枢椎椎弓根内固定的解剖学研究

目的通过标本测量,研究以下关节突中心点为入钉点,枢椎椎弓根螺钉的进钉方法及要点。方法50枚人尸体骨干骨标本,以下关节突中心点A为进针点,在枢椎腹侧测量椎弓根的内倾角α;在椎弓背侧,选择上关节突内缘C点为标志点,测量AC连线的冠状面内倾角β,探讨α与β的相关性。结果枢椎腹侧测量的椎弓根冠状面内倾角为43°±4°(左侧),45°±5°(右侧),均值44°±6°;枢椎背侧测量的下关节突中心点A与上关节面内缘点C的连线内倾角β为39°±5°(左侧),37°±6°(右侧),均值38°±7°;α,β差值平均为5°±2°。结论①椎椎弓根部的解剖特点决定了其椎弓根螺钉的进入方向必须非常精确,否则很容易穿出椎弓根内外壁,造成椎动脉或脊髓的损伤;②枢椎下关节中心点与上关节面内缘点的连线对于确定合理的钉道方向具有较好的参考价值。     

颈椎侧块的形态学测量及其在临床上的应用

目的:通过对成人颈椎侧块干骨标本的形态学测量,选择安全、稳定的进钉途径。方法:测量颈椎侧块上关节面与水平面的夹角;侧块上关节面的长径、前后径;侧块上关节面长径与矢状面的夹角、神经根通道与矢状面的夹角;侧块高度。结果:侧块上关节面与水平面的夹角C_3～C_6数值较为接近(48.4±8.3～53.2±5.9),C_7数值较大(62.7±5.4);侧块上关节面的长径C_3～C_7逐渐增大(10.7±1.0～12.0±1.2),成线性关系;前后径C_(3-6)数值接近,C_7最短;侧块上关节面长径与矢状面的夹角48.8±4.6～50.0±3.7;神经根通道与矢状面的夹角59.4±5.5～62.9±4.7。结论:经颈椎侧块内固定,理论上的最佳进钉途径应当是与侧块上关节面长径平行,钉长不宜超过12mm,进钉点应靠近侧块的内侧缘。保持以上进钉角度和进钉深度不会伤及神经根和椎动脉,     

骶骨纵形骨折后路钢板固定置钉的应用解剖

目的 通过对骶骨的解剖学测量,为骶骨纵形骨折后路钢板固定的临床应用提供钉道基础数据。方法 选取20例成人骶骨标本,按骶骨后路钢板固定置钉的钉道要求,设定进针点：骶（S1）关节突外侧a点,S1关节突下侧b点,S2、S3、S4的入点c、d、e位于a点与S4骶骨后孔假想连线上,且各位于上下骶骨后孔间连线的中点处;两侧进针点间的距离分别为af、bg、ch、ci、dj、ek;内侧钉道长度分别为A1、A2、B、C、D、E;外侧钉道长度分别为F、G、H、I、J、K和外侧钉道角度分别为Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ、Ⅵ。结果A1、A2、B值分别为(31.70±3.54)mm、(35.59±4.50)mm和(27.83±3.80)mm; F、G、H、I、J值分别为(43.68±5.11)mm、(30.10±4.00)mm、(27.66±3.33)mm、(23.51±3.26)mm和(18.72±4.18)mm;Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ值分别为(5.75±4.14)°、(12.65±5.22)°、(10.05±6.78)°、(8.75±5.87)°和(16.33±8.46)°。结论 内外侧置钉进针点间距离适合钢板的使用;置钉钉道长度内侧相对固定,外侧多变;外侧置钉角度变化较大。     

寰枕关节后路经关节螺钉固定的解剖学

目的:为国人提供枕寰枢复合体的相关解剖学参数,寻求枕寰枢后路经关节螺钉固定的解剖学依据和可行性。方法:测量枕骨髁和寰椎干燥标本;观察新鲜尸体标本的枕寰枢后部结构。结果:枕髁关节面舌下神经管间距约9.66mm,两侧枕髁前端间距约14.93mm,枕髁关节面内倾角,左侧约12.5°,右侧约11.6°。枕髁关节面的前后径和横径、寰椎侧块上关节面前后径、侧块上关节面横径、侧块与后弓移行处侧块厚度均在5mm以上。椎动脉第3段恒定行走于椎动脉沟。第1、2颈神经背侧支与寰椎侧块下关节突后方几无交叉,并有一定的活动度。结论:寰枕关节后路经关节螺钉内固定在解剖可行,其理想入钉点在寰椎后弓与侧块下关节突移行处的中点,螺钉指向枕骨髁前上方。     

经后路第2骶椎螺钉进钉方法的应用解剖

目的为临床应用第2骶椎螺钉内固定术治疗腰骶部病变提供解剖学基础.方法 1.在60块干燥骶骨上,对第2骶椎及其相关结构进行观测;2.在25具尸体标本上观测骶前和骶管内神经血管.3.在50例正常成人志愿者的S2椎体中部行CT扫描,观察螺钉的置入角度和深度.结果1.第2骶骨椎体、侧突、侧块具有足够的空间.背侧有内、外两个区域适于进针.2.第2骶椎前、后有丰富的血管、神经,只在椎体前有出钉安全区.3.经外侧区向S2椎体置钉,进针角度为(40±4)°,深度为(35.8±4.0) mm,经内侧区向S2侧块置钉进钉角度为(28±3)°,深度为(45.4±4.1) mm.结论第2骶椎行常规直径的螺钉(4.5～6.5 mm) 固定具有可行性.但要注意进钉的角度、方向和深度,同时宜采用相应的加强螺钉稳固性的措施.     

经皮骶髂螺钉内固定术的应用解剖学研究

目的:为骶髂关节骨折脱位经皮螺丝钉固定提供解剖学依据。方法:50块干燥成人骶骨及30个骨盆防腐标本,测量S1、S2侧突、侧块厚度等指标,观察骶髂关节周围神经血管分布,定位进针点;通过标本断层及正常骨盆CT片测量螺钉进针方向及深度。结果:S1侧突高度为(22.1±4.6)mm,厚度为(27.8±3.1)mm,S2侧突高度为(13.4±3.6)mm,厚度为(20.9±2.2)mm。S1进针点位于髂前上棘-髂后上棘连线中后1/3交点附近,S2进针点位于髂结节-髂后上棘连线前4/5与后1/5交点附近。S1侧突中轴与矢状面夹角约为55°,S2则约为80°,S1侧突中轴与冠状面的夹角约为36°,S2则约为15°。结论:(1)S1侧突能容纳直径为6.5～7.0mm的螺丝钉2枚,S2侧突可容纳1枚。(2)S1侧突螺丝钉进针方向与矢状面夹角约为55°,与冠状面夹角约为36°;对S2则分别约为80°和15°。S1进针深度为68mm,S1为55mm。(3)经皮骶髂螺丝钉固定手术应严格限制在骨折精确复位的病例。     

颈椎侧块的应用解剖及其在后路钢板螺钉内固定术中的意义

目的 :为经颈椎后路侧块和椎弓根螺钉在颈椎的应用提供解剖学基础。方法 :对 10套成年C3～ 7段 5 0节防腐颈椎标本的颈椎侧块和椎弓根的高度、宽度、长度、椎弓根轴线的角度及进钉点定位等作了三维形态学观测。结果 :颈椎侧块的斜径线为 (10 .5 7± 1.41)mm、其倾斜角为 5 .14°± 0 .82° ,后表面中心点距椎动脉距离为 (13 .99± 1.63 )mm ;颈椎椎弓根的高为 (6.77± 0 .61)mm、宽为 (5 .18± 0 .5 9)mm、侧块后表面经椎弓根至椎体前缘间距为 (3 1.70± 1.44 )mm、椎体矢状面与经椎弓根轴线的夹角为 42 .90°±3 .2 1°。颈椎经侧块和经椎弓根螺钉内固定术在进钉的深度、方向、以及螺钉的选择上均有明显的区别。结论 :根据不同节段颈椎后侧路侧块和椎弓根的解剖特点 ,合理设计经颈椎侧块和椎弓根螺钉的直径和长度 ,准确选择相应的进钉点和进钉方向 ,可以保证颈椎后路侧块和椎弓根螺钉内固定在下颈椎的安全应用。     

腰椎上关节突外缘与椎弓根中心关系的解剖学观测及其临床意义

目的 :探讨腰椎上关节突外缘的形态特点及其与椎弓根中心的关系。方法 :对 10 0套成人干燥腰椎骨标本上关节突乳突的形态特点及其外缘切线与椎弓根外侧骨皮质及中心进行了观测。结果 :L110 0 % ,L2 98.1% ,L396 .4% ,L4 4 5 .8% ,L58.1%上关节突外缘切线位于椎弓根中心的外侧。上关节突外缘切线距椎弓根外侧骨皮质的距离为L1(1.8± 0 .7)mm ,L2 (1.5± 0 .5 )mm ,L3(2 .3± 1.5 )mm。结论 :上关节突外缘多位于椎弓根中心的外侧 ,以它做为椎弓根螺钉进钉的定位标志过于偏外。     

骶二椎弓根钉外进钉固定拧紧力与骶骨应变分布规律的研揪

研究骶二椎弓根钉固定拧紧力与骶骨应变分布,为临床骶二椎弓根钉固定术提供生物力学参数.取正常国人新鲜尸体骶骨标本,以椎弓根钉内进钉法固定于骶二椎弓根,以小型力传感器与椎弓根钉固定装置连接,测量椎弓根钉的拧紧力,同时以动静态电阻应变仪对预先粘贴在四个椎弓根螺栓固定边缘部位和骶骨不同部位的应变片进行应变电测量.得出了椎弓根钉的最大拧紧力和S1椎体、S2椎体、S3椎体正中线左侧和右侧应变值,还得出了S1左侧、S1右侧上关节突关节面部位及S1、2左侧,S1、2右侧骶后孔连线与骶中间嵴交点处应变值.说明骶二椎弓根钉术式符合生物力学原理.     

骶二椎弓根钉外进钉固定拧紧力与骶骨应变分布规律的研究

研究骶二椎弓根钉固定拧紧力与骶骨应变分布,为临床骶二椎弓根钉固定术提供生物力学参数。取正常国人新鲜尸体骶骨标本,以椎弓根钉内进钉法固定于骶二椎弓根,以小型力传感器与椎弓根钉固定装置连接,测量椎弓根钉的拧紧力,同时以动静态电阻应变仪对预先粘贴在四个椎弓根螺栓固定边缘部位和骶骨不同部位的应变片进行应变电测量。得出了椎弓根钉的最大拧紧力和S1,椎体、S2椎体、S3椎体正中线左侧和右侧应变值,还得出了s,左侧、S,右侧上关节突关节面部位及S1、2左侧,S1、2右侧骶后孔连线与骶中间嵴交点处应变值。说明骶二椎弓根钉术式符合生物力学原理。     

Effect of hydrogen peroxide on the metabolism of articular chondrocytes

OBJECTIVE: To examine the effect of hydrogen peroxide on chondrocyte metabolism. MATERIALS AND METHODS: Bovine articular chondrocytes were used. Proteoglycan (PG) synthesis was measured with [35S] sulfate incorporation. For detection of apoptosis, the TdT-mediated dUTP-biotin nick end labeling (TUNEL) and annexin V assay were used. Extracellular-regulated protein kinase (ERK) activity was measured using a mitogen-activated protein kinase assay system. RESULTS: Addition of hydrogen peroxide resulted in the inhibition of PG synthesis, apoptosis, and enhanced ERK activity. CONCLUSION: Hydrogen peroxide plays an important role in regulating the metabolism of chondrocytes.     

Observations on the senescence of cells derived from articular cartilage

In the experiments described here, we have sought to determine whether primary cultures of cells derived from articular cartilage will, upon subsequent subculture, undergo in vitro senescence in a manner analogous to that described for several other types of diploid cell. Using cells from the articular cartilage of rabbits, dogs and man, we have established that the population doubling capacity of cultures of these cells is directly related to the specific lifespan of the donor organism. Furthermore, the doubling capacity of the initial cultures of lapine articular chondrocytes is inversely related to the age of the donor rabbit. By these criteria, serially passaged primary cultures of cells derived from articular cartilage appear, a priori, to be a valid system for studies of cellular ageing. Monolayer cultures of lapine chondrocytes appear to "dedifferentiate" after several passages. However, the same cells can be grown as clones, under which conditions they appear to retain better their differentiated properties. Even under these circumstances, lapine articular chondrocytes have a limited capacity for growth, which can be calculated to approximate to the same average number of cell divisions as undergone by monolayer cultures. Lapine chondrocytes frequently transform into established lines of fibroblastic cells. Transformation of canine chondrocytes was more rare, while human chondrocytes have not been observed to transform. This suggests that resistance to transformation is somehow related to lifespan. In addition to furthering our understanding of cellular ageing, studies of the senescence of articular chondrocytes could provide new insights into the aetiology of primary osteoarthritis.     

Effects of temperature,concentration and articular surface removal on transient solute diffusion in articular cartilage

The diffusion of glucose, inulin and dextran into adult bovine articular cartilage was studied as a function of temperature, solute concentration and articular surface integrity. One-dimensional, transient solute diffusion experiments were performed for 5, 15 and 60 min. The diffusion and interface partition coefficients increased with increasing temperature, but exhibited no concentration dependency when the solute concentration was increased 100-fold. Relative to intact tissue, removal of the uppermost articular surface resulted in decreased solute concentrations within the tissue for all solutes and time periods tested.     

Effects of capsaicin on articular afferents of the cat's knee joint

This study on the effects of capsaicin on primary afferents from normal knee joints of the cat was performed to further elucidate the mechanisms of articular pain evoked by an acute arthritis and by chemical irritants. It showed that close i.a. bolus injection of capsaicin (10^–7–10^–4 M) excites most fine articular afferents (conduction velocity 11.3 m/s) whereas fast units are not excited. Fine afferents with low to medium thresholds to knee joint movement are less readily excited by capsaicin than high threshold ones. The response to capsaicin is usually a rapid burst of impulses of a very short latency. This response pattern differs considerably from that seen after application of endogenous substances produced in inflammation. Thus capsaicin seems to differ in its mode of action from that of endogenous algesic substances.     

寰椎上关节面形态与分型

目的　研究寰椎上关节面的解剖形态学特征。 方法　对125例寰椎上关节面的形态进行分型,并测量关节面的长短轴,深度及长轴与前结节、后结节连线的夹角。 结果　根据寰椎上关节面的解剖学形态可分为4型：Ⅰ型是两侧椭圆,占57.6%（72例）;Ⅱ型两侧哑铃,占23.2%（29例）;Ⅲ型左椭圆右哑铃,占12.0%（15例）;Ⅳ左哑铃右椭圆,占7.2%（9例）。 结论　寰椎上关节面存在多种解剖学形态,以两侧均为椭圆形为主,以往对其认识并不全面。