髌下深囊与关节腔间组织结构观察及临床意义

目的　观察髌下深囊和关节腔间组织结构特点,为膝关节疾病的影像学诊断研究提供依据。 方法　对20侧固定后的膝关节标本进行解剖,观察关节腔、髌下深囊的滑膜分布及其之间区域组织结构;对20件膝关节铸型标本进行观察,研究关节腔、髌下深囊及其之间区域的血管来源、分支及分布。 结果　关节腔和髌下深囊内表面有相同的滑膜组织,但彼此间并非延续而成,二者之间被髌下脂肪组织填充分隔;关节腔、髌下深囊及其之间区域主要通过膝降动脉、膝下内侧动脉和膝上、下外侧动脉及其分支连通。 结论　髌下深囊和膝关节腔间滑膜互不延续,二者间有动脉连通。不同的膝关节病变在髌下深囊和膝关节腔可有不同的病理改变和影像学表现。     

髌内侧支持带的解剖观测及临床意义

目的：观察髌内侧支持带的解剖学特点，探讨其对髌股关节稳定性的作用。方法：采用50例经福尔马林固定的成人尸膝标本，观测髌内侧支持带的形态学特点。结果：髌内侧支持带包括浅、深两层。浅层较薄，深层又包括内侧髌股韧带(100％)、内侧髌胫韧带(100％)和内侧髌半月板韧带(80％)三个独立结构，其中内侧髌股韧带是将髌骨同定于股骨的主要结构。结论：在髌内侧支持带中，内侧髌股韧带对限制髌骨外移起决定性作用。     

髌外侧支持带的解剖观测及临床意义

目的：观察髌外侧支持带的解剖学特点，探讨其对维持正常髌骨运动轨迹的作用。方法：采用50例经福尔马林固定的成人尸膝标本，观测髌外侧支持带的形态学特点。结果：髌外侧支持带可分为浅、深两层。浅层较薄，深层包括外侧横韧带(100％)、外侧髌胫韧带(85％)和上髁髌韧带(35％)3个独立结构，其中外侧横韧带是限制髌骨内移的主要结构。结论：髌外侧支持带中外侧横韧带最为粗壮，对维持正常髌骨运动轨迹起决定性作用。     

膈下间隙的冠状断层解剖学研究

目的　为膈下间隙病变的断层影像学诊断和外科治疗提供实用的形态学依据。　方法　在 30例成人尸体上腹部连续冠状断层标本和 2例尸体腹部磁共振冠状图像上 ,研究了膈下间隙的冠状断层解剖。　结果在冠状断层上 ,膈下间隙分为肝周间隙和脾周间隙 ;胃胰襞左部前缘和小网膜左部 (肝胃韧带 )后层之间的间隙构成网膜囊上、下隐窝间的唯一直接交通 ,其交通形式在冠状面上可分为 3型。胃膈韧带右层与小网膜的后层相续 ,左层与膈脾韧带右层及胃脾韧带后层相续 ,向下左、右层靠拢而续为胃胰襞左部。胃裸区居胃膈韧带的左、右层之间 ,其存在率为 10 0 %。脾裸区居膈脾韧带、胃脾韧带、脾肾韧带和脾结肠韧带之间 ,在脾肾韧带处最宽 ,脾裸区可分为脾门部和脾肾部 ,其最大值分别为 :2 6 4± 1 16cm ,4 16± 2 2 4cm。　结论　冠状断层是显示胃胰襞左部及网膜囊上、下隐窝间通连关系的优势断层。网膜囊上、下隐窝相通的约占观察总例数的 73 3%     

内淋巴囊的应用解剖学

本文观察了60侧(左36,右24)正常成人的内淋巴囊,位于颞骨岩部后面的内淋巴囊压迹处,大小约9.2×10.0mm;另外还注意了内淋巴囊与周围结构(特别是乙状)的毗邻关系,从而提出手术入路的新设想,供临床应用作参考。     

复发性泪囊炎鼻腔泪囊解剖学特点及其在内镜下鼻腔泪囊吻合联合支架植入术中的应用

目的 内镜下观察鼻腔泪囊的解剖结构,采用鼻腔泪囊吻合术联合支架植入方式治疗慢性复发性泪囊炎,并观察其疗效。 方法 收集2010年1月至2019年1月期间就诊于甘肃省人民医院耳鼻咽喉头颈外科的已行传统内镜下鼻腔泪囊吻合术后再次复发的慢性泪囊炎患者30例,共计30只眼,予以再次行内镜下鼻腔泪囊吻合术,术中联合支架植入术,术后3个月拔出泪道支架,观察患者术后流泪症状,冲洗泪道判断泪道阻塞情况,随访期为12个月。 结果 随访至12个月时,30例患者14只眼无诉流泪,溢泪,冲洗泪道通畅,鼻内镜下观察见造瘘口通畅,造瘘口无明显缩小;30例12只眼无诉流泪,溢泪,冲洗泪道通畅,但可见造瘘口缩小;4只眼可见造瘘口旁肉芽增生,再次堵塞造瘘口,治疗整体有效率为87%。 结论 内镜下鼻腔泪囊吻合术联合支架植入是治疗慢性复发性泪囊炎一种有效方法,临床效果良好。     

膝关节滑膜囊的应用解剖

在３０２侧成人下肢标本上观测了膝关节的滑膜附着及关节内滑膜隐窝的出现情况。膝关节有膜隐窝有；髌上囊内侧隐窝，髌上囊外侧隐窝，前上隐窝，前上内侧隐窝，前上外侧隐窝，后上内侧隐窝和后上外侧隐窝。其中后上内，外侧隐窝恒定存在。为膝关节附近手术和膝关节镜术入路提供了解剖学基础。     

自体髌韧带重建前交叉韧带后膝关节外侧感觉障碍的研究

目的：研究自体B-P-B中1／3组织重建ACL后膝关节外侧皮肤感觉障碍的发病原因。方法：(1)对21例临床用自体B—P—B中1／3组织重建ACL的患者随访5～6年，测量其膝关节切口外侧皮肤感觉麻木范围。(2)解剖观察成人新鲜尸体标本3具6例和附腐固定的成人尸体标本15具30例的隐神经髌下支的分布范围。结果：术后患者均不同程度的出现膝关节外侧皮肤感觉障碍；隐神经髌下支自深筋膜穿出后，在胫骨内侧髁下方发出分支，横行跨过髌韧带分布至膝外侧皮肤。结论：隐神经髌下支分布到膝外侧皮肤，用自体B-P-B中1/3组织重建ACL在取材时可致其损伤，是术后并发膝外侧皮肤感觉障碍的原因。     

泪囊鼻腔吻合术的解剖学研究及应用进展

<正>慢性泪囊炎为眼科常见疾病,在我国属多发性疾病。药物保守治疗多不满意,主要靠手术治疗[1]。自1904年意大利医生Toti发明泪囊鼻腔吻合术以来,泪囊鼻腔吻合术一直被公认是治疗慢性泪囊炎最理想的方法[2]。但该     

The characteristics of the lobular arrangement indicate the dynamic role played by the infrapatellar fat pad in knee kinematics

The infrapatellar fat pad (IFP) is an intracapsular but extrasynovial structure, located between the patellar tendon, the femoral condyles and the tibial plateau. It consists of white adipose tissue, organised in lobules defined by thin connective septa. The aim of this study is the morphometric and ultrasonographic analysis of IFP in subjects without knee pathology during flexion‐extension movements. The morphometric study was conducted on 20 cadavers (15M, 5F, mean age 80.2 years). Ultrasound was performed on 24 volunteers with no history of knee diseases (5M, 19F, mean age: 45 years). The characteristics of the adipose lobules near the patellar tendon and in the deep portion of the IFP were evaluated. Numerical models were provided, according to the size of the lobules. At histological examination, the adipose lobules located near the patellar tendon were larger (mean area 12.2 mm² ± 5.3) than those at a deeper level (mean area 1.34 mm² ± 0.7, P < 0.001) and the thickness of the septa of the deepest adipose lobules (mean value 0.35 mm ± 0.32) was greater than that of the superficial one (mean value 0.29 mm ± 0.25, P < 0.001). At ultrasound, the IFP was seen to be composed of very large lobules in the superficial part (mean area 0.29 cm² ± 0.17 in extension), with a significant reduction in flexion (mean area 0.12 cm² ± 0.07, P < 0.01). The deep lobules were smaller (mean area 0.11 cm² ± 0.08 in extension) and did not change their values (mean area 0.19 cm² ± 0.52 in flexion, P > 0.05). In the sagittal plane, the reduction of thickness of the superficial layer (with large adipose lobules) during flexion was 20.6%, whereas that of the deep layer (with small adipose lobules) was 1.3%. Numerical simulation of vertical loads, corresponding to flexion of the knee, showed that stress mainly developed within the interlobular septa and opposed bulging of the lobules. The characteristics of the lobular arrangement of the IFP (large lobules with superficial septa in the superficial part and small lobules with thick septa in the deep one), significant changes in the areas and perimeters of the superficial lobules, and the reduced thickness of the superficial layer during flexion all indicate the dynamic role played by the IFP in knee kinematics.     

髌下脂肪垫血供特点及在TKA术中的意义

目的　观测髌下脂肪垫血供特点,为TKA术中如何保护其提供应用解剖学基础。 方法 　20侧防腐及2侧新鲜成人膝关节标本,用巨微解剖法观测髌下脂肪垫血管网的组成、走行及分布。 结果 髌下脂肪垫血管网外侧由膝下外侧动脉、膝上外侧动脉降支构成,内侧由膝下内侧动脉升支、膝降动脉髌上支的降支、膝降动脉关节支的髌下支构成,各支互相吻合形成网状结构,为"密集血管区",位于在髌骨内、外侧旁开5 mm范围以内,髌尖下约14 mm,髌韧带后面10 mm区域。此血管网向髌骨下极、髌韧带后部、髌下脂肪垫及其表面的滑膜提供血供。 结论　髌下脂肪垫具有滋养其周围结构的功能,在TKA术中应予保留,若需切除至少应保留"密集血管区"部分。     

Revisiting the infracardiac bursa using multimodal methods: topographic anatomy for surgery of the esophagogastric junction

In embryology, the infracardiac bursa (ICB) is a well‐known derivative separated from the omental bursa. During surgeries around the esophagogastric junction (EGJ), surgeons often encounter a closed space considered to be equivalent to the ICB, but the macroscopic anatomy in adults is hardly known. This study aimed to revisit the ICB using multimodal methods to show its development from the embryonic to adult stage and clarify its persistence and topographic anatomy. Histological sections of 79 embryos from Carnegie stage (CS) 16 to 23 and magnetic resonance (MR) images of 39 fetuses were examined to study the embryological development of the ICB. Horizontal sections around the EGJ obtained from three adult cadavers were examined to determine the topographic anatomy and histology of the ICB. Further, 32 laparoscopic surgical videos before (n = 16) and after (n = 16) the start of this study were reviewed to confirm its remaining rate and topographic anatomy in surgery. The ICB was formed in 1 out of 10 CS17 samples, and in 8 out of 10 CS18 samples. Further, it was observed in all CS19–23 except one CS23 sample and in 25 (64%) out of 39 fetus samples. Three‐dimensional reconstructed MR images of fetuses revealed that the ICB was located at the right alongside the esophagus and the cranial side of the diaphragmatic crus. In one adult cadaver, the caudal end of the ICB arose from the level of the esophageal hiatus and the cranial end reached up to the level of the pericardium. The inner surface cells of the space consisted of the mesothelium. In laparoscopic surgery, the ICB was identified in only 11 (69%) out of 16 surgeries before. However, subsequently we were able to identify the ICB reproducibly in 15 (94%) out of 16 surgeries. Thus, the ICB is the structure commonly remaining in almost all adults as a closed space located at the right alongside the esophagus and the cranial side of the diaphragmatic crus. It may be available as a useful landmark in surgery of the EGJ.     

国人股骨假体设计的解剖学基础

目的 :为选择和设计适合中国人的髋关节假体提供参考值。方法 :对 12 9例成人股骨标本进行X线摄片 ,并对其中 2 0例标本行CT扫描 ,测量小转子及其上下 2cm平面处髓腔宽度、前倾角等参数。结果 :小转子处髓腔宽为 ( 2 4.85± 2 .94)mm ,其上 2cm处为 ( 4 2 .47± 5 .14 )mm ,其下 2cm处为 ( 17.87±3 .0 4)mm ,个体间有较大差异。CT测量值与X片测量值无明显统计学差异。结论 :股骨上段的解剖学资料 ,可为选择和设计适合国人的人工髋关节假体提供参考。     

桡神经深支的体表定位及其临床意义

目的:建立桡神经深支的体表定位方法。方法:取成人尸体标本48具(96侧上肢标本),显露桡神经深支,在前臂中立位,分别测量桡神经深支发出点与肱桡关节线的距离、桡神经深支穿出旋后肌的部位与肱桡关节线的距离及其与肱骨外上髁和Lister结节连线的水平距离、桡骨茎突与肱桡关节线的距离,并作统计学分析。结果:桡神经深支自桡神经主干发出的位置在肱桡关节上方平均为(15.4±2.5)mm。桡神经深支穿出旋后肌的部位均位于肱骨外上髁与桡骨Lister结节连线的尺侧,与连线的水平距离平均为(6.1±2.1)mm,与肱桡关节线的平均距离为(61.3±17.6)mm。结论:桡骨小头正前方或略偏外侧可作为桡神经深支近端的定位标志,肱桡关节线下方约6cm,肱骨外上髁与桡骨Lister结节连线尺侧约0.6cm可作为桡神经深支远端的定位标志。     

眼科麻醉应用解剖观测

利用100个成人颅骨对与眼部神经阻滞麻醉有关的结构进行了观测。结果表明:球后麻醉时可根据枕额径判断眶深度以决定进针深度;眶下孔上缘至眶下缘距离小于7mm时,眶下管内穿刺深度不应超过10mm;眶下沟有被骨壁覆盖的情况,对麻醉不利,各测量数据可作为麻醉时进针深度的参考。     

少年举重运动员膝关节形态结构的X线研究

本文对少年举重运动员与不从事专项运动者的左右膝关节正位 X 线片进行了形态学观察。结果表明:举重运动员的股骨下端与胫骨上端内外侧髁肥大突出,骨小梁的压力曲线增粗,排列密集,清晰;膝关节股外侧关节面与胫骨外侧髁上关节面间隙较大;髁间隆起略大;股骨角与胫骨角均在正常值范围内,未出现膝内、外翻现象。上述结果可作为举重运动训练及临床诊断的参考.     

旋股内侧动脉解剖学观测及在介入法治疗下肢动脉疾患的意义

目的:为利用旋股内侧动脉深支介入法治疗下肢动脉疾病提供解剖学依据。方法:股部正常经福尔马林固定动脉灌注红色乳胶成人下肢标本50侧。观测旋股内侧动脉及其深支的起源、起点外径、走行和分布。以两侧髂前上棘的连线作为X轴,经髂前上棘所作垂直线为Y轴。分别测量旋股内侧动脉及其深支起始处至X轴和Y轴的距离,以此定位旋股内侧动脉及其深支的起始端。结果:旋股内侧动脉起始处外径,男(4.75±0.94)mm,女(3.92±0.88)mm。其深支起点的外径,男(3.90±0.70)mm,女(3.43±0.69)mm。旋股内侧动脉起点距X轴的距离:男(10.21±1.16)cm,女(9.58±1.67)cm;与Y轴间距:男(5.66±1.02)cm,女(5.37±0.59)cm。旋股内侧动脉深支起点与X轴的间距:男(10.61±1.21)cm,女(9.92±1.42)cm;与Y轴之间的距离分别为(6.48±1.18)cm和(6.31±0.66)cm。上述指标中,旋股内侧动脉主干及其深支的外径具有性别差异(P<0.05)。结论:旋股内侧动脉深支可运用于介入治疗下肢动脉疾患。髂前上棘可作为标志定位旋股内侧动脉及其深支的起点。在操作中,要注意性别差异,并注意保护股血管。     

Anatomical basis for the choice of the femoral implant in the total hip arthroplasty

Summary There is within the population a considerable variation in the endosteal canal anatomy of the proximal extremity of the femur. This anatomical variation might jeopardize the result of the total hip arthroplasty when the surgeon uses a cementless femoral shaft. Inded, if the secondary fixation of an implant stays under the dependency of many parameters, one has to obtain before anything else a very good primary stability, obtained by the morphological appropriateness of the bone-implant. The authors propose to define the cementless indications, as regards total hip arthroplasty, defining two radio-anatomical parameters: the Cortico-Medullary Index and the Femoral Flare Index.

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Bases anatomiques du choix de l'implant fémoral dans l'arthroplastie totale de hanche

Résumé Il existe au sein de la population une grande variabilité dans l'anatomie du canal endosté de l'extrémité proximale du fémur. Cette variation de l'anatomie pourrait compromettre le résultat de l'arthroplastie totale de hanche lorsque le chirurgien utilise une tige fémorale sans ciment. En effet, si la fixation secondaire d'un implant reste sous la dépendance de nombreux paramètres, il faut avant toute chose obtenir une excellente stabilité primaire, obtenue par l'adéquation morphologique os-implant. Les auteurs se proposent de définir les indications des prothèses fémorales sans ciment, en matière d'arthroplastie totale de hanche, en définissant deux paramètres radio-anatomiques : l'Index Cortico-Médullaire et l'Index d'Evasement Fémoral.