerves and the pharyngeal plexus were examined under a binocular microscope in 30 Japanese cadavers.

Results

The inferior constrictor consisted of the oblique fibers from the thyroid and cricoid cartilages and the horizontal ones from the cricoid. The oblique fibers were innervated by the pharyngeal plexus from the dorsal and ventral surfaces. The external laryngeal nerve gave twigs to the oblique fibers and the cricothyroid from the lateral surface. The recurrent laryngeal nerve supplied the horizontal fibers from the ventral surface. The internal laryngeal nerve sometimes and the main trunk of the superior laryngeal nerve rarely supplied the upper oblique fibers. The communicating branches between the laryngeal nerves and the pharyngeal plexus sometimes gave twigs to the constrictor from the dorsal surface.

Conclusions

The innervations to the inferior constrictor from the laryngeal nerves and the pharyngeal plexus are classified into some types based on their branching patterns and anastomoses, suggesting that the dysfunctions of the laryngopharyngeal region vary according to the positional relationships between the affected part and the innervations types.