颅骨锁孔经小脑幕上至幕下内镜手术入路的应用解剖

目的:探讨经颅骨锁孔由小脑幕上至幕下内镜手术入路的可行性和解剖学基础。方法:利用50件颅骨干标本观测相关骨性标志及其与硬脑膜窦沟的对应关系;利用10具湿性头部标本观测锁孔体表定位标志、小脑幕切口定位标志、内镜入路的角度、深度等解剖参数。结果:顶乳缝前角、乳突尖、枕外隆凸与乙状窦、横窦体表投影之间具有对应关系;小脑幕外侧部,颞骨弓状隆起后缘、小脑幕窦入口和乙状窦上曲内缘之间有1个安全三角区(小脑幕安全三角);以星点至顶乳缝前角连线中点所作上垂线15 mm处作为锁孔中心点,内镜可从锁孔经小脑幕安全三角至幕下脑桥小脑三角区。结论:颅骨锁孔经小脑幕上至幕下内镜手术入路具有可行性。有利于切除累及幕上下的病灶。     

锁孔入路治疗基底动脉瘤的应用解剖

目的 :研究眶上、颞下锁孔入路到达基底动脉顶端的入路解剖 ,探讨其治疗基底动脉分叉部动脉瘤的可行性。方法 :在 2 1例福尔马林固定尸体头颅标本上测量入路相关数据 ,在 9例新鲜尸体头颅标本上模拟行内窥镜辅助经眶上锁孔入路、经颞下锁孔入路基底动脉分叉部动脉瘤夹闭的手术操作 ,观察显露范围及操作范围 ,入路中各解剖结构对手术区显露及操作的影响。结果 :眶上孔、角突及颧弓上缘颞颧缝处与同侧及对侧后床突尖的距离分别为 (61.5± 1.7)mm、(92 .1± 3 .6)mm、(3 3 .5± 3 .1)mm、(73 .6±1.1)mm、(95 .6± 1.7)mm、(5 2 .3± 2 .2 )mm ;眶上孔、角突及颧弓上缘颞颧缝处与同侧及对侧后床突尖分别连线与中线的夹角分别为 (3 6.6± 1.2 )°、(8.5± 2 .3 )°、(82 .6± 3 .0 )°、(4 5 .1± 3 .0 )°、(3 0 .5± 3 .4)°、(83 .5± 4.0 )°。眶上、颞下锁孔入路均能通过多种神经血管间隙达到靶区 ,显露良好 ,照明充分 ,操作空间充分。结论 :采用内窥镜辅助的锁孔入路能满意的治疗基底动脉分叉部动脉瘤。     

乙状窦后入路骨瓣开颅应用解剖学研究

目的对乙状窦后入路的骨瓣设计进行改良研究,寻找一种安全、快速、有效、并发症少的骨瓣开颅技术。材料成人颅骨标本10例,福尔马林固定尸头标本15例,新鲜头颅标本3例。高速磨钻。电动开颅钻。照像器械:Sony S-75数码相机。Leica M500-N,Opton手术显微镜。方法确定横窦和乙状窦的交界内下缘(A点)和星点(枕乳缝和人字缝交叉点,S点)的解剖关系;乙状窦垂直部和水平部交汇处内下缘(B点)和枕乳缝乳突基底水平处(C点)的关系。测量A-S和B-C点的距离。在距星点内侧3cm处横窦的下缘钻孔M点,测量星点和枕外粗隆-星点连线的垂直距离。结果1.横窦和乙状窦交点的位于星点外下方,横断面上,平均距离为10.8±1.1mm。在矢状位方向,平均距离为3.5±0.7mm。且颅骨和头颅标本无明显的统计学差异。2.乙状窦水平段和垂直段交点(B点)位于乳突基底水平枕乳缝点(C点)的外下方,在横断面上平均距离5.8±1.8mm。矢状位方向距离为8.4±0.8mm.头颅标本所测得的数据和颅骨的数据在统计学上无显著差异。3星点内侧3cm处横窦下缘(M点)和枕外粗隆-星点连线的垂直距离(M-P)左右存在差异,左侧1.2±0.3mm,右侧4.2±0.4mm.右侧高于左侧。结论行乙状窦后入路骨瓣开颅时,取星点外下方、枕乳缝乳突基底外下方为钻孔点是安全、快速的方法;在横窦下方钻孔时要注意左右横窦高度的。     

面神经颞颧支临床应用解剖学研究

目的：观测面神经颞颧支及其分支的正常局部解剖,旨在为颧骨颧弓骨折开放复位内固定手术入路提供解剖学参数.方法：对11例（22侧）成人尸体面侧区及颞额区进行层次解剖,观察面神经颞颧支在颧弓区域分布与走向,测量面神经颞颧支各分支与颧弓间位置和距离.另对10例（10侧）颧骨颧弓联合骨折患者手术进行临床观测.结果：22侧颞支及分支均跨颧弓后端浅面上行,其中14侧含1～2分支位于颧弓后1/3段上缘0.8～2.0 cm处,呈20°～35°角斜向上行.颧支分支多且粗大,22侧中19侧（86.4%）颧支及分支位于颧弓后段下缘0.5～1.2 cm处前行,并于颧弓前中1/3段上跨颧弓表面,呈28°～45°角斜向上行,3侧（13.6%）位于颧弓表面或上缘0.5～0.8 cm 处向前行并斜向眼外眦.上颊支位于颧弓中1/3段下缘最短距离1～1.5 cm,最长距离2.3～2.8 cm.10侧手术野见颞支均位于颧弓根部上方跨过,沿后1/3段上缘1.2～2.5 cm斜向前上方;颧支位于颧弓后1/3段下缘前行,并于前中1/3段跨过颧弓斜向外眦.结论：掌握面神经颞颧支及其分支的解剖层次、分布走行以及与颧弓的位置关系,对于经头皮冠状切口入路颧骨颧弓骨折开放内固定复位术中避免损伤面神经颞颧支具有重要意义.     

面神经颞支的应用解剖学研究

目的:为预防额颞区手术和翼点入路的颅内手术损伤面神经颞支提供解剖学资料。方法:60侧成人头部标本,解剖观测面神经颞支的分支、行程及层次。结果:(1)面神经颞支多为2~4支,占95.00％(57侧)。(2)面神经颞支离开腮腺上缘后向前上走行,从颧弓浅面跨过进入额颞区,后走行于浅筋膜和颞筋膜浅层之间;在腮腺上缘及颧弓上缘处面神经颞支的最后1支距耳屏尖的距离分别为(23.79±0.27)mm和(30.67±0.37)mm。结论:面神经颞支入肌前在颧弓以下一段位置较深、以上表浅。从耳屏尖向前23mm范围内无该神经通过,为手术安全区。     

成人CT血管成像横窦体表定位研究及其意义

目的　利于64排螺旋CT确定横窦和乙状窦的体表定位,评价采用上项线和颧弓-枕外隆突连线作为横窦标志的准确性,为横窦区入路相关手术的骨窗定位提供解剖学基础。 方法　回顾性重建100例进行过64排螺旋CT头部CTA检查患者的横窦和乙状窦影像,对比观察体表骨性标志与静脉窦的位置关系,确定横窦的体表定位。 结果 星点主要位于横窦和乙状窦连接部的横窦侧;星点位于横窦和乙状窦连接部前上方占4%,星点恰好位于连接部占81%,星点位于连接部后下方占15%。颧弓-枕外隆突连线和上项线走行不完全一致,它们与横窦的关系多样;上项线与横窦走行不一致;颧弓-枕外隆突连线可作近段横窦的定位标志,但是随着它们向外移行,颧弓-枕外隆突连线则主要位于横窦下方,并且它们的距离越来越远。 结论 上项线不能代表颧弓-枕外隆突连线的走行,同时它们都不是定位横窦的可靠标志,64排螺旋CT的头部减影CTA检查可作为常规术前检查来明确个体解剖资料从而定位横窦和乙状窦,以便指导横窦区相关手术入路设计。     

内窥镜辅助颞下锁孔入路的应用解剖

目的 :为颞下锁孔入路提供解剖学基础。方法 :2 1例福尔马林固定尸体头部标本上进行入路相关解剖结构观察和测量 ,在 9例新鲜标本上模拟内窥镜辅助颞下锁孔入路手术 ,记录入路的显露范围及可利用的操作空间 ,尝试增加显露和操作空间的方法。结果 :圆孔、卵圆孔、棘孔、三叉神经压迹、弓状隆起、岩大神经裂孔到颞下颌关节处颧弓上缘和中线的距离分别为 :(4 5 .2± 3 .3 )mm和 (2 0 .1± 2 .3 )mm、(3 2 .6± 2 .1)mm和 (2 3 .7± 1.2 )mm、(2 8.9± 1.1)mm和 (3 1.2± 3 .1)mm、(4 0 .1± 1.2 )mm和 (15 .6±2 .7)mm、(2 5 .0± 2 .7)mm和 (3 3 .8± 0 .9)mm、(2 6.7± 2 .3 )mm和 (2 9.6± 0 .8)mm ,Kawase三角各边长度 :耳蜗至岩大神经与下颌神经交点 (18.6± 1.6)mm、耳蜗至三叉神经孔 (19.6± 1.5 )mm、三叉神经孔至岩大神经与下颌神经交点 (16.2± 0 .8)mm ;Day菱形区各边长度 :三叉神经孔至岩大神经与下颌神经交点(16.2± 0 .8)mm、弓状隆起至三叉神经孔 (2 1.7± 2 .5 )mm、岩大神经与下颌神经交点至膝状神经结 (7.2± 1.3 )mm、膝状神经结至弓状隆起 (12 .5± 2 .1)mm ;颞下锁孔入路最大控制范围前至视交叉 ,后到脑干腹外侧乳头体至中下斜坡的区域。结论 :颞下锁孔入路是治疗鞍上区和岩斜区病变     

枕下远外侧手术入路的临床解剖学研究

目的研究远外侧入路的解剖标志和解剖参数,为术中保护重要结构提供解剖学依据。方法采用远外侧入路解剖成人头颅标本10具,在显微镜下对该入路涉及的肌肉、骨性结构、血管、神经进行解剖学观察和测量。结果前星点到星点的距离:左侧(21.68±1.88)mm,右侧(22.34±2.62)mm;前星点至乳突尖的距离:左侧(38.56±3.48)mm,右侧(39.14±2.24)mm;星点至颧弓根的距离:左侧(55.72±3.64)mm,右侧(56.16±2.72)mm。结论枕下三角和第2颈神经是寻找椎动脉的重要标志,前星点、星点、乳突尖和颧弓根可作为远外侧入路的骨性标志。     

内窥镜辅助乙状窦后锁孔入路的应用解剖

目的:研究内窥镜辅助下乙状窦后入路中的相关解剖,为临床应用提供参考资料.方法:在15具甲醛固定国人成年头颅标本上模拟乙状窦后入路手术操作,内窥镜下观察桥小脑角及入路相关解剖结构并测量手术相关解剖数据.结果:乙状窦大多分布在顶乳缝前角-乳突尖连线深面.乳突导静脉存在率为93.3%,均汇于乙状窦,其中67.9%与枕静脉的分支相交通.乙状窦后缘中点与Meckel囊内口、Dorello管、岩静脉-岩上窦交点、内耳门、舌咽神经、舌下神经及椎动脉的距离分别为(45.15±2.35)mm、(52.82±2.98)mm、(34.68±5.80)mm、(31.79±2.55)mm、(32.59±2.39)mm、(40.45±2.80)mm及(41.12±3.16)mm,横窦-乙状窦交点后缘与以上各点的距离分别为(48.10±2.34)mm、(57.41±2.76)mm、(38.19±4.87)mm、(36.00±2.11)mm、(38.39±3.02)mm、(47.71±3.08)mm及(49.31±3.18)mm.结论:内窥镜的应用和手术操作中熟悉乙状窦后缘、横窦-乙状窦交点及其毗邻结构的位置关系,可使乙状窦后锁孔入路更加微创.     

颧骨缩小术的临床应用解剖

目的 :为更好地开展颧骨缩小术并减少其并发症提供解剖学基础。方法 :用巨微解剖的方法观察 13例防腐成人头部和 9例新鲜成人头部标本 ;用断面解剖的方法观察 2例防腐成人头部标本。结果 :①面神经颞支在颧弓下缘出腮腺后斜向前上方行走 ,相对集中在颧弓中部越过颧弓并逐渐分支 ,达颞部已分支成网。②颧支出腮腺后分为深、浅两支 ;深支平行于颧弓下缘前行 ,在距颧大肌起点 (1.2± 0 .3 )cm处进入颧大肌的深面 ;浅支斜向前上方行走 ,在距颧大肌起点 (0 .6± 0 .2 )cm处跨过颧大肌的浅面。③冠突与颧骨间的距离为 (12 .3± 3 .6)mm及该处颧骨的厚度为 (8.8± 2 .3 )mm ,冠突与颧弓间的距离为 (6.5± 1.2 )mm及该处颧弓的厚度为 (3 .3± 0 .4)mm。结论 :在骨膜下操作 ,可减少面神经损伤 ;在上颌骨外侧壁与颧骨眶外侧凸的连线之外部位行颧骨磨削或截骨 ,可避免破坏上颌窦和眼眶。     

臂后侧皮瓣的应用解剖

在50侧经红色乳胶灌注的成年尸体上,对臂后侧皮瓣的血管和神经进行了观察。臂后侧皮瓣的动脉多为1支,大部分由肱动脉、肱深动脉发出,少数由腋动脉发出,起始处外径平均1.4mm,干长4.3cm。伴行静脉注入处外径1.3mm。臂后皮瓣内的臂后皮神经横径为1.3mm。     

Posterior tibiotalar ligament: An anatomic study correlated with MRI

This study was performed to clarify the morphologic characteristics of two layers of the posterior tibiotalar ligament (PTT) and two bands of the deep PTT (dPTT), and to correlate the dissection findings with MR images. Sixty‐four ankles from 42 cadavers were examined. The origin and insertion sites of the superficial PTT (sPTT) and the two bands of the dPTT were identified, and their length, width, and thickness were measured. MRI was performed on four ankles before serial sectioning or dissection. The serial sections were taken at a thickness of 2 mm. The sPTT was observed in 50 out of 60 dissected specimens (83.3%), taken from 64 ankles of 42 cadavers. The dPTT was observed in all specimens. The sPTT, superficial band of the dPTT (sdPTT), and deep band of the dPTT (ddPTT) arose from the inferior surface of the medial malleolus. The sPTT attached to the posterior process of the talus, and the sdPTT and ddPTT attached to the depression below the articular facet for the medial malleolus. The sPTT and two bands of the dPTT could be distinguished on coronal MR images, where the sPTT appeared as a thin string superficial to the two bands of the dPTT, which were separated as two thick, low‐density strings. In the coronal plane of frozen sections, the outermost sPTT appeared as a thin, white bundle attached to the sdPTT. The PTT is composed of superficial and deep layers, and the dPTT is composed of superficial and deep bands. Clin. Anat. 27:798–803, 2014. © 2013 Wiley Periodicals, Inc.     

以颞浅血管为蒂的耳后乳突区皮瓣的应用解剖

在17侧防腐尸体上于颞浅动脉内推注染料,观察其对耳后乳突区皮瓣的血供。耳后乳突区皮肤的血供除来自耳后动脉外.还有颞浅动脉顶支发出的耳后支直接分布。顶支与耳后动脉之间有一血管吻合区域.临床6例活体观察证实了上述结果。应用以颞浅血管为蒂的耳后乳突区皮瓣,进行颜面器官的修复再造14例,获得良好效果。     

胃后动、静脉的应用解剖学

用100具尸体(成尸66、童尸34),观测了胃后血管。(1)胃后动脉 出现率88.0%,1支者占89.8%,2支者占10.2%.起自脾动脉中1/3段者居多(78.6%),有94.9%的胃后动脉穿入胃底部后壁。该动脉平均长3.5cm,外径1.5mm.(2)胃后静脉 出现率87.0%,1支者占92.0%.注入脾静脉中1/3段者较多(76.6%),该静脉平均长4.4cm,外径1.7mm。     

Anatomical dissection of the deep posterior compartment and its correlation with clinical reports of chronic compartment syndrome involving the deep posterior compartment

Patients with clinical presentation of deep posterior chronic compartment syndrome (CCS) frequently have symptoms limited to either proximal or distal components of the deep posterior compartment. In this study the posterior aspect of 15 cadaver legs was dissected to document anatomical separations and delineate boundaries, if any, of the deep posterior compartment and to correlate the findings to these patients. Origins of flexor hallucis longus (FHL), flexor digitorum longus (FDL), and tibialis posterior (TP), as well as whether TP existed in its own osseofascial compartment, were noted. Ten specimens had an identifiable distinct layer of tissue separating the deep posterior compartment into two potentially clinically relevant components. Much of this layer was derived from origins of FDL and its anatomical position in relation to the TP muscle. In seven of these cases, FDL had a significant fibular origin in addition to the well-established tibial origin. This essentially compartmentalized the distal third of the tibialis posterior as it descends anterior and medial to FDL in the lower one-third of the leg in five specimens. No cadaver possessed a significant fascial septum encasing TP and separating it from other deep posterior muscles. This study confirms the existence of a proximal and distal sub-compartment of the deep posterior compartment as a variant and supports the most frequent clinical presentation of deep posterior CCS as involving either the distal or proximal deep compartment, rather than the entire deep posterior compartment. The anatomic arrangement of muscles in the deep posterior compartment creates sub-compartments, which may explain the successful outcomes following a deep compartment release limited to symptomatic portion(s) of the deep compartment. Clin. Anat. 10:104–111, 1997 © 1997 Wiley-Liss, Inc.     

第5～9肋间后动脉侧副支的观测及临床意义

目的:为临床胸膜腔穿刺术提供直观解剖学依据。方法:在２５侧成人标本上对第５~９肋间后动脉的侧副支进行观测,并对照活体进行比较观测。结果:①在第５~９肋间后动脉,侧副支起始处距椎体侧缘的距离平均为(２．３±０．３)ｃｍ;②第５~９肋间后动脉,侧副支起始处在胸后壁体表投影点距后正中线的距离,分别是(４．３±０．３)、(５．０±０．２)、(５．０±０．３)(５．０±０．２)、(５．０±０．１)ｃｍ。结论:①第５~９肋间后动脉在靠近椎体侧缘附近就已发出了侧副支;②行胸膜腔穿刺时宜于侧副支起始处的体表投影点以外进行。     

游离前臂背侧皮瓣的应用解剖

目的:为以骨间后动脉为蒂的游离皮瓣提供解剖基础.方法:用20侧成尸上肢标本,观测骨间后动脉在前臂下1/3区穿支数日、位置、外径以及最粗皮支到尺骨茎突远端的距离;测量支配尺侧腕伸肌神经支与骨间后动脉交叉处血管外径和到最粗穿支发出点的距离.同时观察前臂后皮神经分布.结果:骨间后动脉在前臂下1/3有(3.0±1.1)条穿支,去除外径小于0.2 mm者,还有(2.6±0.8)条.穿深筋膜点穿支外径(0.4±0.2)mm,发出点外径(0.5±0.3)mm(P>0.05).最粗穿支从穿深筋膜点和发出点到尺骨茎突远端的距离分别为(5.5±1.1)cm和(5.6±1.6)cm(P>0.05).神经支和血管交叉处动脉外径(1.5±0.2)mm.最粗穿支发出点到交叉处距离(10.8±3.3)cm.前臂后皮神经在前臂位于脂肪和深筋膜层间,其终末支支配前臂背侧下1/3皮肤感觉.在前臂中、下1/3交界处神经横径(0.4±0.2)mm,距离肱骨外上髁和尺骨茎突远端连线垂直距离(1.2±0.6)cm.结论:以骨间后血管为蒂可在前臂下1/3设计游离皮瓣,携带前臂后皮神经可构成感觉皮瓣.     

Electron microscopic study of the median structure of the posterior column of the spinal cord of the adult rat with a special reference to the posterior median septum

In neuroanatomy textbooks on humans, the posterior median septum is commonly depicted along the midline of the posterior column of the spinal cord. For intramedullary spinal cord tumors, the standard surgical treatment is posterior midline myelotomy. However, its anatomical basis is still unclear. Therefore, in this study we focused on the ultrastructural characterization of the median structure of the posterior column in an adult rat. In the median part of the fasciculi gracilis, a fine lineal tissue continued from the posterior median sulcus to the 3/4th depth of the fasciculi. At higher magnification, this fine lineal tissue consisted of bundles of astrocytes, which are often disrupted and eventually disappeared. At the junction of the ventral part of the fasciculi cuneatus and the gray commissure, short lineal figures of glial tissues extended dorsally. These lineal figures of glial tissues were morphologically similar to other lineal figures of glial tissues found in the posterior column; bundles of astrocytes extending along the axons that entered the gray commissure and the perivascular lineal figures of glial tissues. In conclusion, this study revealed that the posterior median septum is composed of very fine lineal figures of glial tissues that are often disrupted and eventually disappear. We consider these basic structures to be similar in humans. Therefore, during posterior midline myelotomy, accurately separating along the posterior median septum in the posterior column is extremely difficult.     

A new locus for autosomal dominant posterior polar cataract in Moroccan Jews maps to chromosome 14q22-23

Background

Posterior polar cataract is a clinically distinctive opacity located at the back of the lens. It is commonly acquired in age related cataract, and may infrequently occur in pedigrees with congenital cataract. To date, five loci for autosomal dominant congenital posterior polar cataract have been identified. These include two genes, CRYAB and PITX3, on chromosomes 11q and 10q respectively, and three loci with as yet unknown genes on chromosomes 1p, 16q and 20p.

Purpose

To find the chromosomal location of a gene causing autosomal dominant congenital posterior polar cataract in three Moroccan Jewish families.

Methods

A whole genome scan was performed using microsatellite markers spaced at approximately 10 cM intervals. For fine mapping, five additional microsatellite markers were genotyped. Two‐point lod scores were calculated using MLINK software, from the LINKAGE program package. After linkage was established, several positional candidate genes were assessed by PCR based DNA sequencing.

Results

The new cataract locus was mapped to an 11.3 cM interval between D14S980 and D14S1069 on chromosome 14q22‐23. A maximum two point lod score of 5.19 at θ = 0 was obtained with the markersD14S274. The positional and functional candidate genes SIX1, SIX4, SIX6, OTX2, and ARHJ were excluded as the cause of cataract in these families.

Conclusion

An as yet unidentified gene associated with posterior polar cataract maps to the long arm of chromosome 14q22‐23.