面神经-舌下神经吻合术面神经干的显微解剖研究

目的观测面神经干的显微解剖,为面神经-舌下神经吻合术提供解剖学资料。方法解剖9例18侧福尔马林固定成人尸头,分别利用二腹肌后腹作为标志,在肌肉内侧寻找面神经干;在腮腺上作切口分离,寻找面神经干;以茎突作为标志追踪至颈乳孔,于茎乳孔处寻找面神经干的3种不同方法暴露面神经干。观测面神经干长度、深度、直径、分支及与周围结构的关系。结果面神经均由茎乳孔出颅。茎乳孔处面神经干直径为2.57±0.60mm,距皮肤的最小距离为22.62±2.88mm,面神经干长度为15.71±1.97mm,面神经干分叉至乳突尖的距离为18.20±4.41mm,分叉至下颌角的距离为39.91±8.38mm。乳突尖端至茎乳孔的距离为17.91±2.68mm,面神经干分叉前的主要分支有耳后神经、二腹肌神经和茎突舌骨肌神经。结论以茎突作为标志追踪至颈乳孔,在茎乳孔处寻找面神经干的方法安全可靠,面神经-部分舌下神经吻合是可行的。     

螺旋CT多维重建在胫骨平台骨折中的应用价值

胫骨上端骨质相对疏松，容易被股骨髁撞击，造成平台塌陷移位及交叉韧带断裂。因膝关节结构复杂，骨折块相互重叠，X线片及CT断面像很难全面客观地显示关节内骨折和移位程度。2001年5月至2003年9月我院诊治胫骨平台骨折34例，所有病例均行螺旋CT薄层扫描，采用多平面重建(MPR)、表面遮盖显示(SSD)及容积漫游技术(VRT)重建，对比分析螺旋CT多维重建在胫骨平台骨折中的应用价值。     

螺旋CT和三维重建技术在三踝骨折治疗中的应用

[目的]探讨螺旋CT三维重建技术在三踝骨折中的临床应用意义.[方法]回顾性分析1999～2004年56例三踝骨折病例,手术前均行X线正侧位摄片,螺旋CT的扫描参数为厚层2～5 mm,床速3～5 mm,重建间距1.5～3 mm,而后行螺旋CT三维重建技术并与手术对照.[结果]所有病例螺旋CT三维重建技术明确的显示了骨折的具体情况,螺旋CT三维重建在骨折的分型和碎骨块的描述上较平片优越,与手术中所见相一致.[结论]螺旋CT三维重建能够更为精确的显示三踝骨折的具体情况,对术前治疗方法的选择具有重要的指导意义.     

末节指骨截骨延长相关解剖研究

[目的]通过对末节指骨进行解剖、测量分析,探讨末节指骨延长的适宜截骨部位及末节指骨残端的外观重建方法。[方法]2013年10月~2015年1月,收集成人完整前臂标本30例,灌注红色乳胶并低温保存固定。经甲板、甲床、指腹依次分离暴露末节指骨及其支配血管,并进行测量,具体内容有:测量末节指骨全长,甲板长度,甲根长度;关节面距伸肌腱止点距离,伸肌腱止点距甲基质距离,甲基质长度,甲基质远端距指骨远端距离;远指间关节面距屈肌腱止点距离,关节面距滋养动脉入骨点的距离。采用SPSS 18.0软件包对测量数据进行统计学分析。[结果]拇指:全长为(26.58±1.13)mm,指间关节面距伸肌腱止点距离(6.34±1.15)mm,伸肌腱止点距甲基质距离(3.25±0.24)mm,甲基质长度(5.93±1.41)mm,甲基质远端距指骨远端距离(11.12±0.56)mm,甲根长度为(4.83±0.14)mm,甲板总长度(16.98±0.50)mm,关节面距屈肌腱止点距离(12.68±0.61)mm,关节面距滋养动脉入骨点的距离(16.51±2.64)mm。手指:全长为(18.63±1.32)mm,关节面距伸肌腱止点距离(1.94±0.25)mm,伸肌腱止点距甲基质距离(1.77±0.49)mm,甲基质长度(5.34±1.19)mm,甲基质远端距指骨远端距离(9.38±0.93)mm,甲根长度为(4.67±0.20)mm,甲板总长度(14.91±0.95)mm,关节面距屈肌腱止点距离(7.65±0.81)mm,关节面距滋养动脉入骨点的距离(11.24±1.56)mm。[结论]远节指骨基底是末节指骨延长的适宜部位。     

跟骨前部的解剖测量与多层螺旋CT测量的比较研究及其临床意义

[目的]比较跟骨前部解剖测量和多层螺旋CT测量结果之间的关系,探讨多层螺旋CT在跟骨骨折个案化内固定置钉的应用价值.[方法]使用解剖测量法和多层螺旋CT法,测量40只成人跟骨前部湿性标本的数据,采用SPSS 10.0统计软件分析比较.[结果]解剖测量法测得的跟骨前部最大长度(28.32±2.76) mm,最小长度(9.01±1.88) mm,最大宽度(27.60±2.91) mm,最小宽度(20.35±1.78) mm,最大高度(28.75±2.33) mm,最小高度(19.64±1.93) mm.螺旋CT法测得的跟骨前部最大长度(28.11±3.03) mm,最小长度(9.32±1.32)mm,最大宽度(27.69±2.19) mm,最小宽度(21.10±1.56) mm,最大高度(27.99±2.77) mm,最小高度(18.98±2.34) mm.两种测量方法获得的数据具有一致性(P＞0.05).[结论]多层螺旋CT测量的数据反映了跟骨前部的实际大小.术前使用多层螺旋CT扫描测量并给予三维重建,可以客观地获得跟骨前部的基本数据,直观显示了跟骨前部的立体形态.根据测量的数据制定个案化置钉方案,提高跟骨骨折内固定效果.     

与关节置换相关的华南地区健康成人髋关节形态测量

[目的]本研究旨在测量华南地区正常成人的股骨近段形态学参数,为假体设计及置入提供参考.[方法]招募华南地区正常成人志愿者80例(160髋),对志愿者髋关节行薄层螺旋CT扫描后,使用Mimics 10.01重建出三维模型,分别测量髋臼侧和股骨侧影响关节置换的解剖参数.[结果]华南地区正常成年人髋臼AVA、ABA、CE、SID的测量结果分别为(20.09±2.56)°、(49.32 ±3.77)°、(33.46±4.23)°以及(58.74±4.20) mm;不同性别之间,ABA、SID具有显著性差异,而AVA、CE则无显著性差异.股骨侧股骨前倾角、颈干角、股骨头直径、偏心距、小转子中点上方20 mm处髓腔内外径及前后径、小转子中点处髓腔内外径及前后径、小转子中点下方20 mm处髓腔内外径及前后径、峡部位置、峡部髓腔内径及外径的测量结果分别为(16.47±2.72)°,(129.61±10.32)°,(45.22±3.61) mm,(37.16±3.85) mm,(41.69±4.43) mm,(31.00±3.29) mm,(25.62±4.02) mm,(23.91±3.46)mm,(19.78±2.43) mm,(17.50±3.05) mm,(106.60±5.61) mm,(9.34-±1.68) mm,(25.50±2.32) mm,(4.59±0.84) mm;不同性别之间,除颈干角、小转子中点处髓腔内外径、峡部位置等指标外,其余指标的差异有统计学意义.[结论]华南地区正常成年人的髋臼形态较国外及国内其他地区存在差异.近段股骨形态与国内其他地区相比存在一定差异;与欧美国家相比,颈干角较大,偏心距较小,近段股骨形态整体偏细,峡部位置距离小转子较近且峡部更狭窄.     

载距突螺钉固定跟骨骨折恒定骨折块的植入方法研究

目的探讨跟骨载距突(sustentaculum tali,ST)解剖特点及跟骨后距下关节面ST螺钉固定恒定骨折块(constant fragment,CF)的安全入口位置和植入方向。方法从2016年1月—4月收治并行足踝CT扫描的100例跟骨骨折患者中,纳入33例符合选择标准的患者资料。男18例,女15例;年龄18～60岁,中位年龄41.0岁。骨折侧别:左侧16例,右侧17例。将CT扫描原始数据导入Mimics 17.0软件,建立跟骨三维模型;测量ST上缘长度、下缘长度、中线长度及高度、ST中线与足底水平面成角,ST螺钉入口(P’点)位置、植入角度相关参数以及ST螺钉长度。比较不同性别及侧别间各测量参数的差异。结果跟骨ST上缘长度为(16.60±2.23)mm、下缘长度(20.65±2.90)mm、中线长度(20.56±2.62)mm、中线高度(9.61±1.36)mm,ST中线与足底水平面成角(23.43±3.36)°。P’点至跗骨窦最低点垂直距离为(3.09±1.65)mm、水平距离为(14.29±2.75)mm,P’点至距骨外侧突顶点距离、后距下关节面软骨下骨距离以及跟骰关节面水平距离分别为(11.41±3.22)、(6.59±2.22)、(34.58±3.75)mm。ST螺钉与足底平面成角(–1.17±2.07)°、前倾角(16.18±2.05)°。ST螺钉长度为(41.64±3.09)mm。其中,男性ST上缘长度、下缘长度、中线长度和高度,P’点至距骨外侧突顶点距离、后距下关节面软骨下骨距离、跟骰关节面水平距离,ST螺钉前倾角及长度,均显著大于女性(P0.05)。以上测量参数左右侧比较,差异均无统计学意义(P0.05)。结论跟骨骨折复位后采用经跗骨窦最低点平行足底后方约14 mm、上方约3 mm确定入口,男性前倾约17°、女性前倾约15°植入ST螺钉。     

寰椎前弓双皮质螺钉固定相关解剖学测量

目的 :通过测量寰椎前弓双皮质螺钉固定相关解剖结构数据,为设计出更契合寰椎解剖结构的双皮质可调螺钉提供可靠的数据支持。方法:回顾性分析2017年4月～2018年8月门诊及住院部行上颈椎CT三维重建检查的就诊患者99例。其中男性54例,年龄31～81岁,平均56.67±10.56岁,身高159～180cm,平均172.24±4.95cm,体重55～90kg,平均70.24±7.57kg;女性45例,年龄46～77岁,平均59.84±8.29岁,身高154～171cm,平均163.11±5.24cm,体重40～80kg,平均59.31±8.48kg。通过三维测量软件,对前结节中点与齿状突后缘中点距离(前后距离)、双侧垂直钛板螺钉孔方向置钉长度(垂直长度)、双侧向齿状突后缘中点方向置钉长度(斜行长度)、双侧向齿状突后缘中点方向置钉尾端外倾角度(尾端外倾角度)和双侧置钉处前弓高度等进行测量。按照不同性别将患者分组,两组定量资料的比较采用t检验(方差齐)或Satterthwaite t′检验(方差不齐);左右侧比较采用配对t检验。年龄和各数值的相关性采用简单线性回归分析,身高、体重和各数值的关系采用Pearson相关系数和简单线性回归描述。结果:垂直长度、斜行长度、尾端外倾角度及置钉处前弓高度的左右侧数值差异均无统计学意义(P0.05)。男性前后距离、垂直长度、斜行长度、尾端外倾角度、置钉处前弓高度的均数分别为21.33±1.12mm、8.92±1.48mm、8.37±1.49mm、13.20°±0.93°、12.44±0.48mm;女性前后距离、垂直长度、斜行长度、尾端外倾角度、置钉处前弓高度的均数分别为20.01±1.33mm、8.18±1.56mm、7.67±1.58mm、13.88°±1.38°、12.08±0.75mm;男性患者垂直长度、斜行长度、前后距离及置钉处前弓高度大于女性患者,女性患者尾端外倾角度大于男性患者,有统计学意义(P0.05)。身高和垂直长度及斜行长度在不同性别组中均无相关性(P0.05)。Pearson相关分析显示,身高和尾端外倾角度在不同性别组中均呈负相关(r=-0.123,P0.05)。年龄和各数值的相关性没有统计学意义(P0.05)。结论:男性患者垂直长度、斜行长度、前后距离及置钉处前弓高度大于女性患者,女性患者尾端外倾角度大于男性患者。术者可根据患者性别,参考所得置钉参数选择合适的螺钉,从而提高了寰椎前弓置钉的准确率和安全性。     

螺旋CT三维重建技术在颌面部骨折诊断和治疗中的价值和临床意义分析

目的:探讨螺旋CT重建技术表面遮盖重建(SSD)、容积再现(VR)、多层面重建技术(MPR)重建在在颌面部骨折诊断和治疗中的临床应用。方法:回顾性分析2009年1月～2011年12月我院采用螺旋CT检查的疑似颌面部骨折患者68例的临床资料。结果:SSD重建对下颌骨骨折的位置、范围、碎骨块的移位以及脱位的立体解剖图像及其与周围关系立体直观,显示脱位的空间位置明确,结果优于二维MPR图像;MPR在深处骨折显示上优于SSD;联合使用3种重建方法检查结果显示率为100%,明显优于单独一种重建方法;螺旋CT在骨折预后评价上明显优于X线平片。结论:螺旋CT三维重建技术对颌面部骨折的诊断治疗具有很高的应用价值。     

计算机辅助下颌骨截骨的三维显微结构模型建立

目的 探索计算机重建下颌骨三维显微结构模型及下颌角截骨手术的三维仿真操作方法 ,以减少手术操作中的组织损伤. 方法 利用螺旋CTA数据重建包含血管神经束的下颌骨三维模型并进行测量分析,使用Freeform雕刻刀及其布尔运算的切割方法 对模型进行保护血管的手术模拟.结果 利用计算机辅助技术可以精确的重建包含下牙槽动脉的下颌骨三维模型:血管从下颌孔进入下颌支.依照下颌支外缘弧度走行,下颌孔距下颌支前缘距离为(19.13±0.66)mm,孔距下颌支后缘距离为(18.96±0.64)mm,下颌角的角度为(109.70±4.67)°,下颌支的安全截骨范围和角度是平行下颌支外缘(12.62±0.28)mm宽、与下颌底成角(22.30±4.67)°;根据模型与数据,Fredorm可以模拟安全的下颌角截骨的手术操作. 结论 下颌骨显微结构的三维模型重建和测量分析技术,是增加手术安全性的一条新途径.     

Radial styloid fractures

Radial styloid fractures can occur in isolation or in association with other injuries, including complex intra-articular distal radius fractures, carpal fractures, carpal dislocations, and radiocarpal dislocations. The anatomy surrounding the radial styloid is complex, and complications related to surgical approach, treatments, and symptomatic hardware can occur. Operative treatments vary according to the injury pattern present, and pattern recognition is the key to optimizing treatment of these injuries. Outcomes are related to the precision of the reconstruction as well as the magnitude of the injury; better results are associated with lower-energy patterns.     

Evaluation of ulnar styloid length

PURPOSE: General awareness of the ulnar styloid impaction syndrome is low and often is neglected. Radiographic evaluation of the ulnar styloid length generally includes an x-ray of the posteroanterior view. This study analyzed the effect of different radiographic views to assess the length of the ulnar styloid. The ulnar styloid-capitate ratio (SCR) expresses the relative length of the ulnar styloid, and we compare this ratio with the ulnar styloid process index (USPI). METHODS: To evaluate the ulnar styloid and to analyze the effect of different radiographic views on measurement outcome, measurements were performed in 7 different radiographic positions of both wrists of 69 patients. To assess the relative size of the ulnar styloid and its impaction potential the USPI was calculated, re-evaluated, and compared with the SCR, in which the length of the ulnar styloid is divided by the length of the capitate bone. RESULTS: The mean ulnar styloid length in all standard posteroanterior radiographs is 4.4 +/- 1.2 mm. In our population the average USPI was 0.21 +/- 0.11 and the average SCR was 0.18 +/- 0.05. The SCR has a stronger correlation with the length of the ulnar styloid than the USPI. Furthermore this new ratio eliminates differences related to gender, whereas the USPI does not. CONCLUSIONS: To identify ulnar impaction potential we recommend using the USPI, but to compare ulnar styloid between patients we recommend using the SCR obtained from neutral posteroanterior radiographs. For white patients we suggest defining a long ulnar styloid as having an SCR greater than 0.18 +/- 0.05 and/or an overall styloid length greater than 6 mm.     

Hypertrophic ulnar styloid nonunions

Eleven patients with chronic pain on the ulnar side of the wrist and roentgenographic evidence of a hypertrophic ulnar styloid nonunion were treated with subperiosteal excision of the nonunion fragment. This procedure relieved the localized pain without changing either radiocarpal or distal radioulnar joint stability.     

Ulnar styloid impingement syndrome

The tip of an excessively long ulnar styloid can impinge upon the triangular fibrocartilage complex (TFCC) against the triquetrum. The subtleties in biomechanics of the wrist joint and their role in the production of the symptoms are presented as five cases from a retrospective study. The relationship of the symptoms to the patients’ job activities is also discussed. The embryological and anatomical studies show that the tip of the ulnar styloid is covered by the TFCC. Therefore, the term “ulnar styloid impingement syndrome” is adopted for the entity in cases in which the TFCC has remained intact.     

Carpal impaction with the ulnar styloid process: treatment with partial styloid resection

Carpal impaction with the ulnar styloid process (stylocarpal impaction) occurs less frequently than with the ulnar head (ulnocarpal impaction), and more commonly develops in wrists with negative ulnar variance. Physical examination, radiographic evaluation, and wrist arthroscopy are all helpful in excluding alternative causes of ulnar wrist pain. When an ulnocarpal stress test elicits pain, and radiographs suggest that this is due to carpal impaction with the ulnar styloid, partial resection of the styloid process provides successful treatment, so long as the insertion of the triangular fibrocartilage at the base of the styloid is not disrupted.     

Ulnar styloid triquetral impaction.

BACKGROUND: Ulnar styloid triquetral impaction (USTI), one of many causes of ulnar sided wrist pain, is a pathological entity with clear clinical and radiographic features, distinct and different from the impaction of the ulnar head against the lunate or ulno-carpal impaction (UCI). Pain is ulnar and point-tenderness is present precisely over the ulnar styloid as opposed to the proximal lunate in UCI. The provocative maneouvre of dorsiflexion in pronation followed by supination is markedly different from the ulnar deviation grind test maneouvres used to diagnose UCI. Multiple anatomical and pathological features interplay to produce a situation in which the distance between the tip of the ulnar styloid and the triquetrum is reduced resulting in USTI. The concept of ulnar styloid variance is introduced and anatomical variations of ulnar styloid length are demonstrated. METHODS: The clinical and radiographic features of 56 patients diagnosed with USTI were analysed. One thousand standardised film-file wrist radiographs were measured to determine the average length of the ulnar styloid in the population as well as the average projection of the styloid above the radius (ulnar styloid variance). RESULTS: An aetiological classification system for USTI was developed based on the clinical and radiographic features of the aforementioned patients and radiographs. CONCLUSIONS: The causes of this syndrome are often complex and classification of the aetiological features is clinically useful. It is important for physicians and surgeons to recognise the clinical and radiographic features of this syndrome in order to properly manage the symptoms and prevent an iatrogenic production of USTI.     

Morphological variations of the ulnar styloid process

P.A. radiographs of both wrists were taken in 400 normal individuals to study the configuration of the styloid process of the ulna. Five different morphological variations were noticed, the commonest being an elongated process (102 wrists). Medially deviated (41 wrists), parrot beaked (27 wrists) and hypertrophic (16 wrists) patterns were less common. One person had bilateral unfused separate ossification centres for the ulnar styloid. There was no correlation between the length of the styloid process and ulnar variance.