肩袖间隙的解剖学研究及其临床意义

目的：研究肩袖间隙的组成部分和解剖学特点，及其在肩关节运动中的稳定机制。方法：在12具成人尸体24例肩关节标本上，解剖观察肩袖间隙的位置、组成和形态学特点，以及在肩关节活动中的稳定作用。结果：肩袖间隙是冈上肌腱与肩胛下肌腱之间的三角形区域，主要由喙肱韧带和盂肱上韧带组成；在肩内收位时有限制肩关节外旋和肱骨头下移的作用。结论：①肩袖间隙结构的研究对于RI病变的临床诊治具有重要意义；②肩袖间隙损伤后的修补对于维持肩关节稳定具有重要作用。     

颞下颌关节韧带的断层影像解剖研究

目的：通过cT和MRI扫描,明确颞下颌关节韧带的形态、结构及其断层影像解剖特点。方法：选取60名健康志愿者分别行颞下颌关节CT、磁共振检查,观察颞下颌关节韧带的断层影像解剖特点。结果：颞下颌关节在cT图像中显示韧带呈等密度影,而钙化的韧带呈高密度影;在磁共振T1WI和T2WI图像中,翼下颌韧带、蝶下颌韧带、茎突下颌韧带、颞下颌韧带、下颌锤骨韧带（关节盘锤骨韧带）均显示为结构清晰的低信号影像,骨皮质在T1WI及T2WI图像中均显示为结构清晰的低信号影像,骨髓质均显示为结构清晰的高信号影像。结论：CT、磁共振成像可清楚地显示颞下颌关节韧带的断层影像解剖结构。     

正常踝关节内、外侧韧带的解剖及其影像学表现

目的:探讨正常踝关节内、外侧韧带的解剖形态及其MRI和CT表现。方法:6例正常人踝关节新鲜标本MRI扫描,解剖显示内、外侧韧带后,CT断层扫描与MRI对照观察踝关节内、外侧韧带的影像学表现;在30例正常志愿者踝关节的MRI上测量内、外韧带的宽度及厚度。结果:MRI横断面及冠状面可充分显示踝关节内、外侧韧带及其周围组织的解剖结构;踝关节内、外侧韧带在冠状面及横断面上所测的宽、厚度,男女间存在一定的差异。结论:MRI能清晰地显示踝关节的解剖结构,所测量的正常踝关节内、外侧韧带的宽、厚度数据,为临床诊断踝关节内、外侧韧带的病变提供了形态学依据。     

The pineal region: thin sectional anatomy with MR correlation in the coronal plane

This study was undertaken to explore the anatomic features and adjacent relationships of the pineal region in thin coronal sections. After CT and MR examination verifying no brain lesions, one normal cadaver head was selected for this study from three Chinese adult male cadavers. After being embedded and frozen, the head was sliced into serial sections at 0.1 mm intervals in the coronal plane with SKC 500 computerized freezing milling machine. Then the serial coronal sections were photographed by a high-resolution digital camera and saved in the computer. Subsequently, the anatomic structures of the pineal region on the thin coronal sections were investigated and correlated with in vivo MR images, which were obtained from ten normal Chinese male adult volunteers by a 3.0 T GE scanner. The base lines of the sectioning and the MR scan were all perpendicular to the AC–PC line. A total of 355 coronal sections and 21–23 in vivo coronal MR images related with the pineal region were obtained, respectively. From anterior to posterior, the shape of the pineal region changed from an inverted triangle to a trapezoid and a triangle gradually, and the anatomic details could be depicted clearly in the thin sectional anatomy images in sub-millimeter. Via the comparison, some micro-anatomic structures of the pineal region that cannot be discriminated clearly or missed in the thick sections or MR images were identified. The contrast of the computerized freezing milling technique with the MRI enhanced our ability to comprehend the complex anatomy of the pineal region and to improve the imaging diagnosis and surgical treatments of minute diseases in this region.     

肱骨近端骨折内固定相关应用解剖学研究

目的　为肱骨近端骨折内固定提供解剖学基础。 方法　成人尸体肩关节标本10具20侧。从三角肌前中部肌束间隙钝性分离游离出腋神经,将钢板插入腋神经与骨之间,固定于肱骨大结节顶点下方,结节间沟后方。测量腋神经上缘与大结节顶点、与肩峰上缘的距离。截取带钢板的肱骨近端进行体外测量并观察钢板螺钉与肱骨头颈、大结节顶点和结节间沟的关系。 结果　大结节顶点、肩峰上缘距腋神经距离分别为(3.44±0.38)cm和(5.44±0.62)cm;钢板上缘到肱骨大结节顶点距离为(0.59±0.14)cm,到结节间沟距离为(0.74±0.19)cm。体外观察并测量见钢板置于肱骨大结节顶点下0.5 cm,结节间沟后方0.5 cm时螺钉平行肱骨颈并位于肱骨颈中央。 结论　(1)肱骨大结节下2.90~4.32 cm是容易损伤腋神经的危险区域。(2)肱骨大结节顶点下0.50 cm,结节间沟后方0.50 cm是钢板放置的最佳位置。(3) PHILOS钢板的C、D、E孔和LPHP的C、D孔是危险区域。     

Sonographic anatomy of the pubic symphysis in healthy nulliparous women

Pregnancy‐related symphyseal pain is a condition commonly encountered by clinicians but its pathogenesis is poorly understood. The pubic symphysis is readily visualized with ultrasound, yet the normal sonographic anatomy of the joint has not been accurately documented. This study aimed to describe the anatomy of the pubic symphysis in healthy, nulliparous women using ultrasound. An experienced and inexperienced sonographer scanned the joint in 30 female volunteers (mean age 26 years). Interobserver and intraobserver reliability of ultrasound measurements were examined and the accuracy of these measurements was validated by ultrasound and dissection of six female cadaver pelves (mean age 75 years). In healthy young women, pubic symphysis morphology varied, and six categories of anterosuperior joint shape were defined. Mean values of several anatomic parameters were obtained in supine and standing positions: joint width (widest 10.1 mm, narrowest 2.6 mm); superior pubic ligament (SPL) length and depth (41.4 and 3.4 mm, respectively); and pubic crest length (left 24.4 mm, right 24.4 mm). Statistically significant relationships between SPL width and depth and anthropometric variables (body mass index, pelvic width, and body fat percentage) were established. Larger ultrasonographic measurements, such as wide joint width and SPL length, could be measured more reliably than smaller measurements, such as narrow joint width and SPL depth, in both healthy volunteers and cadavers. Findings from this study provide normative reference data for examination of the pubic symphysis in pregnant women and may therefore be relevant to understand pregnancy‐related symphyseal pain. Clin. Anat. 27:1058–1067, 2014. © 2014 Wiley Periodicals, Inc.     

MRI不同序列对骶髂关节软骨成像的比较

背景：平片及CT不能显示关节软骨的改变,磁共振虽可显示软骨,但常规序列软骨显像效果欠佳,因此若要提高MRI检出软骨病变的能力,序列的优化显得非常重要。 目的：比较骶髂关节常用磁共振成像序列,筛选适合骶髂关节软骨MRI最佳成像序列。 方法：对45健康志愿者分别行骶髂关节MRI自旋回波T1WI、T2WI、T1-flash-3d-water-cor、T2-me3d-cor和T2-me2d-cor和T1-se-cor-water-fil扫描,比较各个序列显示骶髂关节软骨的清晰度、内部信号变化及软骨表面缺损。 结果与结论：自旋回波T1WI和T2WI序列45均显示骶髂关节软骨为一条稍高信号带,关节间隙不清;梯度回波T1-se-cor-water-fil序列45均显示两侧关节面骨皮质与髂侧软骨、骶侧软骨及软骨间隙形成的5条平行线状结构;T2-me3d-cor、T1-flash-3D-water-cor-fil序列45例受检者关节软骨为一条明亮、清晰高信号,与周围骨皮质及骨髓分界非常清晰,但骶侧、髂侧软骨不能够区分。T2-me2d-cor序列 37例能显示髂侧、骶侧软骨及软骨间关节间隙,8例分辨不清;弥散成像序列仅部分层面能显示关节软骨,诸结构显示较模糊,信号强度对比不鲜明。结果说明,T1-se-cor-water-fil在关节软骨显示程度、内部信号变化和软骨表面缺损程度等方面明显优于其他序列。T1-flash-3d-water-cor、T2-me3d-cor和T2-me2d-cor对软骨表显示方面优于常规MRI序列,但不如T1-se-cor-water-fil。 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程      

Interpretation of multi-detector computed tomography images before dissection may allow detection of vascular anomalies: a postmortem study of anomalous origin of the right subclavian artery and the right vertebral artery

The Graduate School of Medicine at Chiba University is planning to introduce computed tomography (CT) images of donated cadavers to the gross anatomy laboratory. Here we describe an anomaly of the right subclavian artery that was detected by interpretation of CT images prior to dissection. The anomaly was verified to be the right subclavian artery, as the last branch of the aortic arch, by subsequent dissection of the cadaver. We also identified an anomalous origin of the right vertebral artery by dissection. This anomaly was also visible on CT images, although it had not been recognized in the first interpretation of the CT images. Our results suggest that branching anomalies of arteries with a diameter of >1?cm are detectable on CT images even without the injection of contrast medium. We also discuss the utility of interpreting CT images prior to dissection as a means by which medical students can gain a better understanding of human body during the gross anatomy laboratory.     

Surgical and clinical anatomy of the interclavicular ligament

Dislocation of the sternoclavicular joint can be associated with life-threatening complications; therefore, a thorough knowledge of the ligaments contributing to sternoclavicular joint stability is essential for the clinician dealing with this anatomical area. The aim of our study was to examine the anatomy of the interclavicular ligament. We examined 50 human cadavers. The interclavicular ligament was identified in 90% of the specimens. The interclavicular ligament was located at the base of the sternal notch in 50% of the cases and connected the superior portions of the capsule of the sternoclavicular joints of each side. The interclavicular ligament connected with the posterior superior aspect of each medial end of the clavicle and with the fibers of the posterior and anterior interclavicular ligaments forming a continuous ligamentous layer. The mean length of this ligament was 2.1 cm, the mean width was 0.72 cm and the mean thickness was 0.36 cm. With the elevation of the shoulder joint and the abduction of the humerus, the interclavicular ligament remained lax. With the depression of the shoulder joint and the adduction of the humerus, this ligament became fully taut. As a result, the interclavicular ligament prevented the upward displacement of the clavicle during forceful depression of the humerus and the shoulder. The tensile force necessary for failure was >53.7 N/cm² in all the specimens. These data may be useful to surgeons for instituting techniques for surgical procedures that reconstruct the sternoclavicular joint. Moreover, a future study aimed at evaluating the long-term consequences of surgical transection of this ligament may be in order.     

Visible Korean Human: its techniques and applications

Three recent studies have offered an unprecedented view of the human body. The Visible Human Project, the Visible Korean Human (VKH), and the Chinese Visible Human have featured the serial sectioning of whole cadavers, producing cross-sectional images that methodically catalogue gross human anatomy. By volumetric reconstruction, these cross-sectional images can be transformed into three-dimensional (3D) images of anatomic structures. Compiling these 3D images would create an invaluable library for medical education and research. The goal of this report is to promote the expansion of such a library of 3D anatomic images and to help users fully understand and utilize the serially sectioned images. To do this, we will discuss the fundamental techniques and equipment used in the VKH and its preliminary experiments. We will also address new applications of the VKH, including virtual brain surgery, virtual endoscopy, and virtual cardiopulmonary resuscitation via the development of virtual dissection software.     

肩关节周围滑膜囊,鞘的观察及其临床意义

在50侧成人标本上,对肩关节周围的滑膜囊及鞘进行了解剖和测量,其中有与关节腔相通的结节间滑膜鞘、肩胛下肌腱下囊和冈下肌腱下囊;与关节腔不通的肩峰下囊、三角肌下囊、喙突下囊,背阔肌腱下囊及胸大肌腱下囊.观察了它们的形态、位置、数目,测量了有关径线,讨论了其应用解剖学要点。     

The spinoglenoid ligament: an anatomic study

The spinoglenoid ligament and its anatomic variations are described in 27 shoulders from 15 cadavers. In each shoulder one or two distinct spinoglenoid ligaments originated from the base of the spine of the scapula; they inserted on the neck of the scapula or the shoulder joint capsule. In the 19 shoulders in which only one spinoglenoid ligament was present, it inserted into the neck of the scapula in 14 cases and into the shoulder joint capsule in five instances. In the eight shoulders in which there were two ligaments, one inserted into the neck of the scapula and the other into the shoulder joint capsule. We did not observe any hypertrophic spinoglenoid ligaments that may have compressed the suprascapular nerve.     

Classic versus millennial medical lab anatomy

This study investigated the integration, implementation, and use of cadaver dissection, hospital radiology modalities, surgical tools, and AV technology during a 12‐week contemporary anatomy course suggesting a millennial laboratory. The teaching of anatomy has undergone the greatest fluctuation of any of the basic sciences during the past 100 years in order to make room for the meteoric rise in molecular sciences. Classically, anatomy consisted of a 2‐year methodical, horizontal, anatomy course; anatomy has now morphed into a 12‐week accelerated course in a vertical curriculum, at most institutions. Surface and radiological anatomy is the language for all clinicians regardless of specialty. The objective of this study was to investigate whether integration of full‐body dissection anatomy and modern hospital technology, during the anatomy laboratory, could be accomplished in a 12‐week anatomy course. Literature search was conducted on anatomy text, journals, and websites regarding contemporary hospital technology integrating multiple image mediums of 37 embalmed cadavers, surgical suite tools and technology, and audio/visual technology. Surgical and radiology professionals were contracted to teach during the anatomy laboratory. Literature search revealed no contemporary studies integrating full‐body dissection with hospital technology and behavior. About 37 cadavers were successfully imaged with roentograms, CT, and MRI scans. Students were in favor of the dynamic laboratory consisting of multiple activity sessions occurring simultaneously. Objectively, examination scores proved to be a positive outcome and, subjectively, feedback from students was overwhelmingly positive. Despite the surging molecular based sciences consuming much of the curricula, full‐body dissection anatomy is irreplaceable regarding both surface and architectural, radiological anatomy. Radiology should not be a small adjunct to understand full‐body dissection, but rather, full‐body dissection aids the understanding of radiology mediums. The millennial anatomy dissection laboratory should consist of, at least, 50% radiology integration during full‐body dissection. This pilot study is an example of the most comprehensive integration of full‐body dissection, radiology, and hospital technology. Clin. Anat. 27:988–993, 2014. © 2014 Wiley Periodicals, Inc.     

Pathological analysis of cadavers for educational dissection by using postmortem imaging

This study was performed primarily to clarify whether pathological analysis of cadavers for anatomical dissection is possible using postmortem imaging (PMI), and whether this is worthwhile. A total of 33 cadavers that underwent systematic anatomical dissection at our medical school also underwent PMI. Fixative solution was injected into the corpus 3–4 days after death. PMI was then performed using an 8‐slice multi‐detector CT scanner 3 months before dissection. Before dissection, a conference was held to discuss the findings of the PMI. First, two radiologists read the postmortem images without any medical information and deduced the immediate cause of death. Then, the anatomy instructor revealed the medical information available. Based on this information, the radiologist, anatomy instructor, and pathologists suggested candidate sampling sites for pathological examination. On the last day of the dissection period, the pathologists resected the sample tissues and processed them for pathological examination. In 12 of 33 cases, the presumed causes of death could be determined based on PMI alone, and revision of the cause of death described in the death certificate was considered in five (15.2%) cases, based on PMI and pathological analysis. This article presents a novel method of pathological analysis of cadavers for anatomical dissection using PMI without disturbing the anatomy education of medical students.     

颈椎钩突邻近结构薄层断面与MRI对照研究

目的阐明颈椎钩突在薄层断面和MRI断面图像上与周围结构的毗邻关系,为颈椎退行性疾病提供影像学诊断依据。方法选取5例中国数字化可视人体（CVH）数据集中C3-C7椎体上缘清楚显示钩突的薄层断面图像,观察并测量钩突与邻近的椎动脉和颈神经的位置关系,选择对应平面的MRI断面图像对照分析。结果CVH数据集的薄层断面清晰显示颈椎钩突及其周围结构,在断面上测量并得出钩突与颈神经、钩突与椎动脉的距离的平均值,MRI清楚显示颈椎钩突及其邻近结构。结论将CVH数据集中的颈椎钩突平面的薄层断面与对应的MRI图像进行对照研究,可为颈椎病的影像学诊断和治疗提供形态学参考。     

Radiological anatomy of the intratemporal course of facial nerve

Preoperative evaluation of the facial nerve (FN) anatomy within the temporal bone by high-resolution computed tomography (HRCT) helps in minimizing surgical trauma to the nerve. In order to demonstrate the radiological correlation of the intratemporal FN, eight adult, formalin-preserved cadavers were studied by comparing the transaxial and coronal sections of HRCT with anatomic microdissection findings. It was possible to visualize all segments of the FN canal in its intratemporal course. The most difficult part of the FN to demonstrate was the pyramidal section. Anatomic microdissection findings were consistent with the HRCT images. It was concluded that adequate information on the FN anatomy could be obtained from standard HRCT scans.     

喉部动脉影像解剖学的应用研究

目的研究喉部动脉的影像解剖学为临床提供解剖学依据和资料。方法取36例喉部结构完整的尸体标本,8例尸体标本做动脉铸型,12例尸体标本用MR扫描仪进行水平面和矢状面的扫描,8例尸体标本进行1mm/片冰冻磨铣,8例尸体标本进行大体及显微解剖,并对5种不同的形态学研究方法关于喉部动脉的观测结果进行统计学分析和定性、定量研究。结果左、右甲状腺上动脉的长度分别为(42.30±0.20)mm和(40.50±0.20)mm,起点处的管径分别为(1.80±0.30)mm和(1.65±0.30)mm;左、右甲状腺下动脉的长度分别为(23.60±0.27)mm和(22.40±0.24)mm,起始点的管径为分别为(1.40±0.25)mm和(1.35±0.30)mm。喉上动脉起点处的管径(1.50±0.20)mm,入喉处管径为(1.32±0.15)mm,长度为(18.60±2.45)mm;其入喉处在甲状软骨的前下方,距甲状软骨上角尖的距离,左侧为(6.80～25.50)mm,平均(14.60±2.45)mm;右侧为(7.60～28.60)mm,平均(15.58±2.58)mm,两侧差异有统计学意义(<0.05)。喉下动脉起点处的管径(1.70±0.30)mm,长度为(15.50±1.80)mm。结论喉部动脉的影像解剖学研究,为耳鼻喉头颈科特别是喉部病变的临床诊断和治疗提供更为科学和全面的影像解剖学依据及血供形态学资料。     

上下唇血液供应及其临床意义

目的：研究上下唇的血液供应,为新的组织瓣设计提供解剖学基础。方法：对10具从面动脉灌注红色乳胶的成年新鲜尸体标本的口周区域进行解剖研究,在2具尸体标本的面静脉内注入兰色乳胶。在3.5倍的手术放大镜下解剖显著血管。结果：上唇动脉发生浅隔支与深隔支,向上走行进入鼻中隔前下部参与克氏动脉丛的组成。观察到2种新的下唇动脉的分布情况。下唇动脉沿途发出唇颏支,与进入颏部的其它血管分支相互吻合。结论：上下唇血供丰富,可设计含浅、深隔支的上唇岛状组织瓣、含鼻隔支的岛状鼻中隔软骨粘膜瓣及含颏唇支的颏唇瓣;了解下唇动脉的解剖变异,对成功地施行一期下唇动脉岛状瓣手术是很重要的。     

A rare accessory coracobrachialis muscle: a review of the literature

During previous dissections to investigate the incidence of the third head of the biceps brachii in neonate cadavers an accessory coracobrachialis muscle was unilaterally found in a neonate male cadaver. This muscle originated from the coracoid process and the capsule of the shoulder joint. It was inserted into the antebrachial fascia and the medial epicondyle of the humerus. The coracobrachialis muscle is used as a transposition flap in deformities of infraclavicular and axillary areas and in postmastectomy reconstruction. It is also a guide to the axillary artery during surgery and anesthesia. This additional muscle may cause musculocutaneous or high median nerve paralysis. We were unable to find any similar case in the published literature. The anatomic variations of the coracobrachialis muscle may cause confusion during surgery or evaluation of CT and MRI scans.