输尿管芽的发生分支与肾脏疾病

输尿管芽发育最初源于中肾管尾部突起,在后肾间充质信号的诱导下侵入后肾。胶质细胞源性神经营养因子(GDNF)和成纤维细胞生长因子(FGF)在输尿管芽上皮表达,诱导输尿管芽反复延长分支20次左右,随后诱导周围间充质细胞上皮化,进行一系列形态学改变,形成肾的基本功能单位-肾单位。由各种因子表达障碍引起的输尿管芽发生和分支缺陷导致肾单位数量减少,进而导致慢性肾病的发生。Mi RNAs和RAS基因的突变可导致肾囊肿以及CAKUT的发生。。     

Age changes in the human sacroiliac joint: Joint fusion

In order to investigate further the incidence, sex frequency, nature and location of fusion in the sacroiliac joint, the joint of one side was removed from 49 embalmed cadavers, aged 52–89 years, 22 male and 27 female, and examined by A/P radiography, radiography of transverse slices through the joint, stereomicroscopy, and histology. Fusion of the joint occurred both by synostosis and by fibrous interconnections. Synostosis occurred in a para-articular form, especially along the ventral border and in the cranial limb of the joint and also in an intra-articular form. Fibrous fusion was found more commonly in the caudal limb of the joint. Radiography of transverse slices revealed a high incidence of synostosis (60.8%). A/P radiography, on the other hand, indicated a much lower incidence of joints showing clear evidence of synostosis (18.4%), but if to this were added those joints showing radiographic changes involving the possibility of some degree of fusion then a comparable incidence (65.3%) was obtained. Both methods revealed a higher frequency of synostosis in the male, although it did in fact occur quite frequently in females; 66.7% in male 53.8% in females when assessed by radiography of transverse slices.     

Age-related changes in the articular cartilage of human sacroiliac joint

 Iliac and sacral articular cartilage of 25 human sacroiliac joints (1–93 years) are examined by light microscopy and immunohistochemistry in order to gain further insight into the nature and progress of degenerative changes appearing during aging. These changes can already be seen in younger adults as compared to cartilage degeneration known in other diarthrodial joints. Structural differences between sacral and iliac cartilage can already be observed in the infant: the sacral auricular facet is covered with a hyaline articular cartilage, reaching 4 mm in thickness in the adult and staining intensely blue with alcian blue at pH1. Iliac cartilage of the newborn is composed of a dense fibrillar network of thick collagen bundles, crossing each other at approximately right angles. A faint staining with alcian blue suggests a low content of acidic glycosaminoglycans. In the adult, iliac cartilage becomes hyaline and its maximal thickness reaches 1–2 mm. Both articular facets exhibit morphological changes during aging that are more pronounced in the iliac cartilage and resemble osteoarthritic degeneration; the staining pattern of the extracellular matrix becomes inhomogenous, chondrocytes are arranged in clusters and the articular surface develops superficial irregularities and fissures. Sometimes fibrous tissue fills up these defects. Nevertheless, large areas of iliac cartilage remain hyaline in nature. Sacral articular cartilage often remains largely unaltered until old age. The sacral subchondral bone plate is usually thin and shows spongiosa trabeculae inserted at right angles, suggesting a perpendicular load on the articular facet. Iliac subchondral spongiosa shows no definite alignment and joins the thickened subchondral bone plate in an oblique direction. The iliac cartilage therefore seems to be stressed predominantly by shearing forces, arising from the changing monopodal support of the pelvis during locomotion. The subchondral bone plate on both the iliac and sacral auricular facet is penetrated by blood vessels that come into close contact with the overlying articular cartilage. These vessels may contribute to the high incidence of rheumatoid and inflammatory diseases in the human sacroiliac joint. Immunolabelling with an antibody against type II collagen reveals a diminished immunoreactivity in the upper half of adult sacral cartilage and only a faint and irregular labelling in the iliac cartilage. Type I collagen can be detected in a superficial layer on the sacral articular surface and around chondrocyte clusters in iliac cartilage, as in dedifferentiating chondrocytes during the development of osteoarthritis. Accepted: 22 April 1998     

骶髂关节的有限元建模及临床应用研究进展

骶髂关节病变导致腰痛的问题日益受到重视,有限元分析(finite element method,FEM)方法已成为分析此类复杂解剖结构器官的重要研究方法之一。通过总结有限元分析方法在骶髂关节建模中的发展,以及在生物力学、疼痛机制、关节内固定器方面的临床应用研究,分析目前有限元建模存在的不足,提出未来可能建立的高精度、高自动化、更加适应临床的骶髂关节三维有限元模型的方向和方法。     

Anterior pelvic plating and sacroiliac joint fixation in unstable pelvic ring injuries

Purpose

To analyze the effectiveness of anterior pelvic plating and subsequent percutaneous sacroiliac joint screw fixation in patients with unstable pelvic ring injuries.

Materials and Methods

Thirty-two patients were included with twenty-one males and eleven females. The mean age was 41 years (range, 19-76). The mean follow-up period was 51 months (range, 36-73). According to AO-OTA classification, there were 11 cases of B2 injuries, 8 cases of B3 injuries, 9 cases of C1 injuries, 2 cases of C2 injuries and 2 cases of C3 injuries. In the posterior lesions, there were 20 cases of sacral fractures and 12 cases of sacroiliac joint disruptions or dislocations. Anterior pelvic plating and subsequent percutaneous sacroiliac joint fixation were performed.

Results

The clinical results were 16 cases of excellent, 10 cases of good, 4 cases of moderate and 2 cases of poor functional results. The 2 cases out of 7 moderate reductions had poor functional results with residual neurologic symptoms. The radiological results were 16 cases of anatomic, 9 cases of nearly anatomic and 7 cases of moderate reduction. All patients were healed except 3 cases of nonunion at the pubic ramus. The complications encountered were 3 cases of screw loosening, 2 cases of anterior plate breakage and 1 case of postoperative infection.

Conclusion

In patients with unstable pelvic ring injuries, anterior pelvic plating and subsequent percutaneous sacroiliac joint screw fixation may be a useful surgical option. The radiological results and residual neurologic symptoms had effects on its functional results.     

Variations in thickness of articular cartilage in the human sacroiliac joint

Differences in articular cartilage thickness in the sacroiliac joint were investigated in different regions of the sacral and the iliac articular surfaces in the embalmed cadavers of five males and six females. The mean thickness of the sacral articular cartilage was greater than that of the iliac articular cartilage (P < 0.001) and the sacral articular cartilage of the female was thicker than that of the male (P < 0.02). Differences between thicknesses of the iliac articular cartilage in the male and female and in different regions of the sacral and iliac articular cartilages were found to be not significant. © 1995 WiIey-Liss, Inc.     

On biomechanical properties of the sacroiliac joint in purebred dogs.

Relative to the Yorkshire Terriers and Maltese dogs the mean expected sacroiliac joint load was calculated to be 1.4-1.6 times higher in other small breeds and 1.7-2.7 times higher in large breeds. The statistically significantly different (p < 0.01, p < 0.001) and mechanically less efficient inclination angles of the wings of the sacrum in adult large breeds (especially German Shepherd Dogs) suggest even higher forces acting on their sacroiliac ligaments. Unlike the case in small breeds, the sacral auricular surface was concave in large dogs to improve interlocking between sacrum and ilium and to reduce craniocaudal translation. An additional ossification center forming the ventral aspect of the transverse process of the second sacral vertebra was present in large breeds, occasionally in midsized and small, but never in toy breeds. This and the relationship between age and inclination angles of the wings of the sacrum in juvenile specimens indicate an affection of the three-dimensional modeling of the wings of the sacrum by formative stimuli such as body weight and locomotion.     

Cobalt-induced polycythaemia causing right ventricular hypertrophy and ascites in meat-type chickens

Cobalt increases the red cell mass in both man and animals by increasing the production of erythropoietin. Since meat-type chickens can develop pulmonary hypertension from increased erythropoiesis and polycythaemia, two trials were conducted to investigate the role of cobalt on broiler chicken erythropoiesis and pulmonary hypertension. The results showed that feeding cobaltous chloride at 500 parts/10(6) to meat-type chickens from 1-day-old for 42 days significantly increased haemoglobin content and, to a lesser extent red blood cell count, and haematocrit. No effect was observed on mean corpuscular volume. Increased haemoglobin content was linearly correlated with pulmonary hypertension as measured by the right ventricle weight to total ventricle weight ratio (RV:TV). Levels of malondialde-hyde in cardiac tissue were also correlated with the RV:TV ratio, suggesting that peroxidative damage may be related to ventricular hypertrophy. Chickens fed cobalt showed a significantly higher incidence of right ventricular hypertrophy and right ventricular failure and 18.3% developed ascites.     

骶髂关节周围腰骶丛神经的解剖学研究及其临床意义

目的　对腹直肌外侧入路显露骶髂关节周围重要结构的位置关系进行测量及描述,探讨入路的安全性及安全操作空间。 方法 选取新鲜成人完整尸体标本,对每具骨盆标本经双侧腹直肌入路逐层解剖,观察腹膜、髂外血管、髂腰肌、闭孔神经等重要组织结构的位置关系,重点观测L4、L5、S1神经与闭孔神经位置,测量分析神经至骶髂关节的距离。 结果　腹直肌外侧入路可清楚显露骶髂关节、腰骶干、S1神经根、骶骨翼等结构。 L5神经前支出椎间孔处与骶髂关节距离左侧为(23.56±4.30)mm,右侧为(23.69±3.41)mm,L4神经前支与骶髂关节在L5神经前支出椎间孔处的距离左侧为(17.97±1.58)mm,右侧为(17.49±1.49)mm,腰骶干外缘在其形成汇合点平面与骶髂关节的水平距离左侧为(14.34±2.51)mm,右侧为(13.81±2.21)mm,平骶岬处腰骶干外缘与骶髂关节的水平距离左侧为(12.19±1.98)mm,右侧为(12.22±1.55)mm。 结论　腹直肌外侧入路可用于复位固定骶髂关节周围骨折脱位,具有安全的操作空间,且经该入路的操作为骶髂关节复合体损伤引起的神经损伤提供了探查松解的新思路。     

强直性脊柱炎早期骶髂关节病变的CT特征分析

目的研究强直性脊柱炎早期骶髂关节病变的CT特征,探讨CT对强直性脊柱炎早期的诊断价值。方法对67例早期强直性脊柱炎患者骶髂关节病变的CT征象进行了回顾性分析。结果67例强直性脊柱炎患者中119个骶髂关节受累,其中双侧52例,单侧15例,Ⅰ级35个关节,Ⅱ级84个关节。早期CT表现分级:①骶髂关节前下1/3的髂骨侧骨性关节面局限性破坏缺损,密度减低,周围局限性硬化76个关节。②骨性关节面毛糙、皮质白线中断、局限性缺损94个关节。③关节面下微小囊变106个关节,表现为骨性关节面下小囊状缺损。④骶髂关节髂骨侧关节面周围轻度带状硬化117个关节。⑤软骨钙化,关节面下骨质吸收20个关节,表现关节面下带状低密度影。⑥关节间隙基本保持正常或略增宽。结论CT能清晰显示早期强直性脊柱炎骶髂关节改变,骶髂关节炎是早期诊断强直性脊柱炎的重要依据,对强直性脊柱炎早期诊断具有重要意义。     

Possible nociceptive structures in the sacroiliac joint cartilage: An immunohistochemical study

The sacroiliac joint (SI joint) is a known source of low back pain. In the absence of validated physical signs and imaging studies, the diagnosis of SI joint pain can be secured by positive response to SI joint intra‐articular infiltration with local anesthetics. The current anatomical and histological knowledge concerning intra‐articular structures of the sacroiliac joint is insufficient to explain the efficacy of this infiltration. Consequently, this study was undertaken to detect the intra‐articular presence of substance P and calcitonin gene‐related peptide (CGRP) positive nerve fibers, providing indirect evidence of nociceptive innervation of the SI joint. Free‐floating sections, obtained from iliac and sacral cartilage and subchondral bone of the SI joint and adjacent ligamentous tissue, of 10 human cadavers were studied immunohistochemically. Tissue of nine human cadavers showed the presence of substance P and CGRP immunoreactivity in the superficial layer of sacral and iliac cartilage, and the surrounding ligamentous structures. Subchondral bone reacted weakly to the antisera used. These findings support the view that the SI joint may be capable of intra‐articular nociception and may explain the positive response to the intra‐articular deposition of local anesthetic. Clin. Anat. 23:192–198, 2010. © 2009 Wiley‐Liss, Inc.     

个性化全骨盆三维有限元建模及骶髂关节骨折脱位模拟

目的建立高度仿真的个性化的完整骨盆三维有限元模型,并在此基础上进行骶髂关节骨折脱位的模拟。方法从CT精确重建独立的左、右髋骨和骶骨实体模型,根据髋骨和骶骨的外形特征,利用专门的流线型生物力学有限元网格划分器生成规则的体网格模型,并进一步建立骶髂关节的终板、软骨、关节接触面,和骨盆上的主要韧带组织及耻骨间盘。在建立的完整模型上去掉一侧的骶髂关节韧带群进行骨折脱位模拟,并与正常的情况进行对比。结果建立了高精度的个性化全骨盆的三维有限元模型,包括左右髋骨和骶骨的皮质骨、松质骨,骶髂关节的终板、软骨和带摩擦的关节接触面,韧带包括骶髂骨间韧带、骶髂前韧带、骶髂后韧带、骶棘韧带、骶结节韧带、耻骨上韧带和耻骨弓状韧带,以及耻骨间盘。正常模型的加载模拟和骶髂关节骨折脱位模拟的预测结果均与文献试验生物力学结果相符合。结论利用专门的生物力学有限元建模工具能建立更复杂更精确的三维有限元模型,成为全骨盆生物力学分析研究的平台和基础。     

骨盆骨折骶髂关节分离前路钢板固定的应用解剖

目的 :为骨盆骨折骶髂关节分离行前路钢板固定时提供解剖学基础。方法 :2 0具尸体骨盆解剖观测骶骨翼大小及骶丛的位置。结果 :骶丛距骶骨翼边缘距离 (左右平均距离 )分别为 :上缘 :L4(19.1±1.5 )mm ,L5(2 4.5± 1.4)mm ,中点 :L4(17.2± 1.8)mm ,L5(2 0 .1± 1.4)mm ,下缘 :L4(13 .9± 2 .9)mm ,L5(15 .2± 1.6)mm。L4神经位于骶丛外缘。结论 :骶髂关节分离前路钢板固定时L4神经根易受损伤 ,安全放置钢板的位置是骶骨翼中上部 ,距骶骨翼边缘 2 0mm内。     

育龄女性未分化脊柱关节病患者骶髂关节的CT影像特点

目的　探讨育龄女性uSpA患者骶髂关节影像学特征。 方法　对60名育龄女性uSpA患者行骶髂关节CT检查,测量骶髂关节间隙宽度及骶髂骨皮质厚度,观察骶髂关节间隙清晰程度、骶髂骨皮质边缘光滑程度及皮质下骨质密度情况。 结果　53% uSpA女性病例骶髂关节关节间隙模糊。关节间隙小于2 mm的占65.8%。95％表现为单侧或双侧关节面模糊、骶髂骨面皮质边缘毛糙、软骨下骨质密度不均和软骨下微小囊变等,其中20％关节面分级为3级,uSpA女性病例骶髂骨皮质厚度随年龄增长逐渐增厚,关节面骨质破坏及皮质增厚以髂骨侧为著。36.6% uSpA女性病例骶髂关节关节腔内可见线条样点状气体样低密度影。 结论　育龄女性uSpA患者骶髂关节间隙模糊、消失、骶髂关节间隙变窄、关节面骨质破坏及分级、关节面下骨质硬化及骶髂关节真空现象的发生率和程度均较正常育龄女性明显增高,骨质破坏在关节髂骨侧更严重。对骶髂关节有异常表现的无症状育龄女性或有临床症状但CT分级为0级或1级的育龄女性,需要根据临床、实验室检查与MR检查进一步确定。     

腰骶髂联合固定治疗骶髂关节骨折脱位的疗效分析

目的探讨应用腰骶髂联合固定治疗骶髂关节骨折脱位的临床效果。方法对2007年7月~2010年1月收治的11例骶髂关节骨折脱位的骨盆骨折患者进行手术治疗。男6例,女5例;年龄21~60岁,平均36岁。11例均为Tile C型骨盆骨折。采用后路腰骶髂切口,椎弓根钉棒系统固定L5∕S1椎体和髂骨螺钉固定髂骨,配合患肢牵引和器械的撑开、合拢纠正垂直及分离移位。结果 11例患者术后获得12~20个月随访,平均16.5个月。术后X线片均示骶髂关节骨折脱位复位固定满意,骨盆后环形态恢复良好;下肢等长,未出现医源性神经、血管损伤,患者未出现跛行,下蹲功能满意。术后12个月Majeed评分:优9例,良2例。结论腰骶髂联合固定治疗骶髂关节骨折脱位疗效满意,且具有操作简单、并发症少的优点。     

Anatomy and biomechanics of gluteus maximus and the thoracolumbar fascia at the sacroiliac joint

Biomechanical models predict that recruitment of gluteus maximus (GMax) will exert a compressive force across the sacroiliac joint (SIJ), yet this muscle requires morphologic assessment. The aims of this study were to document GMax's proximal attachments and assess their capacity to generate forces including compressive force at the SIJ. In 11 embalmed cadaver limbs, attachments of GMax crossing the SIJ were dissected and their fascicle orientation, length and attachment volume documented. The physiological cross‐sectional area (PCSA) of each attachment was calculated along with its estimated maximum force at the SIJ and lumbar spine. GMax fascicles originated from the gluteus medius fascia, ilium, thoracolumbar fascia, erector spinae aponeurosis, sacrum, coccyx, dorsal sacroiliac and sacrotuberous ligaments in all specimens. Their mean fascicle orientation ranged from 32 to 45° below horizontal and mean length from 11 to 18 cm. The mean total PCSA of GMax was 26 cm² (range 16–36), of which 70% crossed the SIJ. The average maximum force predicted to be generated by GMax's total attachments crossing each SIJ was 891 N (range 572–1,215), of which 70% (702 N: range 450–1,009) could act perpendicular to the plane of the SIJ. The capacity of GMax to generate an extensor moment at lower lumbar segments was estimated at 4 Nm (range 2–9.5). GMax may generate compressive forces at the SIJ through its bony and fibrous attachments. These may assist effective load transfer between lower limbs and trunk. Clin. Anat. 27:234–240, 2014. © 2013 Wiley Periodicals, Inc.     

不同年龄正常人群骶髂关节间隙的CT影像解剖学观测

目的 观测不同年龄段正常人群骶髂关节间隙宽度的CT解剖学特征,为骶髂关节半脱位的诊断提供依据。 方法 对480例无骶髂关节病变受检者的骶髂关节CT影像进行观测,分别比较不同年龄、不同性别、不同层面及不同区域的骶髂关节间隙宽度的差异。 结果 （1）不同年龄段人群的骶髂关节间隙宽度有明显的差异,随着年龄增大,间隙宽度逐渐变窄;（2）女性骶髂关节间隙宽度稍大于男性,差异无统计学意义;（3）不同层面的骶髂关节间隙宽度有明显差异,下部间隙宽度最小;（4）同侧前、中、后3个区域的骶髂关节间隙宽度有明显差异,但同一区域的左侧和右侧无明显差异。 结论 骶髂关节间隙宽度存在年龄相关性、空间不均匀性和多样性。本研究可为不同年龄人群骶髂关节间隙宽度提供影像解剖学参考。     

Clinical incidence of sacroiliac joint arthritis and pain after sacropelvic fixation for spinal deformity

Purpose

Sacroiliac fixation using iliac screws for highly unstable lumbar spine has been reported with an improved fusion rate and clinical results. On the other hand, there is a potential for clinical problems related to iliac fixation, including late sacroiliac joint arthritis and pain.

Materials and Methods

Twenty patients were evaluated. Degenerative scoliosis was diagnosed in 7 patients, failed back syndrome in 6 patients, destructive spondyloarthropathy in 4 patients, and Charcot spine in 3 patients. All patients underwent posterolateral fusion surgery incorporating lumbar, S1 and iliac screws. We evaluated the pain scores, bone union, and degeneration of sacroiliac joints by X-ray imaging and computed tomography before and 3 years after surgery. For evaluation of low back and buttock pain from sacroiliac joints 3 years after surgery, lidocaine was administered in order to examine pain relief thereafter.

Results

Pain scores significantly improved after surgery. All patients showed bone union at final follow-up. Degeneration of sacroiliac joints was not seen in the 20 patients 3 years after surgery. Patients showed slight low back and buttock pain 3 years after surgery. However, not all patients showed relief of the low back and buttock pain after injection of lidocaine into the sacroiliac joint, indicating that their pain did not originate from sacroiliac joints.

Conclusion

The fusion rate and clinical results were excellent. Also, degeneration and pain from sacroiliac joints were not seen within 3 years after surgery. We recommend sacroiliac fixation using iliac screws for highly unstable lumbar spine.