舌骨下区颈脏器周围的筋膜间隙

作采用断面解剖和间隙灌注方法观察了36具成年男尸的舌骨下区颈部脏器周围的筋膜间隙，结果表明，在颈部脏器的前方存在气管前间隙和舌骨下肌后间隙，在后方存在咽后间隙和危险间隙，本讨论了这四个间隙的延伸和相互通连情况，有助于颈深部感染的诊断和治疗。     

颈深筋膜间隙的薄层断面解剖研究及其临床意义

目的：为颈深筋膜间隙的影像和临床疾病的诊治提供解剖学依据。方法：应用低温冰冻技术，制作15套颈部连续薄层横断面标本，在断面上对颈深筋膜各间隙进行观测研究。结果：明确了各间隙的位置、毗邻及出现范围；证实了危险间隙的存在；得出胸骨上间隙应是由颈深筋膜浅层和舌骨下肌筋膜围成；发现颈动脉间隙不是一密闭的间隙，其后外侧与颈后间隙相通。结论：用横断层解剖方法能清楚显示各颈深筋膜间隙的形态结构。     

颈深筋膜及筋膜间隙的薄层断面解剖及三维重建

目的　明确颈深筋膜的分层及筋膜间隙的位置、毗邻 ,为颈深筋膜间隙的影像识别与分析提供参考 ,为临床诊治感染蔓延、肿瘤侵润提供解剖学依据。　方法　采用低温冰冻和生物塑化技术用 17例标本 ,制作了颈部连续薄层横断面 ,对颈深筋膜及筋膜间隙进行了观测。从颈部薄层塑化断面标本上 ,用双线提取间隙轮廓的方法 ,在SGI工作站上对颈深筋膜间隙进行三维重建。　结果　 1.颈深筋膜应分为四层 ,颈深筋膜深层分为翼筋膜和椎前筋膜 ,颈深筋膜各层均参与颈动脉鞘的形成。 2 .颈动脉间隙是一开放的间隙 ,其后外侧与颈后间隙相通 ;证实了危险间隙的存在。 3.重建出咽后间隙、颈动脉间隙和内脏间隙的三维图像 ,并能同时显示间隙内的主要结构。结论　得出了颈深筋膜和筋膜间隙的模式图 ,并为筋膜间隙的三维重建提供了一种新的方法。     

面部表浅肌肉腱膜系统(SMAS)的解剖学研究

目的 :深入探讨SMAS的形态学特点 ,为颜面部整形手术的开展提供翔实的形态学基础。方法 :对 6例新鲜和 8例固定头颈部标本进行大体和显微解剖以及组织切片观察。结果 :SMAS位于皮下脂肪深面 ,直接与颈阔肌延续 ,向前连于眼轮匝肌、颧大肌和蜗轴 ,向上与颞浅筋膜相连 ,向后与颈深筋膜浅层融合 ;SMAS分为肌性部和膜性部 ;SMAS与腮腺咬肌筋膜之间有脂肪组织存在 ,面神经在腮腺咬肌筋膜中行走。结论 :SMAS是面部皮下脂肪和腮腺咬肌筋膜之间的独立组织结构层次 ;SMAS与颈阔肌、颧大肌、颞浅筋膜 -枕额肌相连 ,构成头面颈部浅筋膜和深筋膜之间的连续而独立的组织结构层次。     

颈深筋膜及筋膜间隙的计算机三维重建

目的 :对颈深筋膜及深筋膜间隙进行计算机三维重建以显示其立体结构。方法 :用生物塑化技术制作薄层断面标本 ,在SGI工作站上 ,采用双线提取筋膜及间隙轮廓的方法对颈深筋膜及其间隙进行了三维重建。结果 :重建出咽后间隙、颈动脉间隙和内脏间隙及颈部的大血管和重要器官。重建结构均能单独显示、任意搭配显示或总体显示 ,可在三维空间位置上绕任意轴旋转任意角度。结构 :用双线法提取筋膜及间隙轮廓 ,能重建出筋膜间隙并能同时清楚显示间隙内的结构 ,为筋膜间隙的计算机三维重建提供了一种新的方法     

Predisposing factors of complicated deep neck infection: an analysis of 158 cases

Both the introduction of antibiotics and improvements in oral hygiene have made deep neck infections occur less frequently today than in the past. Nevertheless, the complications from these infections are often life-threatening. The purpose of this article was to review the clinical findings of deep neck infections and identify the predisposing factors of these complications. The present study reviewed 158 cases of deep neck infections between the years of 1995 to 2004, 23 of which had life-threatening complications. Cases were excluded if they had peritonsillar abscesses, superficial infections, infections related to external neck wounds, or head and neck tumors. The authors used multiple linear regression and the logistic regression analysis in order to determine the clinical parameters that are associated with longer hospitalizations and complicated deep neck infections, respectively. The multiple linear regression showed that patients with a large number of involved spaces, diabetes mellitus, and complications required longer hospitalizations (p < 0.05). The logistic regression showed that patients with more than two involved spaces were more likely to have complicated deep neck infections (p < 0.05). Patients with odontogenic causes had negative correlation (p < 0.05). We recommend that high-risk groups, such as diabetic patients and/or patients with more than two involved spaces, should be more closely monitored throughout their hospitalization.     

大脑上静脉在上矢状窦各段内开口的观察

本文利用手术显微镜对30例成人上矢状窦前、中、后三段内的大脑上静脉开口进行了观察。其开口较集中于窦前段的前2/3和窦后段的前1/3。在窦前段的后1/3和窦后段的后2/3内,静脉开口稀疏,甚至无。在窦中段静脉开口较为分散。静脉在窦内开口的位置,从窦前段到中、后段,有由高变低的趋势,即从窦的侧角和侧壁上份移向侧壁下份和尖。本文还观察了静脉开口的形态和方向,并讨论了有关上矢状窦各段手术时,选择部位的问题。     

Air dissection of the spaces of the head and neck: A new teaching and dissection method

Our goal was to evaluate a new air dissection technique for the spaces of the head and neck using fresh-frozen cadavers. Eight sides from four fresh-frozen Caucasian cadavers were used in this study. Compressed air was initially placed into the pterygomandibular space while simultaneously observing the spaces of the head and neck. Subsequently, the pterygomandibular space on the contralateral side of the specimen was insufflated and observations made. For these methods, simultaneous observation of mediastina and lungs was made using intrathoracic endoscopy. On all sides, the buccal, submental, sublingual, parotid, parapharyngeal, and retropharyngeal spaces were insufflated on both ipsilateral and contralateral sides. Deviation of the larynx and trachea was observed externally and deviation of the mediastinum and lungs via intrathoracic endoscopy. We introduced air dissection into spaces of the head and neck. This new technique might help students, teachers, dentists, medical doctors, and other healthcare providers to better understand the three-dimensional anatomy of the spaces of the head and neck and their communicating pathways. Clin. Anat. 33:207–213, 2020. © 2019 Wiley Periodicals, Inc.     

人咬肌的肌构筑学研究

对10侧人咬肌的肌构筑学研究表明，咬肌浅部为多羽肌，内部有3－5个与肌表面平行排列的腱板，肌纤维从浅深两面附着于腱板上，深部为带状肌，肌纤维并行排列几乎垂直下行，咬肌浅部明显重于深部，约为深部的2．5倍，生理横切面积约为深部的2倍，但生理横切面积／肌重比率却明显小于深部，浅，深两部各项构筑指数在左，右侧无显性差异，以上结果提示，咬肌浅，深两部均属于力量型肌，咬肌浅部在咀嗳活动及保持下颌位置中起主导作用，深部对下颌姿势位的维持和稳定颞下颌关节的正常位置是必不可少的，本研究结果为进一步研究咬肌的肌生理和肌运动学提供可靠的资料。     

Evidence of antibody production in the rat cervical lymph nodes after antigen administration into the cerebrospinal fluid

We previously showed histologically that, in the rat, the cerebrospinal fluid drains from the subarachnoid space along the olfactory nerves to the nasal lymphatics and empties into the superficial and deep cervical lymph nodes. The present study was performed to investigate whether these lymph nodes play a role in the immune response of the central nervous system. For this purpose, keyhole limpet hemocyanin conjugated with fluorescein isothiocyanate (KLH-FITC) was administered into the subarachnoid space of the rat brain, and the time-kinetics and location of FITC and anti-FITC antibody forming cells in the cervical lymph nodes were studied histologically and immunohistochemically. FITC fluorescence was detected in superficial and deep cervical lymph nodes as well as the subarachnoid space and the nasal mucosa 2 h after FITC-KLH injection into the subarachnoid space. The specific antibody-forming cells first appeared in both the superficial and deep cervical lymph nodes on the 4th day after antigen administration although the reaction was more intense in the deep than in the superficial cervical lymph nodes. These cells were located in the medullary cords of the cervical lymph nodes. The number of antibody forming cells increased thereafter, reached a peak around the day 6, and then declined on day 10. These findings indicate that antigens introduced in the cerebrospinal fluid are drained into the cervical lymph nodes through the nasal lymphatics and initiate the antigen-specific immune response there. Thus, the cervical lymph nodes probably act as a monitoring site for cerebrospinal fluid and play a major role in the central nervous system immune response.     

小白鼠股直肌的肌纤维类型及运动终板配布的组织化学研究

本文用琥珀酸脱氢酶(SDH)和乙酰胆碱酯酶(AchE)结合染色法,研究了小白鼠股直肌的三种肌纤维的分型和运动终板的配布。观察结果表明,股直肌纤维由深层至浅层红肌递减、白肌递增,在深层缺少中间肌,而中间肌在中浅层分布无明显差异。白肌纤维占40%,红肌纤维占34%,中间肌纤维占25%。白肌纤维最大直径70±9.25um,最小直径39.4±7.63um;红肌纤维最大直径41.66±5.54um,最小直径24.8±5.01um;中间肌最太直径53.35±6.82um,最小直径29.6±4.76um。白肌纤维上的运动终板数量占运动终板总数的77.2%,红肌纤维上的运动终板占运动终板总数的13.9%,中间肌纤维上的运动终板仅占运动终板总数的8.8%.     

小指对掌肌腱弓的解剖学研究

目的探讨Guyon管以远尺神经深支卡压征的解剖学基础。方法对20例新鲜成人上肢标本腕部进行显微解剖，肉眼及镜下观测腕部尺神经分支与周围组织的关系。结果尺神经穿出Guyon管后进入小指对掌肌浅、深两头和钩骨钩之间的间隙，该间隙可分为顶、底和桡侧壁，有一个入口和一个出口，暂称其为小指对掌肌间隙。小指对掌肌浅头腱性起点的近侧缘锐利，呈腱弓样，存在率100％，暂称其为小指对掌肌腱弓。结论小指对掌肌腱弓可以卡压尺神经深支，引起除小鱼际肌以外的尺神经支配的所有手内在肌的功能障碍。     

Lamination of the masticatory muscles in the kangaroo according to their innervation

An analysis of the laminations of the masseteric, zygomaticomandibular and temporalis muscles of the Red Kangaroo (Macropus Rufus) and all of the masticatory muscles of the Eastern Gray Kangaroo (Macropus Giganteus) was carried out based on their innervation. The masseteric muscle was divided into superficial and deep layers; the superficial layer was further subdivided into three laminae from the rostro-lateral portion to caudo-internal portion. The deep layer was divided into lateral, caudo-internal and rostro-internal laminae. The zygomaticomandibular muscle which was located between the masseteric and temporal muscles was divided into lateral, internal and rostral laminae, on the basis of its innervation. The lateral and internal laminae were innervated by the nerve which arises between the masseteric nerve and the posterior deep temporal nerve. A small rostral portion of the muscle was innervated by masseteric nerves, which passed through the internal lamina of the deep layer of the masseteric muscle. The temporalis muscle was innervated by an anterior deep temporal nerve and posterior deep temporal nerve. Only the most rostro-internal lamina of the temporalis muscle was innervated by the anterior deep temporal nerve. The anterior deep temporal nerve and lateral pterygoid nerve had a common trunk. We believe that the rostro-internal lamina was closely related to the lateral pterygoid muscle. The lateral pterygoid muscle displayed one lamina, whereas the medial pterygoid muscle was divided into internal and lateral laminae. The lateral lamina was further divided into rostro-internal and caudo-lateral laminae.     

Rare variations of the mylohyoid muscle: case study.

The mylohyoid is a muscular diaphragm in the floor of the oral cavity. Its superficial and deep surfaces have important anatomical relationships. The submandibular gland is uniquely related to both surfaces at the posterior free edge of the muscle. It is here that the submandibular and sublingual tissue spaces become continuous. This case report describes an unusual range of anatomical variations of the mylohyoid muscle and reviews their clinical significance.     

Distribution of sensory neurons of ventral and dorsal cervical cutaneous nerves in dorsal root ganglia of adult rat--a double-label study using DiO and DiI

To examine distribution of sensory neurons of ventral and dorsal cervical cutaneous nerves in dorsal root ganglia (DRGs), DiO and DiI tracers were applied at the proximal section of nerves (transverse superficial cervical and anterior supraclavicular nerves were selected as ventral cervical cutaneous nerves; dorsal cutaneous branches of second, third and fourth cervical nerves were selected as dorsal cervical cutaneous nerves). Located distributions were observed in DRGs of C2, C3, and C4 (25/46 DRGs). Sensory neurons of the ventral cervical cutaneous nerves were distributed in dorso-lateral or dorso-medial portions; neurons of dorsal cervical cutaneous nerves were distributed in ventro-medial or ventro-lateral portions of DRGs. Moreover, sensory neurons of transverse superficial cervical and anterior supraclavicular nerves were mainly distributed from the caudal half of C2 to whole part of C4 DRGs. Results show that there is a tendency for located distribution in two group sensory neurons; also, sensory neurons of ventral cervical cutaneous nerves have a segmental distribution, which has been verified in the brachial and lumbar plexus.     

Anatomical study on arteries of fasciae in the forearm fasciocutaneous flap

The arteries of the forearm flap were studied systematically and quantitatively to determine the survival mechanism of fasciocutaneous flaps and provide morphological basis for clinical application. Fourteen forearms from fresh adult cadavers were investigated by methods of dissection under operating and biological microscopes, tissue clearing, tissue sectioning, and image analysis. There were four arterial types in the forearm flaps in which the intermuscular space cutaneous artery was predominant in number. Both intermuscular space cutaneous arteries and intermuscular septal cutaneous arteries anastomosed by branches as arterial chains along the intermuscular spaces and septa where the stem arteries ran through. Arteries of each type gave off epi- and subfascial branches to the deep fascia, and the former were greater in number and larger in diameter. In the same way, the vascular network was thicker in the epifascial level than that in the subfascial level. The percentage of the area of blood vessels in deep fascia (Aa%) was larger than that of the superficial fascia. In the forearm, the deep fascial vasculature is the main pathway through which the fasciocutaneous flap gains its blood supply, and the epifascial vascular network is especially important. It would be better to select the fascial pedicle where the arterial chain exists.     

Architecture of structures in the urogenital triangle of young adult males; comparison with females

The fibro‐muscular architecture of the urogenital triangle remains contentious. Reasons are small size of the constituting structures and poor visibility with most imaging methods. We reinvestigated the area in serial sections of three males (21–38 years old) of the American and Chinese Visible Human Projects and two 26‐week‐old male fetuses, and compared the findings with earlier observations in females. The mass of the levator ani muscle was approximately twofold smaller and its funnel shape steeper in males than females. In the levator hiatus, a strand of the smooth longitudinal muscle layer of the rectum, the ‘rectourethral (RU) muscle’, extended anteriorly from the anorectal bend to the penile bulb. Fibrous tissue that formed in the inferior reach of the fetal RU muscle identified the location of the developing perineal body (PB) and divided the muscle into posterior ‘rectoperineal’ and anterior ‘deep perineal’ portions. In males, the PB remained small and bipartite, so that the RU muscle presented as an undivided midline structure. The well‐developed female PB, instead, intertwined with the deep perineal muscle and both structures passed the vagina bilaterally to form the perineal membrane in the posterior portion of the urogenital triangle. The urethral rhabdosphincter extended in the anterior portion of the urogenital triangle between the penile bulb inferiorly and the bladder neck superiorly, and consisted of a well‐developed circular ‘membranous’ portion with bilateral posteroinferior ‘wings’ and a thinner ‘prostatic’ portion on the prostate anterior side. In men, muscles occupy the urogenital triangle, but additional tightening of the locally fibrous adipose tissue by the superficial transverse perineal muscle appears necessary to generate functional support in women. An interactive 3D pdf file with these anatomical details (available online) should allow more accurate interpretation of ultrasound, computed tomography and magnetic resonance images.     

腹腔镜下腹膜后筋膜间隙外科平面的解剖观察

目的 探讨在腹腔镜下升、降结肠或肾切除术相关的腹膜后筋膜和筋膜间隙的解剖学特点及毗邻关系,以便正确地寻找、识别和选择安全的筋膜间隙外科平面. 方法在腹腔镜下对5具成人新鲜腹部标本,30例腹腔镜下升、降结肠切除术和95例肾切除术中的腹膜后筋膜和筋膜间隙的位置、沟通和毗邻关系进行了观察.结果升、降结肠外侧缘的脏腹膜与壁腹膜之间有一条黄白交界线,沿此线切开腹膜、腹膜外组织,即可显露深面的融合筋膜.融合筋膜与肾前筋膜之间的潜在间隙为融合筋膜间隙.切开融合筋膜,沿此间隙向内分离,可将升结肠或降结肠及原始结肠系膜向内翻起,完成结肠游离;或显露后方的肾前筋膜.肾前筋膜、融合筋膜外侧部与侧锥筋膜之间的间隙为肾旁前筋膜间隙;肾后筋膜、侧锥筋膜与腰方肌筋膜之间的间隙为肾旁后筋膜间隙.肾旁前筋膜间隙与融合筋膜间隙和肾旁后筋膜间隙沟通,通过这些间隙分离,可将肾安全游离. 结论 黄白交界线为进入融合筋膜间隙的标志,融合筋膜间隙及肾旁前、后筋膜间隙内无重要血管,易于辨认和分离,为腹腔镜下升、降结肠或肾游离的理想外科平面.     

Feedforward activity of the cervical flexor muscles during voluntary arm movements is delayed in chronic neck pain

The objective of this study was to compare onset of deep and superficial cervical flexor muscle activity during rapid, unilateral arm movements between ten patients with chronic neck pain and 12 control subjects. Deep cervical flexor (DCF) electromyographic activity (EMG) was recorded with custom electrodes inserted via the nose and fixed by suction to the posterior mucosa of the oropharynx. Surface electrodes were placed over the sternocleidomastoid (SCM) and anterior scalene (AS) muscles. While standing, subjects flexed and extended the right arm in response to a visual stimulus. For the control group, activation of DCF, SCM and AS muscles occurred less than 50 ms after the onset of deltoid activity, which is consistent with feedforward control of the neck during arm flexion and extension. When subjects with a history of neck pain flexed the arm, the onsets of DCF and contralateral SCM and AS muscles were significantly delayed (p<0.05). It is concluded that the delay in neck muscle activity associated with movement of the arm in patients with neck pain indicates a significant deficit in the automatic feedforward control of the cervical spine. As the deep cervical muscles are fundamentally important for support of the cervical lordosis and the cervical joints, change in the feedforward response may leave the cervical spine vulnerable to reactive forces from arm movement.