腰椎横突平分线与椎弓根侧方平分线关系的解剖学观测及其临床意义

目的 :探讨腰椎横突平分线与椎弓根侧方平分线的关系。方法 :对 10 0套干燥腰椎骨标本横突平分线与椎弓根侧方平分线的关系及距离进行了观测。结果 :在L1有 83 .1% ,L2 73 .1% ,L372 .4% ,L4 87.5 % ,L55 4.1%的横突平分线位于椎弓根侧方平方分线下方 ,距离为L1(2 .4± 1.0 )mm ,L2 (2 .4± 0 .8)mm ,L3(2 .3± 0 .9)mm ,L4 (2 .9± 0 .8)mm ,L5(2 .3± 0 .7)mm。结论 :横突平分线多不通过椎弓根中心 ,所以横突平分线作为腰椎椎弓根螺钉的横向定位标志欠准确。     

颈椎椎弓根的形态观测及临床意义

为给颈椎弓根螺钉的设计和手术方法提供解剖学基础，采用测量方法对20例成人骨骼的颈2至胸1的椎弓根及其相关结构作了观测。椎弓根高为6．4±1．1－9．1±1．3mm，其厚为3．6±1．8－7．2±1．3mm，长为9．6±1．4－15．1±1．2mm.。根体长为25±1．1－30±1．9mm，椎弓根内倾角为26．2°±6．0°－46．0°±3．5°，体根柱角为90．7°±2．3°－105．6°±4．6°，PS值为0．5±0．4mm-4.4±1.2mm，PM值为0．8±0.2-7.4±1.2mm。颈椎弓根螺钉的直径以3．0mm以内较安全，其长度不宜短于15．1±1．2mm，不宜长于29．1±1．4mm，颈椎弓根入钉是位于关节突柱背面，可根据纵向的上关节突关节面最低点下方距离（PS值）和横向上关节突柱外缘内侧距离（PM值），在胸1此值为椎板外缘外侧距离）来确定，螺钉置入方向通过水平面上的内倾角和矢状面上的体根柱角确定。     

枢椎椎弓根最狭部形态学观察

目的:确定枢椎椎弓根的最狭窄部位并观察其内部结构特点,为临床应用提供解剖学参数-方法:32例经GE LightSpeed 16 Pro螺旋CT扫描的成人图像.扫描完成后行内插重建为层厚0.625mm、层距0.3mm,在ADW4.2软件上进行多平面重建处理在椎弓根狭部复合体内倾中轴线做内倾纵向切面,于纵向切而上确定椎弓根上倾中轴线,沿该上倾中轴线做上倾斜向切面,在该上倾斜面上的最狭窄部作垂直切面即椎弓根的最狭窄部位.结果:如果不考虑上关节突皮质骨,典型椎弓狭部的皮质骨轮廓形状近似钩状,钩身为椎弓狭部的内侧壁,钩尖为椎弓狭部的外侧壁部分,髓腔形状多呈竖置的椭贺形,内侧壁厚度(2.4±0.53)mm明显大于外侧皮质骨厚度(1.2±0.76)mm.椎弓狭部上方骨皮质厚度(2.7±0.76)mm明显小于下方部骨皮质厚度(3.2±0.92)mm,P<0.01.结论:椎弓狭部中段的外侧皮质骨厚度呈菲薄样,经椎弓根狭部复合体螺钉的方向以偏内偏上的安全系数高;对于国人来讲,枢椎的椎弓根内固定螺钉直径多以3～3.5 mm较为合适.     

寰枢椎的解剖学测量及其临床意义

目的 :为寰枢椎区病损机制和手术治疗提供解剖学依据。方法 :在 15 0例中国成年人干燥寰枢椎标本上 ,对具有临床意义的数据进行解剖学测量。结果 :寰椎上关节面内倾角、下关节面外倾角及侧块内倾角两侧不对称分别占 19.3 %、10 .7%和 7.3 % ;椎动脉沟处形成沟环者占 16 .0 % ;所有横突孔的前后径和横径均大于 4mm ;后弓内侧半距仅为外侧半距的 1/2。枢椎椎弓根内倾角变异较大 (-3 .5°～2 1.5°) ;齿突腰部宽度小于 9mm者占 71.2 % ,齿突后倾角的变异较大 (0°～ 2 2°) ;2 7.5 %的椎动脉在经过枢椎侧块下方时会形成一动脉压迹沟 ,致使侧块外端和椎弓根变薄。结论 :①寰枢椎的解剖学形态与其生物力学性质及损伤机制密切相关 ;②手术时寰椎前弓向外显露不宜超过 2 0mm ,后弓切除向外不宜超过 10mm ,经寰枢外侧关节融合或内固定术应选择在关节的内侧 2 /3 ;③大部分中国人不适宜于两枚齿突螺钉内固定术 ;④ 2 7.5 %的中国人不适宜于经椎弓根螺钉固定术 ,枢椎椎弓根变异较大 ,手术前应作CT检测。     

枢椎椎弓根及峡部的临床解剖学观察

目的:明确枢椎椎弓根及峡部的解剖部位,指导枢椎后路螺钉的临床应用。方法:成人C2干燥骨标本30具,C3干燥骨标本10具,以横突孔周围结构为重点,进行枢椎形态比较学观察;测量枢椎椎弓根轴线在下关节突背侧的坐标点。结果:C2的下方结构与C3下方的表面解剖结构接近,枢椎上方结构与C3相比较,上关节突移向齿突的外下方,并使峡部拉长前移,其轴向角度为11.1°±2.4°;枢椎椎弓根轴向角度为42.6°±4.9°,椎弓根轴线-下关节突背侧关节突上缘的交点坐标O与下关节突上缘-中垂线交点O’基本重合。结论:枢椎上下关节突之间的部分,应为峡部和椎弓根的复合体,复合体的上部较为扁平的部分为峡部,其中下部分位于横突孔内后侧的半管柱状结构为椎弓根部,连接着椎体和下关节突。     

下位腰椎椎弓根内固定术的断层解剖与CT

目的为临床腰椎弓根内固定术的开展提供断层解剖学基础与CT资料.方法在5 0例(标本24,CT 26)经L4、L5椎弓根层面上,观察确定进针点,并测量椎弓根厚度、进针角度和从进针点经椎弓根中心至椎体前缘的距离等数据.结果L4 、L5椎弓根厚度、进针角度、从进针点经椎弓根中心至椎体前缘的距离,平均分别为11.55、15.25mm;16.01°、18. 55°;53.69、50.85 mm.固定针直径、进针角度和进针深度,分别为6.50～7.50、7.50 ～8.50 mm;14.00°～20.00°、17.00～23.00°和32.50～39.00、29.25～35.75 mm.结论在L4、L5椎弓根层面上,以上关节突基部外侧缘为进针点较佳 .     

枢椎椎弓根的解剖观测及临床意义

目的:为枢椎椎弓根螺钉固定技术提供解剖学依据.方法:采用15具枢椎干骨标本,观察枢椎椎弓根的形态特点及其与横突孔的毗邻关系,测量椎弓根的高度、宽度,以及椎弓根的轴线在水平面和矢状面的角度.结果:枢椎椎弓根被峡部和上关节突的一部分所覆盖,可分成前(内)后(外)两部分:前部位于上关节突内侧部的下面,连接椎体;后部位于峡部的下面连接下关突.横突孔存在一定的解剖变异,以左侧为多.椎弓根的上宽(7.90±1.41)mm、下宽(4.90±0.82)mm、高度(6.70±0.90)mm,内倾角(32.33±3.45 )°、上倾角(24.07±5.30)°.结论:90%的人适合枢椎椎弓根螺钉固定,了解枢椎椎弓根的正常解剖参数及其与横突孔的毗邻关系,对枢椎椎弓根螺钉技术的应用有重要的参考意义.     

经颈前路螺钉内固定治疗齿突骨折的应用解剖

目的 :通过齿突的观测 ,为颈前路螺钉直接内固定治疗齿突骨折提供应用解剖学依据。方法 :测量 5 0例枢椎干燥标本的枢椎的高度、齿突基底部的外径和基底部皮质厚度。结果 :枢椎的高度为 3 8.3 2± 2 .1 1mm ,齿突基底部横径和矢径分别为 1 0 .5 1± 0 .83mm和 1 1 .65± 0 .92mm ,齿突基底部前、后及左、右侧的皮质厚度分别为 1 .62±0 .4 2mm、1 .5 5± 0 .3 1mm、1 .91± 0 .2 3mm和 2 .1 6± 0 .2 4mm。结论 :96%齿突不适合两枚直径 3 .5mm的螺钉固定 ,建议用直径 4 .5mm螺钉以 3 5～ 4 5mmm的深度和后倾 1 0°角度固定     

椎弓根螺钉入点定位及双侧入点间距的应用测量

目的提供椎弓根螺钉入点定位法及双入点间距的解剖学资料.方法观测螺钉入点并测量双入点间距.结果①螺钉入点分4组,第1组,C2为横突下缘水平线与中外1/4垂线交点处;第2组C3～L1,除C5外均在横突中上水平线与关节突中垂线及中外1/4垂线限定的四边形内.第3组L2～L4在横突中水平线与外缘垂线交点处;第4组L5在横突中水平线与乳突外缘垂线交点处,距关节突外缘垂线(4.8±0.7)mm.②双入点间距L5最大,C5次之而T5～T7最小.结论C3～L3入点多集中在横突中上水平线与关节突中外垂线限定的四边形内,其中C3～C4、C6～L1均在横突中上水平线与关节突中垂线及中外1/4垂线限定的四边形内;双入点间距变化有明显的规律性.     

颅后窝外侧入路术的应用解剖

目的 :为颅后窝手术入路提供避免损伤血管神经等的解剖学依据。方法 :解剖测量 16例成人头颅标本。结果 :乳突尖至茎突尖、寰椎横突外侧端和茎突尖至寰椎横突外侧端三者之间的距离分别为(3 0 .67± 6.3 8)mm ,(2 4.15± 4.46)mm和 (15 .2 0± 3 .5 0 )mm。乳突尖至面神经、颈静脉孔的外缘和颈动脉管外口的外缘、枕骨髁外侧缘中点的距离分别为 (10 .11± 3 .0 2 )mm ,(2 2 .93± 3 .5 9)mm ,(3 0 .40±3 .3 7)mm和 (3 1.43± 3 .11)mm。乳突尖至Ⅸ、Ⅹ、Ⅺ和Ⅻ对脑神经出颅处的距离分别为 (2 6.13± 5 .49)mm ,(2 4.2 7± 4.11)mm ,(2 1.17± 4.3 4)mm和 (2 4.64± 4.64 )mm。结论 :在颅后窝外侧入路的手术中 ,应重视乳突至茎突、寰椎横突外侧端和茎突至C1横突外侧端的间距 ,以及乳突至颈内静、动脉 ,Ⅸ、Ⅹ、Ⅺ和Ⅻ对脑神经的位置和距离等能有效地在手术时保护它们。     

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     

Characteristics of the topographic interrelation of the head of the pancreas and the duodenum and pathology of the organs of the pancreatoduodenal area

Seventy pancreatoduodenal complexes of 55 patients with chronic pancreatitis and tumours of this zone and 15 patients died from other diseases are studies histotopographically . The pieces of the pancreatic head tissue in the medial wall of the duodenum were found in 12 cases of the first group and in 4 control cases. The pancreatic tissue consisted either of all elements of this organ or cystically dilated ducts and seemed to infiltrate different layers of the duodenum wall. Three variants of the pancreatic head structure are suggested on the basis of anatomo-topographical interrelationships of the pancreatic head and duodenum. In 12 out of 14 cases chronic pancreatitis and carcinoma of organs of this zone were combined with the variants of the pancreatic head structure, in 2 cases there was a true heterotopy . Pathogenetic significance of these variants for the development of chronic pancreatitis is discussed.     

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.     

指背腱膜滑动与近侧指间关节屈曲关系及临床意义

目的:探讨指背腱膜滑动距离与近侧指间关节(PIP)屈曲关系,为临床修复提供解剖学基础。方法:男性成人新鲜尸体标本10侧30指(示、中、环指各10指),切除手指皮肤,不破坏腱鞘、屈肌支持带、伸肌支持带、内在肌及外在肌,使肌腱保持正常的生理状态,分别测量各指中央束(CS)、侧束(LB)在PIP屈曲45°和90°时的滑动距离。结果:当PIP屈曲45°时,CS滑动距离为(2.7±0.4)mm,LB滑动距离为(2.8±0.6)mm;当PIP屈曲90°时,CS滑动距离为(4.3±0.7)mm,LB滑动距离为(4.8±0.6)mm。结论:指背腱膜滑动距离减少,严重影响手指的屈曲功能。对于指背腱膜的新鲜性损伤应予以精确修复;对于陈旧性损伤的修复应确保指背腱膜的正常滑动范围。