人外侧膝状体的血液供应及其临床意义

目的：为外侧膝状体（LGB）缺血所致的视野缺损提供形态学依据。方法：手术显微镜下观察成人和胎儿脑的LGB动脉的来源和微血管构筑,部分脑标本用组织切片方法观察营养LGB动脉的粥样硬化病理改变。结果：LGB营养动脉第一级来自颈内动脉和大脑后动脉,二级为脉络丛前动脉、脉络丛后外动脉和丘脑膝状体动脉,三级构成LGB的小动脉。50岁以上的标本,LGB的一、二级动脉有硬化改变的占88％,二级小动脉被阻塞占10％。结论：二级动脉在LGB内有各自的供血区,脉络丛前动脉是供应LGB前部和外侧部的唯一动脉,大脑后动脉营养LGB的其余部分。不同动脉的阻塞可导致不同种类的视野改变,是视野缺损的原因之一。     

颈内动脉压迫视神经引起的形态学改变

在102侧成人脑标本上,用大体解剖和病理解剖方法对颈内动脉与视神经颅内段的关系进行了研究。颈内动脉发生动脉粥样硬化后可压迫视神经颅内段形成明显的压迹。受动脉压迫严重的视神经可有视神经萎缩等病理学改变。     

脑动脉硬化对视交叉血供影响的形态学研究及临床意义

目的：研究视交叉动脉起源、数量、分布及相关动脉的病理变化，为视交叉因缺血所致的视野缺损提供形态学依据。方法：在体视显微镜和手术显微镜下，对102侧成人脑标本进行观察，研究视交叉动脉起源、数量和分布，对其中年龄50～70岁的60侧脑标本的视交叉和相关动脉做病理切片观察。结果：视交叉动脉主要来自颈内动脉、后交通动脉和大脑前动脉，其中单来源型占48％，双来源型占27．3％，三来源型占7．9％。病理切片观察动脉管壁有粥样硬化改变者88．3％，其中被硬化斑块阻塞者占5．O％，部分阻塞者占13．3％。小动脉阻塞相应的视交叉组织切片，可见有神经纤维萎缩变性。结论：50岁以上出现不明原因的视野缺损，尤其是鼻上象限视野缺损可能是由脑动脉硬化引起视交叉血供障碍所致。     

脉络丛前动脉的解剖及其临床意义

目的：为脉络丛前动脉与视束病变关系提供形态学基础。方法：用体视显微镜和手术显微镜对１００侧成人脑标本的脉络丛前动脉进行解剖观察，对其中５０～７０岁６０侧脑标本的颈内动脉，脉络丛前动脉做病理组织学观察。结果：脉络丛前动脉９２％起自颈内动脉，是视束血供的主要动脉。观察发现，６０侧标本中颈内动脉管壁内有粥样硬化斑块，纤维斑块及中膜钙化等病变者占８８．３％（５３侧），与颈内动脉相应的脉络丛前动脉内有斑块形成并阻塞管腔者占３．８％（２侧），管腔缩小者占６．７％（４侧）。结论：５０岁以上，突然视力改变，有视野缺损，眼底正常，无视神经萎缩，可能是脉络丛前动脉的病变所致。     

桡神经臂部血供的微血管构筑

目的为临床工作中修复桡神经长段缺损及利用该神经修复其他神经损伤提供形态学基础。方法对35侧经腋动脉灌注带色乳胶的成人上肢标本,组织学切片观察供给桡神经的微血管构筑、营养动脉的外径、神经外膜、神经束组间、神经束间以及神经束内血管层动脉内径,在显微镜下观察神经干内不同水平的血管内径和血管网的分布及吻合情况,显微镜下进行追踪观察并用测微尺计测。结果镜下所见的血管内径相差较大,在臂部桡神经束组间血管层中,上、中、下各1/3段动脉平均内径(μm)分别为31.03±1.26,29.88±1.60和35.70±1.87。中、下1/3段动脉平均内经相比较,两者无显著差异(t=1.43,P>0.05)。在臂部桡神经外膜血管层中,以中、下1/3段动脉内径较大,与上1/3段动脉平均内经相比较,差异非常显著(t=2.67,P<0.01)。结论在光镜下,桡神经微血管构筑可分4层,各层血管内径在神经的不同部位可发生一定的变化,血管集中区域的动脉外径较大时,它所在部位的外膜、束组间、束间甚至束内的血管内径都有增大的趋势。桡神经纵切片中,外膜血管网密度高于束内血管网密度。     

去细胞异体神经的形态结构及移植后的组织相容性

目的:为面神经缺损寻找一种理想的异体神经移植物。方法:取Wistar大鼠胫神经,经Triton X-100和脱氧胆酸钠溶液进行化学去细胞处理。将处理后的神经行组织学染色和免疫组织化学染色;并行异体移植修复面神经缺损,观察其组织相容性。结果:去细胞神经为一中空的神经基质管,其中的细胞和髓鞘成分被有效清除,神经基底膜被保留;异体移植后无明显炎症反应,无排斥和吸收反应,能引导宿主轴突和Schwann细胞增殖。结论:去细胞异体神经移植物具有良好的仿生性和组织相容性,可能用于修复面神经缺损。     

合并移行椎腰椎间盘突出症患者腰骶神经根支配区的变化

背景:腰骶移行椎是一种常见的先天脊柱畸形,国内外学者均有报道移行椎患者的腰骶神经根支配I区可能会发生改变,但并未系统阐述其支配区的变化以及该种改变对腰椎间盘突出症患者手术的指导意义。目的:探讨当存在腰骶移行椎时,腰骶神经根的运动和感觉支配区发生改变的可能性。方法:研究方案的实施符合滨州医学院附属医院对研究的相关伦理要求,参与试验的患病个体及其家属对试验过程完全知情同意。回顾分析321例单一节段腰椎间盘突出症行手术治疗患者的病历资料。其中38例(11.8%)存在腰骶移行椎,包括骶椎腰化26例、腰椎骶化12例。26例骶椎腰化患者中,23例为L5/S1(L6)椎间盘突出,压迫S1(L6)神经根。12例腰椎骶化患者中,8例为L3/4椎间盘突出,压迫L4神经根。在283例正常结构的患者中,138例患者L5/S1椎间盘突出压迫S1神经根,95例患者L4/L5椎间盘突出压迫L5神经根,47例患者L3/L4椎间盘突出压迫L4神经根。比较术前骶椎腰化患者S1神经根受压的症状、腰椎骶化患者L4神经根受压的症状与正常腰骶椎患者L4、L5或S1神经根受压的症状。结果与结论:(1)S1神经根受压所致运动功能减退的分布在骶椎腰化患者组和正常组之间差异有显著性意义(P<0.05);(2)L4神经根受压所致运动功能减退的分布在腰椎骶化患者组和正常组之间差异有显著性意义(P<0.05);(3)骶椎腰化患者S1神经根受压所致的运动功能减退与正常状态下L5神经根受压所致的运动功能减退相似;而腰椎骶化患者L4神经根受压所致的运动功能减退与正常状态下L5神经根受压所致的运动功能减退相似;皮肤感觉异常的分析也显示了相似的结果;(4)结果说明,腰骶神经根的功能在移行椎患者中发生改变,使得骶椎腰化患者的S1神经根起到L5神经根的通常功能(神经根功能上移),腰椎骶化患者的L4神经根起到L5神经根的通常功能(神经根功能下移)。     

重组人睫状神经营养因子干预家兔视神经损伤动物模型视神经蠕变特性的分析

以蠕变特性指标研判重组人睫状神经营养因子干预动物视神经损伤的效果。以钳夹法复制动物视神经损伤模型,以重组人睫状神经营养因子连续干预30 d后,对各组动物进行视觉电生理检测,之后取各组动物视神经进行组织形态观察和蠕变实验。视神经损伤模型以重组人睫状神经营养因子干预治疗组Pl峰值大于视神经损伤模型组,差异显著(P0.05)。以重组人睫状神经营养因子干预治疗组视神经纤维结构尚存,较少部分视神经纤维排列不规则,视神经无明显变细,视神经损伤模型组兔视神经纤维束结构消失,神经纤维和胶质细胞变性、坏死。视神经损伤以重组人睫状神经营养因子干预治疗组7 200 s应变上升量大于视神经损伤模型组组、差异显著(P0.05)。以重组人睫状神经营养因子干预治疗动物视神经损伤模型后视神经的织形态、蠕变特性等得到较大的恢复。     

富血小板血浆诱导骨髓间充质干细胞结合化学萃取去细胞神经修复坐骨神经缺损

背景:周围神经损伤早期许旺细胞尚未大量分裂增殖,此时由于解剖连续性的中断,通过轴浆逆向运输提供的营养因子骤减,缺乏神经营养因子支持的神经元有可能死亡,从而使周围神经不能再生或再生乏力。目的:观察植入经富血小板血浆诱导的骨髓间充质干细胞结合去细胞神经修复坐骨神经缺损的效果。方法:取新西兰大耳白兔制备坐骨神经缺损模型,随机抽签法分成4组:去细胞神经组,移植同种异体去细胞神经;骨髓间充质干细胞组,移植同种异体骨髓间充质干细胞结合化学萃取的同种异体去细胞神经:经诱导骨髓间充质干细胞组,移植经富血小板血浆诱导的同种异体骨髓间充质干细胞结合化学萃取的同种异体去细胞神经;自体神经组,移植自体神经。术后进行形态学观察与靶肌肉肌湿质量恢复率、运动神经传导速度、轴突直径和髓鞘厚度的检测。结果与结论:经富血小板血浆诱导的骨髓间充质干细胞结合化学萃取的去细胞神经移植修复神经的靶肌肉肌湿质量恢复率、运动神经传导速度、轴突直径和髓鞘厚度及形态学观察明显优于移植单纯化学萃取的去细胞神经与骨髓间充质干细胞结合化学萃取的去细胞神经的效果,而与移植自体神经修复结果相似。说明经诱导后的骨髓间充质干细胞在体内具有许旺细胞的部分功能,可作为组织工程化外周神经的种子细胞,用于周围神经缺损的修复。     

陈旧性坐骨神经损伤后相关结构的组织学变化

为了观察大鼠陈旧性神经损伤后相关结构的组织学变化,了解陈旧性神经损伤后多长时间仍有修复神经损伤的组织学基础,本实验采用切断成年大鼠右侧坐骨神经,形成10mm缺损。术后1~12月不同时间段取材后,在光镜和电镜下观察相应组织的形态变化。结果显示:(1)坐骨神经损伤后1月,同侧脊髓前角神经元的数目明显减少,但随后未见进一步减少;(2)损伤远侧神经干中,伤后1月时椭圆形核细胞增生,形成B櫣ngner带;2月时B櫣ngner带断裂,梭形核细胞明显增生;6~12月时梭形核细胞明显减少,胶原纤维呈致密平行排列。神经损伤1~12月时,电镜下神经内膜管内出现指样突起的细胞,内膜管下及内膜管之间有大量胶原纤维增生;(3)损伤侧腓肠肌纤维萎缩随损伤时间的延长而加重,伤后4个月肌纤维间结缔组织增生明显。本研究结果提示大鼠坐骨神经损伤后3~4月时,仍有神经修复的组织学基础。     

视束血供形态学研究及其临床意义

目的：研究视束动脉起源、数量、分布以及相关动脉的病理变化，为视束因缺血所致视野缺损提供形态学依据。方法：在体视显微镜和手术显微镜下，对45例90侧成人脑标本进行观察，研究视束动脉的起源、数量、分布，对其中50—70岁年龄的60侧脑标本的视束相关动脉做病理切片观察。结果：视束的血供主要来自颈内动脉、大脑中动脉、大脑前动脉、后交通动脉、和脉络丛前动脉的分支，呈节段性分布，上述动脉有动脉粥样硬化改变者占88．3％，动脉粥样硬化斑块引起视束动脉完全阻塞的占6．7％(4侧)，部分阻塞的占5．0％(3侧)。结论：50岁以上者出现一过性或持续性不同程度的视野缺损，若除外其他疾患则可能是脑底动脉粥样硬化引起视束血供障碍所致。     

视交叉前间隙有关结构的解剖观察及其临床意义

目的为经额入路行蝶鞍区手术提供外科解剖学依据。方法对30个经福尔马林固定的成年人尸头标本的视交叉前间隙及有关结构在肉眼和SXQ鄄Ⅱ型手术显微镜下进行观察,对视交叉前间隙的面积进行测算。结果①视交叉前间隙之间的面积为(28.4±6.2)mm2。两侧视神经颅内段越长,夹角越小,视交叉前间隙越大;两侧视神经颅内段越短,夹角越大,视交叉前间隙越小。②视交叉前缘至鞍结节之间的距离为(4.1±0.8)mm,两侧视神经于视交叉前之间的夹角为63.2°±5.8°。③颈内动脉自前床突内侧向上穿过硬脑膜之后,先向前、内、上方行至视神经下面,再弯向后、外、上方行于视神经外侧。④分布于视交叉上后面的视交叉上动脉来源于两侧大脑前动脉水平部段和前交通动脉。分布于视交叉下前面的视交叉下动脉来源于两侧颈内动脉和后交通动脉。结论经额入路蝶鞍区手术主要是通过视交叉前间隙,在颈内动脉之间的间隙操作,手术中应注意保护好视神经和视交叉的营养动脉,以减少并发症的发生。     

Nerve pathways between the pterygopalatine ganglion and eye in cats

By dissection of thiocholine-stained orbital preparations, it has been determined that three different nerve pathways link the pterygopalatine ganglion and the eye in cats. 1) Nerves from the proximal half of the ganglion join a plexus of nerves and ganglion cells in the rete mirabile of the maxillary artery. Branches of the internal carotid nerve also supply this plexus. Fine nerves from the plexus travel to the optic nerve and then to the eye, accompanying both the nasociliary nerve that passes through the rete and the ciliary arteries that arise from the rete. 2) One or more nerves from the nerve of the pterygoid canal and from a prominent accessory ganglion near the orbital apex course to the inferior optic nerve surface at the optic foramen; these then run distally along the optic nerve to fuse with ciliary nerves or to accompany ciliary arteries entering the eye. 3) Other nerves from the pterygopalatine ganglion travel medially around the extraocular muscle cone to join the ethmoidal and infratrochlear branches of the nasociliary nerve; some nerves from the ganglion then take a retrograde course to the optic nerve, where they join ciliary nerves or arteries to the eye. All three pathways may transmit sympathetic, parasympathetic and somatic sensory nerve fibers.     

Access of autonomic nerves through the optic canal, and their orbital distribution in man

The notion that autonomic nerves from the internal carotid plexus are transmitted to the orbit with the ophthalmic artery through the optic canal has been variously assumed, disregarded, or denied, but never demonstrated. The objective of this study was to examine the contents of the canal, identify any autonomic nerves, and follow their passage within the orbit. The soft tissues of the optic canal, and the apical tissues of the orbit were removed and examined histologically using 10 cadaver preparations. Additionally, tissues from an orbital exenteration and 10 ocular enucleation or donor specimens were prepared. Some of the latter material was examined with an electron microscope. Numerous autonomic nerves (four to 25, ranging in diameter from 23 to 130 microm) entered the orbit from the internal carotid plexus in the periosteum of the optic canal, the optic nerve dura mater, or the adventitia of the ophthalmic artery. In the orbit they advanced in the loose connective tissue covering the optic nerve dura and joined ciliary nerves close to the eye or entered the eye directly. None were observed to penetrate the dura, apart from a nerve accompanying the central retinal artery. Others were distributed with the ophthalmic artery and its branches. It is concluded that the optic canal is a regular, and often major, route for autonomic nerve distribution to the eye and orbit.     

Development of AChE-positive, NA-containing and VIP- and NPY-immunoreactive nerves in the major cerebral arteries of the rat

Summary The development of cerebrovascular nerves containing noradrenalin (NA), acetylcholinesterase (AChE), neuropeptide Y (NPY), and vasoactive intestinal polypeptide (VIP) was studied in rats from before birth to adulthood. All these nerves entered the cranial cavity along the cerebral carotid, internal ethmoidal, and vertebral arteries during the early stages of development, but the subsequent growth and distribution of NA-containing and NPY-immunoreactive (IR) nerves differed greatly from that of AChE-positive and VIP-IR nerves. NA-containing and NPY-IR nerves extended rapidly from the cerebral carotid artery and spread over all the major arteries of the internal carotid system by postnatal day 3, as well as descending the posterior ramus of the cerebral carotid to mingle with nerves from the vertebral artery around the mid-basilar artery by day 5. AChE-positive and VIP-IR nerves from the internal ethomoidal artery covered the whole internal carotid system during the first postnatal week, and projected to the upper basilar artery after the second week, while those from the cerebral carotid artery remained limited to the middle cerebral artery throughout development. By day 21, all major arteries of the internal carotid system had dense plexuses of the four nerve types that were similar to those observed in adult rats. The vertebrobasilar system also had a well-organized network of NA-containing and NPY-IR nerves, but only a poor supply of AChE-positive and VIP-IR nerves. Even on day 30, the latter two nerve types were sometimes absent from the middle to caudal basilar artery, owing to a lack of interdigitation by nerves from the internal ethomoidal and vertebral arteries.     

Microsurgical anatomy of the pituitary gland (hypophysis cerebri) and the sellar region. Part IV: The optic nerves and optic chiasma

The anatomical relationships of the optic nerve and optic chiasma to the different structures of the sellar region were studied in 100 cadaver sphenoidal blocks and in patients during transfrontal surgery to the sellar region. This study includes the relationships with the bony structures (tuberculum sellae, dorsum sellae, sella turcica, optic canal), with the meninges (arachnoidal cisterns, tentorium of the optic nerve), with the vessels (carotid and ophthalmic arteries), and finally with the neural structures (hypophysis cerebri, cranial nerves third ventricle). Relevant clinical or surgical aspects in relation to normal anatomy and anatomical variations of the optic nerves and optic chiasma are discussed. The varieties of the chiasma (normal, prefixed, postfixed) and the measurements of the optic nerves and optic chiasma (width, length, height, distance, and angle between optic nerves) were studied in the cadaver only. Different transfrontal approaches to the sellar region are discussed according to the morphology of the chiasma.     

外伤性视神经损伤后视神经及视网膜形态的动态观察

目的:了解外伤性视神经损伤后的病理变化、溃变特点与时相间的关系。方法:参照Allen脊髓损伤法,造成视神经眶尖段间接600gcm力冲击、挤压伤。伤后对视神经和视网膜行形态学动态观察。结果:①伤后48h,视神经轻度肿胀和空泡反应;1周时损伤处视神经出现溃变,神经胶质细胞增生,视网膜神经节细胞(retinalganglioncells,RGCs)形态改变不明显;2周时神经纤维轴束间空泡样改变,局灶性坏死,RGCs核固缩和细胞数量减少。术后3月,视神经损伤部位直径缩小,形成胶质疤痕,RGCs数量明显减少,核固缩细胞增多。②RGCs数量于术后48h、1周、2周、1月和3月分别比正常对照组低3.35%、13.23%、19.74%、23.20%、29.28%。③视网膜细胞在48h内出现凋亡。结论:本实验模型可造成明确的视神经和视网膜损伤,神经元的损伤程度从节细胞、中间神经元、感光细胞的次序依次递减。视网膜和视神经损伤的严重程度与时间呈相关性。RGCs数量在48h至1周时下降速率最快。