活体肾上腺血管的解剖观测及临床意义

目的：研究活体肾上腺血管的应用解剖。方法：对１８例２４侧肾上腺手术时分离出血管，测量血管外径及长度，对６个完整肾上腺灌注染色。结果：右膈下动脉从下腔静脉右缘至末支肾上腺上动脉长８．５（７．５～１１．０）ｃｍ，外径２．５～３．０ｍｍ；左膈下动脉从腹主动脉左缘至末支肾上腺上动脉长８．０（７．０～９．０）ｃｍ，外径２．５～３．１ｍｍ；肾上腺上动脉１～６支，均源于膈下动脉。肾上腺中动脉右侧长１．７～２．２ｃｍ，外径１．０～１．５ｍｍ；左侧长１．５～２．０ｃｍ，外径１．０～１．５ｍｍ。肾上腺下动脉两侧基本相同，长１．５～２．０ｃｍ，外径１．０～２．０ｍｍ。肾上腺中心静脉右侧长０．４～０．８ｃｍ，左侧长３．０～４．０ｃｍ，外径３．０～４．０ｍｍ。结论：肾上腺血管加部分膈下血管的长度可供带血管蒂肾上腺转位治疗柯兴氏病；活体切取供移植的肾上腺；选择性肾上腺血管造影等。     

胫后动脉筋膜皮支为蒂的小腿内侧皮瓣与超薄皮瓣应用解剖

解剖１０具新鲜成年尸体的下肢，并将小腿内侧全厚皮片作透明标本观察，采用超声Ｄｏｐｐｌｅ探测正常活体小腿２０例。结果显示：胫骨滋养动脉自胫后动脉后出后即分为两支：胫骨滋养支与筋膜皮支。筋膜皮支在穿深筋膜前长度为３．３（１．５～８．４）ｃｍ；在皮下组织内的长度为２．５（１．４～４．８）ｃｍ，外径１．２（０．８～２．０）ｍｍ；在真皮下的长度为１．０（０．２～２．１）ｃｍ，外径为１．０（０．５～１．１）ｍ     

桡动脉-冠状动脉旁路移植术的应用解剖

目的：为桡动脉与冠状动脉搭桥术提供解剖学基础。方法：２７具成人尸体,上肢标本（其中左侧２７侧;右侧２５侧）,分别进行解剖观察及测量,可作为冠状动脉搭桥术的桡动脉长度、外径。结果：①桡动脉左侧长（１０．３ ±１．２）ｃｍ;右侧长（１０．２ ±１．２）ｃｍ。②左侧上、中、下段外径分别为：（４．２ ± ０．８）ｍｍ;（４． １± ０．８）ｍｍ;（４．０ ± ０．８）ｍｍ。右侧上、中、下段外径分别为：（４．２ ± ０．９）ｍｍ;（４．１ ± ０．９）ｍｍ;（４．５ ± ０．８）ｍｍ。结论：桡动脉下２／３段位置浅表,并有足够的长度和管径,可作为冠状动脉搭桥术的供体。     

腓肠内外侧血管解剖特点及其在小腿创伤修复中的意义

目的：为小腿创伤皮瓣移植修复与腓肠内、外侧血管吻合提供解剖学基础。方法：在７０侧成人下肢标本上解剖观测了腓肠内、外侧血管的长度、外径、血管神经的毗邻关系及其形态特点。结果：①腓肠内、外侧动脉起于动脉，伴行静脉注入静脉；②动脉起点至入肌段的长度内、外侧分别为４．１±０．７（１．８～６．４）ｃｍ、３．７±０．５（２．０～６．５）ｃｍ；③肌门处内、外侧动脉的外径分别为２．２±０．１（１．１～３．４）ｍｍ、２．０±０．１（０．９～３．１）ｍｍ；④肌门处伴行静脉有１～２条，内、外侧静脉外径为２．５±０．３（１．８～４．５）ｍｍ，２．３±０．３（１．５～４．１）ｍｍ。结论：腓肠内、外侧血管恒定、径粗、较长，是小腿创伤皮瓣移植修复受区可供应用的吻合血管     

骶前区静脉丛的解剖学特点及临床意义

目的：研究骶前区静脉丛（Ｖｅｎｏｕｓ ｐｌｅｘｕｓ ｏｆ ｐｒｅｓａｃｒａｌ ｒｅｇｉｏｎ ，ＶＰＰＳＲ） 的解剖学特点，为骶前区静脉破裂大出血的防治提供解剖学基础。方法：在３４ 具成人尸体上，分虽观测ＶＰＰＳＲ 的组成、管壁、瓣膜、长度及直径。结果：ＶＰＰＳＲ 管壁薄、缺少静脉瓣，呈网状。ＶＰＰＳＲ Ｓ１～５ 横干的长度和直径（ Ｆ 检验） 均有显著差异，Ｐ＜ ０ ．０５ 。其长度平均（ 珋ｘ ±ｓ） ：Ｓ１ 为３ ．２ ±１ ．５ ｃｍ ，Ｓ２ 为４ ．４ ±１ ．０ ｃｍ ，Ｓ３ 为３ ．５ ±１ ．１ ｃｍ ，Ｓ４ 为２ ．３ ±０ ．９ ｃｍ ，Ｓ５ 为１ ．０ ±０ ．３ ｃｍ ；其直径平均（珋ｘ ±ｓ） ：Ｓ１ 为１ ．２ ±０ ．７ ｍ ｍ ，Ｓ２ 为２ ．５ ±１ ．５ ｍ ｍ ，Ｓ３ 为２ ．５ ±１ ．５ ｍ ｍ ，Ｓ４为１ ．７ ±１ ．５ ｍ ｍ ，Ｓ５ 为０ ．９ ±０ ．６ ｍ ｍ 。Ｓ４ 椎体前穿通支静脉口径２ ～４ ｍ ｍ 占８ ．８ ％ ，０ ．１ ～１ ．９ ｍ ｍ 占９１ ．２ ％ 。结论：ＶＰＰＳＲ 解剖变异多、血管壁薄、缺少静脉瓣是引起ＶＰＰＳＲ 损伤大出血甚至死亡的解剖学基础。     

X线投照视神经管的应用解剖

为进一步向临床提供视神经管的资料并试寻Ｘ线投照视神经管新的入射点，我们在２０个颅上（中颅型９个，短颅型１１个），分别测量了视神经管轴与颅正中矢状面及与颅水平面间的夹角。结果前者为３６．７°，颅型间差别显著；后者为１４．８°，差别不明显。新入射点位于顶首，至乳突的垂直距离，中、短颅型分别为７．３ｃｍ和７．０ｃｍ，无明显差别；至乳突的水平炬离分别是４．２ｃｍ和３．４ｃｍ，差别显著。经新入射点行Ｘ线实拍，视神经管显示良好。讨论了Ｒｈｅｅｓ’ｓ位摄影片时的临床应用要点。     

一个新的甲状腺手术麻醉点的解剖学基础及临床应用

目的：为甲状腺手术提供新的麻醉方法。方法：用３０侧成人标本，在手术显微镜下观察了颈前部神经的来源、分支分布及其吻合。结果：颈皮神经分单干，上、下干和上、中、下干三种类型。上、中、下干的起始宽度分别为１．６±０．６ｍｍ，１．８±０．６ｍｍ和１．８±０．７ｍｍ；干长１７．７±７．８ｍｍ，３１．７±１２．３ｍｍ和２５．４±９．０ｍｍ。锁骨上内侧神经分布至胸锁关节和胸骨柄上方的皮肤。面神经颈支的降支均与颈皮神经吻合。明确了通过胸锁乳突肌前缘，甲状软骨上缘下方１．５ｃｍ与颈前正中线外侧４ｃｍ的交点处（麻醉点）１ｃｍ和２ｃｍ半径圆形区的神经来源和分布。结论：经临床１００例应用验证新麻醉点具有安全可靠、效果理想、并发症少等特点，有推广前途     

以桡动脉鼻烟窝段为蒂岛状皮瓣的应用解剖

目的：为桡动脉鼻烟窝段为蒂的岛状皮瓣提供解剖基础。方法：在４３例成人手标本上，观察了桡动脉鼻烟窝段的形态及其发出的筋膜皮支。结果：桡动脉鼻烟窝段的长度为２．５±０．１ｃｍ，其近侧端和远侧端外径分别为２．６±０．１ｍｍ和２．２±０．１ｍｍ；发自该段桡动脉的筋膜皮支有５．４（２～１１）支，外径为０．５～１．０ｍｍ；皮瓣的面积为４ｃｍ×６ｃｍ左右。结论：可设计以桡动脉鼻烟窝段为蒂的岛状筋膜皮瓣，修复手部软组织缺损，对手部的血供无明显影响。     

输精管精索部的应用解剖

目的：为输精管结扎术、吻合术的临床应用提供形态学基础。方法：选用３０具成人男性尸体对输精管精索部进行了解剖学观测。结果：输精管精索部位于精索后方，睾丸动脉位于中央，静脉位于最前方，生殖股神经生殖支位于输精管精索部外侧。输精管精索部长左侧７．６±２．９（５０～１１．３）ｃｍ；右侧７．３±３．２（５．２～１１．０）ｃｍ。其内径左、右侧均为０．６±０．１（０．４～０．８）ｍｍ。经统计学处理（Ｐ＞０．０５）左右侧均无显著性差异。结论：在输精管结扎术、吻合术手术时应注意保护输精管外侧的生殖股神经生殖支、输精管精索部管径小、壁厚、吻合成功率高。因管径小、术后不宜安放支架，以免术后引起管腔阻塞。     

以第1或第2穿动脉为蒂骨瓣转位重建股骨距的应用解剖

目的：为带血管蒂骨瓣转位重建股骨距提供解剖学依据。方法：３０侧经动脉内灌注红色乳胶的成人下肢标本，对第１、２穿动脉起始、走行、分支分布和骨膜支进行详细的解剖学观察。结果：股深动脉在小转子尖下４．５±１．３ｃｍ、９．３±２．７ｃｍ处分别发出第１、２穿动脉，外径分别为２．８±０．７ｍｍ、２．４±０．６ｍｍ。穿动脉发出１～３支外径在１．０ｍｍ以上的肌骨膜支，分布于股骨后部中上段骨膜。结论：可以第１或第２穿动脉为蒂设计股骨瓣，可转位重建股骨距或修复股骨颈。     

Angles of Axes of Incudes

Incus angles of axes (the angle between “short process axis” and the “long process axis”) are more open in humans than chimpanzees: 64.0 versus 55.7 degrees (Quam et al.: J Anat 225 (2014) 167–196). However, Flohr et al. (Anat Rec 293 (2010) 2094–2106) raise concern about interobserver agreement of the axes. The concern is important as phylogenetic relationships of mammals are inferred from the incus (and malleus and stapes). We sought to check (1) interobserver agreement; and (2) if the angles of the axes of incudes (incuses) exhibit bilateral symmetry, which is expected if the axes are genetically determined. We studied incudes from 41 modern adult crania with clinically normal temporal bones. Angles of axes were determined on rectilinear digital photographs of incudes in standard lateral orientation. Two observers independently drew the axes and measured the axes. Interobserver agreement was within 4 degrees for 24 of 34 left-sided incudes and for 27 of 35 right-sided incudes. The mean of the two observers' angle determinations were used. Left incudes' median was 67 degrees, range 60–73; right 67.5 degrees, range 58–77. Bilateral symmetry of angles of axes was found: r = 0.55, N = 31, 95% CI 0.24–0.75. Angles of axes of modern human incudes are probably genetically determined features, but are of doubtful physiologic or evolutionary advantage in modern humans. Interobserver agreement of angles of modern human axes is concerning and must be specified in reports. Consideration should be given to a convention to designate axes in ambiguous cases. Anat Rec, 302:1615–1619, 2019. © 2019 American Association for Anatomy     

Malakoplakia of middle ear: a case report

Malakoplakia of the mastoid cavity occurring in a 10-year-old boy is reported. Malakoplakia of the middle ear does not previously appear to have been recorded. The patient has had repeated ear infections and an episode of meningitis. Clinical and histological features are described. Possible pathogenesis is discussed.     

乳突后平台锁孔入路至脑桥小脑角的显微外科解剖

目的:为神经内镜乳突后平台锁孔入路手术提供基础资料。方法:在干性颅骨标本上确定乳突后平台锁孔的定位。在血管内灌注固定的成人尸头标本上,显微镜解剖观察脑桥小脑角各结构,测量锁孔至脑桥小脑角各神经血管的距离。结果:(1)锁孔在星点与乳突尖连线中点后方1.5cm为中心直径为2.0cm处;(2)小脑下前动脉袢与面神经、内耳道关系密切;(3)分别测得锁孔至前庭蜗神经根、面神经根、三叉神经根、舌咽神经根、小脑下前动脉袢的距离(mm)。结论:从乳突后平台锁孔入路可较好地显露脑桥小脑角和内听道的解剖结构,参考相关测量数据可避免或减少在脑桥小脑角手术时重要结构的损伤。     

Determination of Sex from Mastoid Process By Discriminant Function Analysis

Sex determination is vital for the identification of an individual. Often fragmentary remains are available for forensic identification making sex determination difficult. The mastoid region, a fragmentary piece of skull, is ideal for studying sexual dimorphism as it is resistant to damage due to its anatomical position at the base of skull. The skull measurements vary significantly in different ethnic groups and the discrimination models for Indian populations are rare.In the present study, 60 adult human skulls of North Indian individuals were studied to determine accuracy of mastoid process in sex determination. Mastoid length, breadth and antero-posterior diameter of the mastoid process were measured to calculate the size of mastoid process.Discriminant function analysis revealed that mastoid process correctly classified the sex in 76.7% of the subjects and mastoid length was found to be the best determinant for sex although the classification rate dropped to 66.7%. A discriminant function equation specific for North Indian population has also been derived from mastoid variables.     

颈动脉管外口及周边骨性结构的解剖特点

目的:探究颈动脉管外口及周边骨性结构的解剖结构特点.方法:选取成人颅骨,由1位口腔专业教师确定各观测点的位置后,用游标卡尺、圆规和直尺等测量颈动脉管外口的长径、短径及该口长径外侧点至茎突根部内侧点、茎乳孔内侧点、乳突尖、舌下神经管外口长径内侧点、枕髁最前点、枕骨大孔最前点和正中矢状面的最短距离,所得数据进行统计学分析....     

中国人乳突管(道)的螺旋CT观测

目的:探讨乳突管(道)在中国人中的检出率及其CT解剖特点.方法:收集了1 074例颞骨CT资料,在横断位及三维重建图上观察乳突管(道)的检出率、长度、直径、形态及其在颅板的开口情况.结果:1 074例中有880例出现乳突管(道),检出率81.94%.男性乳突管(道)检出率80.94%(497/614),女性乳突管(道)检出率83.26%(383/460),两者比较差异无统计学意义(P＞0.05).2 148侧乳突中1 437侧出现乳突管(道),检出率66.90%.右侧乳突管(道)检出率70.11%(753/1074),左侧乳突管(道)检出率63.69%(684/1 074),右侧高于左侧(P＜0.05).在CT图片上(横断位和/或三维重建图)观察,乳突管(道)可呈现5种不同的形态:单管型、盲管型、"Y"字型、浅凹或凹槽型、双管型.结论:中国人乳突管(道)检出率较高.乳突区CT检查能有效显示乳突孔及乳突管(道),并能显示乳突管(道)的不同形态和开口位置,为该区手术入路或开窗暴露提供准确、直观的术前评估.     

Evaluating sexual dimorphism in the human mastoid process: A viewpoint on the methodology

The mastoid process is one of the most sexually dimorphic features in the human skull, and is therefore often used to identify the sex of skeletons. Numerous techniques for assessing variation in the size and shape of the mastoid process have been proposed and implemented in osteological research, but its complex form still presents difficulties for consistent and effective analysis. In this article, we compare the different techniques and variables that have been used to define, measure, and visually score sexual dimorphism in the mastoid process. We argue that the current protocols fail to capture the full morphological range of this bony projection, and suggest ways of improving and standardizing them, regarding both traditional and 3D‐based approaches. Clin. Anat. 28:593–601, 2015. © 2015 Wiley Periodicals, Inc.     

Bony landmarks as an aid for intraoperative facial nerve identification

Identification of the facial nerve trunk is essential during surgery of the parotid gland. Numerous landmarks have been researched and used. The relation between the facial nerve to two constant bony landmarks, the tip of the mastoid process and the central point of the transverse process of the atlas was investigated. Forty cadavers were dissected. A preauricular incision exposed the nerve trunk. Bony landmarks were identified and marked. The distance from the nerve trunk to the mastoid process and the atlas was measured. The mean distance between the mastoid process and nerve for the left was 9.18 +/- 2.05 mm and for the right, 9.35 +/- 1.67 mm. The mean distance between the atlas and the nerve for the left was 14.31 +/- 3.59 mm and for the right, 13.76 +/- 4.65 mm. Confidence intervals were determined. The importance of the aforementioned data revolves around minimizing the chance of injury to the facial nerve during surgery. The applicability of these landmarks needs to be studied in the clinical setting.