胸腰椎横突形态学对比研究及其临床意义

目的：对比研究胸、腰椎横突形态,并探讨其临床意义.方法：测量45具胸、腰椎干燥骨标本T1～L5节段（T11-T12除外）横突长度、厚度、高度、上仰角、及后仰角,对数据进行统计分析,对比胸椎横突与腰椎横突形态的具体差异.结果：胸椎横突与腰椎横突间各项测量参数除个别节段外差异均有显著意义（P＜0.05）,胸椎横突长度长于腰椎（L3及L5除外）,厚度厚于腰椎（L5除外）,高度高于腰椎（L5除外）,后仰角大于腰椎.结论：胸腰椎横突形态明显不同,胸椎横突可做内固定之用,腰椎横突宜做定位标志,从胸椎横突至椎体螺钉固定是可能的.     

第5腰椎横突肥大综合征的解剖学研究

目的 为第5腰椎横突肥大综合征提供解剖学基础.方法 用第5腰椎、骶骨各390块,测量第5腰椎横突、椎间孔的上下径和前后径.结果 第5腰椎横突正常上下径为13.3±2.6mm,前后径12.4±2.5mm正常椎间孔前后、上下径.第5腰椎肥大的横突上下径为20.9±2.4mm,前后径30.9±3.3mm.第5腰椎横突肥大L5～S1椎间孔的前孔,左侧:上下径11.5±4.3mm,前后径10.5±2.7mm;右侧:上下径10.2±4.5mm,前后径9.6±3.0mm.结论 第5腰椎横突肥大,可引起L5～S1椎间孔的前孔狭窄,累及第5腰神经,为腰腿痛的原因之一.     

胸椎棘突及其间隙的应用解剖学

目的:通过对胸椎棘突及其间隙的实地测量,为临床提供应用解剖学依据,并为国人体质调查积累资料。方法:测量30具完整福尔马林固定标本第1~12胸椎段脊柱的棘突间距、长度、宽度、厚度以及倾斜角度。结果:棘突间距,尖端以第4~5胸椎最大,以第9~10胸椎最小;中央间距和根部间距均以第11~12胸椎最大,以第5~6胸椎最小。棘突长度,上缘以第6胸椎最大,中央以第8胸椎最大,下缘以第1胸椎最大;上缘和下缘均以第12胸椎最小,中央以第11胸椎最小。棘突宽度,各部分均以第12胸椎最大,第1胸椎最小。棘突厚度,尖端以第1胸椎最大,中央以第12胸椎最大,根部以第6胸椎最大;尖端和中央以第7胸椎最小,根部以第9胸椎最小。棘突倾斜角度,均以第12胸椎最大,第7胸椎最小。结论:本研究积累了国人胸椎棘突解剖学数据;为临床内固定器设计、后入路手术、穿刺角度提供了解剖学依据。     

Giant-cell reparative granuloma of the thoracic vertebra

Giant-cell reparative granuloma occurring in the thoracic vertebra of a 16-year-old girl is presented, and the literature concerning the subject is reviewed. This report is of the second documented case with this essentially rare lesion arising in the vertebra. Microscopically, the lesion was characterized by a reactive granulation tissue with formation of reactive osteoid, collagenization and vascularization, and focal accumulations of giant cells, particularly around hemorrhagic portions. The patient is doing well without further recurrence 38 months after the second therapeutic curettage. The authors describe the clinicopathologic features of this particular case because of its rarity in location, and briefly discuss the difference from other giant-cell lesions of bone mainly in view of differential diagnosis.     

Study of the contents of the foramen transversarium of the seventh cervical vertebra

The purpose of this study was to evaluate the individual variations of the foramen transversarium of the seventh cervical vertebra. This foramen sometimes has the same dimensions as the foramina of the other cervical vertebrae, but it can also be smaller, or absent. In cases where a foramen is present in the seventh cervical vertebra, vascular or nervous structures (or both) can be occasionally observed within the space. Results confirm that the transverse foramina of the seventh cervical vertebra almost always contain vascular and nervous branches, as well as fibrous and adipose tissue. This report concerns the findings of the macroscopic and microscopic studies concerning the contents of the transverse foramina of the seventh cervical vertebra. The study was carried out by the Department of Anatomy of the Faculty of Medicine, Université Laval.     

An unusual cavity within the styloid process.

A rare case of an unusual sinus within the styloid process is described. The radiological appearance of this malformation is presented with CT-scans and a hypothesis for its development is presented. The malformation is designated as "Recessus processus styloidei" and this entity is considered to be a dysgenesis of the second branchial arch.     

胸椎椎基静脉孔的CT影像学观测

目的　通过对胸椎椎基静脉孔（BF）的数字化观测,明确其解剖位置、形态特点,为临床应用提供参考依据。 方法　 40例成人胸椎CT扫描数据,运用Mimics15.0软件重建测量BF宽(BFW)、高(BFH)、深(BFD);BF距椎体上、下终板（VHU、VHB）和左、右缘（VWL、VWR）间距;观察其在椎体中的位置与形态。 结果　（1）胸椎BFW总体呈V形分布,T6为最小值（3.69±1.29 mm）; BFH在T1~3趋于平稳,T4～6渐减,T7～11渐增;BFD在T1～3渐增,T3～10趋于平稳,T10～12渐减。（2）BF距上终板与下终板间距总体呈上升趋势,T1最小：VHU为（7.05±1.27） mm,VHB为（7.21±0.87） mm,T12最大：VHU为(11.00±1.10) mm,VHB为(11.37±1.48) mm;距左、右缘间距在T1～4渐减,T5～12渐增,T4最小:VWL为(10.50±1.40) mm,VWR为(10.81±1.66) mm,T12最大:VWL为(15.74±2.55)mm,VWR为(16.23±2.82)mm。 结论　胸椎椎体后壁近中央处均存在BF,其形态结构复杂且在不同个体、不同节段中均存在差异。BF在T1～8、T10、T11位于椎体后壁近中央,T9和T12稍偏向左侧。BF在T1～3、T10～12形似棱锥体形,而T4～9形似长方体形。     

Functional morphology of the first cervical vertebra in humans and nonhuman primates

The cervical vertebral column bears or balances the weight of the head supported by the nuchal muscles that partly originate from the cervical vertebrae. The position of the head relative to the vertebral column, and consequently locomotion and posture behavior, could thus be associated with the form of the cervical vertebrae. In spite of this assumption and some empirical indications along these lines, primate vertebral morphologies have been reported to be very similar and not clearly related to locomotion. We therefore study the relationship between the morphology of the first cervical vertebra, the atlas, and the locomotion pattern within primates using a geometric morphometric approach. Our analysis is based on a total of 116 vertebrae of adult Homo sapiens, Gorilla gorilla, Pan troglodytes, Pongo pygmaeus, Hylobates lar, Macaca mulatta, Papio hamadryas, Ateles geoffroyi, and Alouatta palliata. On each atlas, 56 landmarks were digitized and superimposed by Procrustes registration. The resulting shape variables were analyzed by principal component analysis, multivariate regression, and partial least-squares analysis. We found that the nine primate species differ clearly in their atlas morphology and that allometric shape change is distinct between the nonhuman primates and Homo sapiens. We could further identify morphological features that relate to the species' locomotion pattern. Human atlas shape, however, cannot be predicted by an extrapolation of the nonhuman primate model. This implies that either the primate atlas is generalized enough to allow bipedal locomotion or else the human atlas morphology is a unique adaptation different from that in the more orthograde nonhuman primates.     

胸椎上关节突基底外1/3点为椎弓根进钉点的应用解剖

目的:研究胸椎上关节突基底外1/3点与椎弓根的解剖关系,为胸椎椎弓根穿钉提供一种新的定位方法。方法:选取45具成人干燥骨标本(男25具,女20具),测量胸椎上关节突基底外1/3点至相应椎弓根上缘、下缘、中轴线垂直距离,至内缘、外缘、中轴线水平距离,最适内倾角度、最适尾倾角度、最大内倾角度、最大尾倾角度。据测量结果设置穿钉参数,在5具尸体上模拟穿钉,CT评价螺钉位置。结果:各组长度、角度之性差比较无显著统计学意义(P>0.05)。胸椎上关节突基底外1/3点在椎弓根上缘、下缘、内缘、外缘所成框内,与椎弓根中轴线接近;最适内倾角度T1￣T3为25°,T4￣T10为15°,最适尾倾角度10°,据此参数在5具尸体上模拟穿钉均获成功。结论:胸椎上关节突基底外1/3点作胸椎椎弓根穿钉定位点,具有准确、可靠、简单实用等优点,是一良好的解剖定位标志。     

颈椎横突间韧带异常l例

颈椎横突间韧带通常缺如,但作者在解剖1具成年男性尸体时发现其右侧颈椎横突间但不存在横突间韧带,而且韧带的起止和行程异常,同时C7横突前结节与第1肋颈间存在异常韧带,现报道如下:     

颈椎横突间韧带异常1例

颈椎横突间韧带通常缺如，但作者在解剖1具成年男性尸体时发现其右侧颈椎横突间但不存在横突间韧带，而且韧带的起止和行程异常，同时C7横突前结节与第1肋颈间存在异常韧带，现报道如下：     

自体髂骨植骨与钢板置入内固定修复胸椎结核

背景：胸椎与相应节段的肋骨相连构成胸廓,椎体部位深在,邻近组织结构复杂,所以胸椎椎体的充分暴露显得较为困难。通常多采用切除相应肋骨,经胸腔到达病灶,创伤较大,常有胸痛、局部皮肤麻木等并发症。为此能否通过肋间隙入路不切除肋骨而达到同样的目的成为新的临床命题。 目的：探讨经肋间隙入路自体髂骨植骨与钢板置入内固定治疗胸椎结核的安全性及有效性。 方法：对2008年1月至2013年12月明确诊断为胸椎结核的30例患者,常规给予抗结核治疗两至三周后,采用经肋间隙入路行自体髂骨植骨融合,前路钢板置入内固定。术后随访6-22个月,观察骨折愈合情况、疼痛缓解程度、Cobb角改变、切口长度、出血量、手术时间、术后神经功能恢复等指标进。 结果与结论：30例患者切口长度(12.4±1.8) cm,切口纵向撑开宽度(10.0±3.2) cm;开胸时间(16.0±2.5) min,关胸时间(12.0±1.5) min;术中出血量(430.0±87.4) mL。后凸畸形角度术前平均27°,术后平均8°,平均矫正19°。术后一至两周背部疼痛基本缓解。28例患者痊愈,2例好转;术后随访复查X射线片显示自体髂骨植骨全部融合,融合时间为四至五个月。提示经肋间隙入路自体髂骨植骨与钢板置入内固定是治疗胸椎结核一种有效、安全有效的方法,经肋间隙入路的显露范围能满足结核病灶彻底清除、自体髂骨植骨、钢板置入内固定的操作要求,且可保全胸廓完整性及脊柱稳定性。中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程全文链接：     

经肋横突入路病灶清除植骨加后路椎弓根内固定治疗进展性胸椎结核的临床疗效

目的观察经肋横突入路病灶清除植骨加后路椎弓根内固定治疗进展性胸椎结核的临床疗效。方法选择我院52例行经肋横突入路病灶清除植骨加后路椎弓根内固定术的进展性胸椎结核的患者为观察组(n=52),另选择50例同时期行前后路联合病灶清除植骨融合椎弓根内固定术的进展性胸椎结核患者视为对照组(n=50);对比两种手术方法的临床效果。结果两组患者手术前后Cobb’s角、血沉(ESR)差异显著(<0.05),但组间对比无显著差异(>0.05);两组患者在手术时间、术中出血量、住院时间方面差异显著(<0.05);两组患者的神经功能均有效改善,组间差异不大(>0.05)。结论经肋横突入路病灶清除植骨加后路椎弓根内固定可有效改善进展性胸椎结核患者的神经功能、纠正脊柱畸形,且手术时间短、术中出血量少、住院时间短,临床效果良好。     

Chord distributions across 3D digital images of a human thoracic vertebra

Radiation dose estimates to the trabecular region of the skeleton are of primary importance due to recent advancements in nuclear medicine. Establishing methods for accurately calculating dose in these regions is difficult due to the complex microstructure of this anatomic site and the typical ranges of beta-particles in both bone and marrow tissues. At the present time, models of skeletal dosimetry used in clinical medicine rely upon measured distributions of straight-line path lengths (chord lengths) through bone and marrow regions. This work develops a new three-dimensional, digital method for acquiring these distributions within voxelized images. In addition, the study details the characteristics of measuring chord distributions within digital images and provides a methodology for avoiding undesirable pixel or voxel effects. The improved methodology has been applied to a digital image (acquired via NMR microscopy) of the trabecular region of a human thoracic vertebra. The resulting chord-length distributions across both bone trabeculae and bone marrow cavities were found to be in general agreement with those measured in other studies utilizing different methods. In addition, this study identified that bone and marrow space chord-length distributions are not statistically independent, a condition implicitly assumed within all current skeletal dosimetry models of electron transport. The study concludes that the use of NMR microscopy combined with the digital measurement techniques should be used to further expand the existing Reference Man database of trabecular chord distributions to permit the development of skeletal dosimetry models which are more age and gender specific.     

下胸椎前路单钉棒固定系统有限元分析

目的建立T11～12前路病灶清除植骨+单钉单棒固定系统三维有限元模型,分析单钉单棒所受应力对其进行改进。方法对一名成年男性进行螺旋CT扫描,将所得数据导入计算机,通过Mimics13.0软件和Ansys11.0有限元软件建立T11～12前路病灶清除植骨+单钉单棒固定系统三维有限元模型,并在在椎体上表面施加500N压力和10Nm的力矩模拟腰椎前屈、后伸、侧屈和旋转四种生理载荷,观察不同载荷下固定器械的应力分布,并对其进行比较。结果下位椎体钉尾部与连接棒下段为应力较集中部位,两部位在侧弯时最小,旋转时最大,旋转运动容易导致这两部位疲劳性断裂。结论侧前方单钉棒固定系统应增粗螺钉尾部与连接棒的下端或术后严格限制腰椎的各方向活动尤其是旋转,以减小两部位的应力,降低螺钉疲劳断裂的可能性。