用于显露前臂骨间膜的桡骨背侧入路应用解剖

目的 找出显露前臂骨间膜的最佳入路.方法 用卡尺测量了30例成人上肢,测量项目如下:桡骨头至旋后肌腱弓处骨间背神经的长度(LHA);桡骨头到旋后肌管下口之间骨间背神经的长度(LHS);骨间背神经从旋后肌管下口至桡骨外缘的距离(DSR);骨间背神经从旋后肌管下口至尺骨内缘的距离(DSU);骨间背神经最外侧分支穿拇长展肌处至桡骨外缘的距离(DSP).结果 LHA、LHS、DSR、DSU和DSP的测量结果分别为19.3±4.4mm(11mm～29mm)、53.4±5.2mm(45mm～62mm)、9.7±3.1mm(4mm～15mm)、22.8±3.5mm(20mm～28mm)和7.5±1.6mm(5mm～9mm).牵开拇长展肌、拇短伸肌和拇长伸肌,于桡侧腕短伸肌与指伸肌之间显露前臂骨间膜中1/3和远1/3段.结论 桡骨背侧入路可较少剥离肌肉和软组织,能方便、安全显露前臂骨间膜中1/3和远1/3段.     

阻塞性睡眠呼吸暂停低通气综合征的解剖学基础

目的 :为阻塞性睡眠呼吸暂停低通气综合征的诊断、手术治疗提供解剖学参考资料。方法 :选用经福尔马林固定的成尸头颈部正中矢状切面 (30例 ) 6 0侧咽标本 ,用游标卡尺测量咽腔相关解剖结构。结果 :腭帆后缘中点的厚度为 (1.2± 0 .6 )mm ,下鼻道底至腭垂尖的高度为 (31.7± 5 .9)mm ,腭垂根部的前后径、左右径、上下径分别为(6 .1± 1.5 )mm、(5 .2± 2 .2 )mm、(7.5± 2 .0 )mm ,腭垂两侧腭帆根部的厚度为 (11.3± 1.8)mm ,舌根、腭垂尖、会厌尖分别至咽后壁之间的直线距离分别为 (16 .7± 4 .8)mm、(10 .6± 4 .9)mm、(12 .7± 4 .2 )mm。结论 :咽腔的异常结构在引发阻塞性睡眠呼吸暂停低通气综合征的过程中具有重要的意义     

收肌管下口处隐神经阻滞的应用解剖

目的探讨收肌管下口处隐神经的精细解剖和体表定位。方法采用12具尸体标本20侧下肢对收肌管及其下口部位进行精细解剖和测量。结果收肌管下份隐神经在前内侧、股动脉居中、股静脉在后。在收肌管下口和稍上位置,膝降动、静脉和隐神经分别穿大收肌腱板出收肌管并伴行下行,隐神经在膝内侧缝匠肌腱和股薄肌腱之间穿深筋膜,伴大隐静脉下降至小腿和足内侧。收肌管下口分别距髌骨上缘(5.85±0.15)cm、髌骨底内侧缘(2.72±0.60)cm、股内侧皮肤表面(4.08±0.66)cm。结论髌骨上缘上5.85 cm、髌骨底内侧缘内2.72 cm、股内侧皮肤表面4.08 cm深处为收肌管下口隐神经阻滞的体表定位;股动脉是收肌管下口上隐神经阻滞的定位标志;膝降动脉的隐支是收肌管下口下隐神经阻滞的识别标志。     

桡侧腕屈与腕长伸肌腱部分转位修复手部关节脱位应用解剖

目的 :为桡侧腕屈与腕长伸肌腱部分转位修复桡尺远侧及第 1腕掌关节脱位提供解剖学基础。方法 :3 0侧成人上肢标本 ,分别对桡侧腕屈肌腱、桡侧腕长伸肌腱进行形态学测量。结果 :桡侧腕长伸肌腱性部长 ( 17.8± 2 .6)cm ,肌腱的上、中、下段宽分别为 ( 13 .7± 3 .1)、( 5 .6± 1.1)和 ( 4 .6± 0 .5 7)mm肌腱的上、中、下段厚分别为 ( 1.5± 0 .5 )、( 2 .0± 0 .3 )和 ( 2 .4± 0 .3 )mm。桡侧腕屈肌腱性部长 ( 14 .3± 1.1)cm ,肌腱的上、中、下段宽分别为 ( 9.11.4)、( 5 .5± 0 .9)和 ( 4 .0± 0 .4) ,肌腱的上、中、下段厚分别为 ( 2 .4± 0 .6)、( 2 .2± 0 .4)和 ( 2 .6± 0 .5 )mm。结论 :采用桡侧腕屈肌腱和桡侧腕长伸肌腱部分转位 ,有足够的长度和强度 ,适用于桡尺远侧关节或第 1腕掌关节脱位的修复 ,临床应用获得良好效果     

带膝降动脉大收肌腱骨皮瓣修复小腿创伤的应用解剖

目的 :为带膝降动脉大收肌腱骨皮瓣修复小腿及跟骨的创伤提供应用解剖学基础。方法 :在70侧成人下肢标本上解剖观测了膝降动脉的起始、分支、分布及大收肌腱的形态特点和血管分布。结果 :①膝降动脉的主干长 1.2± 0 .5cm ,起点外径为 2 .6± 0 .6mm ,主要分支有股内侧肌支、关节支、隐支。②关节支的主干长 6.6± 1.2cm ;起点外径为 1.9± 0 .5 ,分支营养大收肌腱和股骨内侧髁骨质骨膜 ,并参与吻合形成膝关节动脉网。③隐动脉长 10 .9± 3 .3cm ,起点外径 1.8± 0 .6mm。分支营养缝匠肌下部、膝内侧上部皮肤 ,并参与吻合形成膝关节动脉网。④胫后动脉、腓动脉在内踝上方 11cm处的直径分别是 2 .5± 0 .6mm和 2 .0± 0 .4mm。⑤大收肌肌腱部长 6.8± 1.2cm ,宽 9.6± 2 .0mm ,厚 2 .2± 0 .6mm。结论 :带膝降动脉大收肌腱骨瓣、皮瓣血供丰富 ,供区形态可塑性大 ,可作为修复跟腱、跟骨及皮肤缺损的供体。     

内窥镜下第三脑室手术的应用解剖

目的 :为神经内窥镜下进行第三脑室手术提供解剖学资料。方法 :对 2 1例成人尸头固定标本进行第三脑室的解剖观察和测量 ,对 9具新鲜尸头进行经室间孔入路神经内窥镜下第三脑室的解剖学观察。结果 :室间孔长径、宽径为 (5 .4± 1.2 )mm、(2 .7± 0 .9)mm ,中间块长径、宽径为 (6.8± 2 .3 )mm、(3 .8± 1.0 )mm ,前后联合间距 (2 1.8± 2 .1)mm ,前、后联合到中间块为 (6.3± 0 .8)mm、(8.8± 1.3 )mm ,前后联合中点处第三脑室高度 (13 .8± 1.4)mm ,室间孔下、后联合前及中间块上、下第三脑室宽度分别为 (6.3±2 .2 )mm、(4 .9± 1.8)mm、(3 .4± 1.6)mm和 (4 .3± 1.8)mm ,中间块上、下最小高度为 (4 .4± 1.3 )mm和(4 .3± 1.3 )mm。内窥镜可较清晰显示第三脑室内结构 ,但中间块可影响显露。结论 :内窥镜下经室间孔入路进行第三脑室手术有一个理想的操作空间。     

收肌管下口处隐神经阻滞的应用解剖

目的　探讨收肌管下口处隐神经的精细解剖和体表定位。 方法　采用12具尸体标本20侧下肢对收肌管及其下口部位进行精细解剖和测量。 结果　收肌管下份隐神经在前内侧、股动脉居中、股静脉在后。在收肌管下口和稍上位置,膝降动、静脉和隐神经分别穿大收肌腱板出收肌管并伴行下行,隐神经在膝内侧缝匠肌腱和股薄肌腱之间穿深筋膜,伴大隐静脉下降至小腿和足内侧。收肌管下口分别距髌骨上缘（5.85±0.15）cm、髌骨底内侧缘（2.72±0.60）cm、股内侧皮肤表面（4.08±0.66）cm。 结论　髌骨上缘上5.85 cm、髌骨底内侧缘内2.72 cm、股内侧皮肤表面4.08 cm深处为收肌管下口隐神经阻滞的体表定位;股动脉是收肌管下口上隐神经阻滞的定位标志;膝降动脉的隐支是收肌管下口下隐神经阻滞的识别标志。     

枢椎横突孔观测及其临床意义

目的 :探讨枢椎横突孔结构在转头引起寰枢段椎动脉狭窄或闭塞的临床解剖学意义。方法 :观测 10 0例枢椎横突孔上口的开口方向、孔径、上口与下口之间的成角、以及横突孔水平距离。结果 :两侧枢椎横突孔孔径相差不大 ,最大径为 6.1± 0 .7mm,最小径 5.4± 0 .6mm。两侧横突孔上口开口方向明显不对称 ,上口与下口之间的角度为 12 7± 2 2°,左侧较右侧明显 ,甚至形成直角或锐角 ,且左侧横突孔水平距离较长 ,说明椎动脉在孔内弯曲或扭曲。结论 :枢椎横突孔的结构对其中椎动脉起着一种牵系作用 ,在寰枢椎不稳时易导致椎动脉的损害     

内窥镜下经鼻蝶切除垂体瘤鞍区应用解剖

目的 :为临床开展神经内窥镜下经鼻蝶切除垂体腺瘤提供解剖基础。方法 :对 2 5例成人头部固定标本进行蝶鞍区的解剖测量 ,并对 9具新鲜尸头进行内窥镜下经鼻蝶至蝶鞍的解剖观察。结果 :鞍膈高度(5 .5± 0 .6)mm ,鞍膈孔前后径 (6.2± 1.3 )mm ,鞍膈孔左右径 (6.5± 1.5 )mm ,鞍膈孔前缘到鞍结节 (3 .4± 1.3 )mm ,鞍膈孔前缘到垂体柄 (2 .5± 1.1)mm ;视神经出视神经颅口宽 (5 .0± 0 .4)mm ,两侧内缘间距 (13 .7±2 .3 )mm ,视交叉前缘距视神经间沟中点 (6.8± 1.3 )mm ,视交叉宽 (11.5± 1.4)mm。结论 :神经内窥镜下经鼻蝶切除垂体腺瘤应熟悉蝶鞍底及窦内的解剖标志 ,并充分利用鞍膈等解剖结构有序地做肿瘤切除。     

腋神经和桡神经与肱骨的关系及其临床意义

目的　观测腋神经、桡神经与肱骨骨性标志的关系 ,为肱骨手术或外固定提供帮助。方法　在 30例 6 0侧成人上肢标本上观、测了腋神经、桡神经与肱骨有关骨性标志的距离。结果　肱骨最大长 (30 6 6 5± 17 4 8)mm ;肱骨最近端到腋神经(5 8 10± 5 6 1)mm ;肱骨最近端到桡神经穿外侧肌间隔处 (177 75± 11 86 )mm ;解剖颈最低点到腋神经 (16 2 4± 2 78)mm ;肱骨最近端到肱骨肌管入口处 (118 4 9± 6 6 1)mm ;并测量计算了各段占肱骨最大长的比例。结论　腋神经在肱骨近端 1/ 5处容易受损 ,而桡神经在肱骨下 3/ 5段为易损伤部。从术前和术中的影像 ,能测量和计算出神经的基本位置 ,可减少或避免神经损伤     

Clinical efficacy of adductor canal block in medial open wedge high tibial osteotomy

BackgroundTo evaluate the effect of adductor canal block (ACB) on short-term postoperative outcomes in patients who underwent medial open-wedge high tibial osteotomy (MOWHTO) compared to that of a placebo.Methods35 patients who underwent unilateral MOWHTO between 2017 and 2019 were prospectively reviewed and randomly divided into two groups: 19 patients who received a single-shot ACB and 16 patients who received a saline injection (a placebo group). Primary outcomes were (1) pain measured using the visual analog scale and range of motion, (2) patient satisfaction, (3) postoperative need for additional opioids, (3) quadriceps strength (the time to straight leg raising [SLR]), (4) clinical outcomes, and (5) complications.ResultsThe pain score was lower in the ACB group than in the placebo group in the first 12 h (p = 0.04). ACB did not exhibit significantly less quadriceps strength weakness postoperatively. There was no statistical difference in the time to SLR (23.5 ± 17.7 h in ACB vs. 27.6 ± 11.4 in placebo, p = 0.520). The opioid consumption rate within postoperative 12 h was significantly decreased after ACB (16.7% in ACB, 70% in placebo, p = 0.017). The proportion of patients with more than 5 opioid injections within 72 h postoperatively was lower in the ACB group (8.3% in ACB, 50% in placebo, p = 0.043). Both groups did not show any localized and systemic complications.ConclusionACB following MOWHTO exhibited better outcomes than a placebo with respect to opioid consumption with no changes in the quadriceps strength and complications.Level of EvidenceII, Prospectively comparative study     

Electromyographic analysis of hip adductor muscles during incremental fatiguing pedaling exercise

The purpose of this study was to investigate activity of hip adductor muscles over time and during a representative crank cycle in fatiguing pedaling. Sixteen healthy men performed incremental pedaling exercise until exhaustion. During the exercise, surface electromyogram (EMG) was detected from adductor magnus (AM), adductor longus (AL), and selected thigh muscles. Temporal changes to normalized EMG in AM muscle resembled those in vastus lateralis (VL) muscle, whereas those in AL muscle showed later onset of increase from baseline compared with AM and VL muscles. During a representative crank cycle, the same level of normalized EMG was found between propulsive and pulling phases for AM muscle, whereas muscle activation of AL muscle during the pulling phase was statistically significant higher than that during the propulsive phase. We concluded that AM and AL muscles were gradually recruited over time during fatiguing pedaling exercise, but their temporal change and activation phases were not completely the same.     

罗哌卡因复合羟考酮收肌管阻滞在膝关节镜手术ERAS中的应用

目的 观察罗哌卡因复合羟考酮收肌管阻滞在膝关节镜手术快速康复（ERAS）中的应用效果。方法 选取120例拟行单侧膝关节镜手术治疗的患者为观察对象,并随机分为复合组与对照组,复合组予以罗哌卡因复合羟考酮收肌管阻滞,对照组单予以患者罗哌卡因收肌管阻滞。观察比较两组患者的疼痛程度,采用视觉模拟评分（VAS）予以评估。观察两组患者的不良反应及满意度。结果 复合组患者术后8 h、12 h、24 h、36 h、48 h的VAS评分均明显低于对照组,差异有统计学意义（P＜0.05）;两组患者的呕吐、恶心、局麻药中毒等不良反应发生率比较,差异无统计学意义（P＞0.05）;复合组患者的满意度明显高于对照组（P＜0.05）。结论 罗哌卡因复合羟考酮收肌管阻滞在膝关节镜手术后快速康复中发挥积极作用,镇痛效果明显且安全性较高。     

拇收肌腱弓处尺神经卡压征的应用解剖

目的 :为拇收肌腱弓处的尺神经卡压征机理和治疗提供解剖学基础。方法 :解剖 2 0个 ( 4 0侧 )成人尸体标本手的拇收肌腱弓 ,对拇收肌起始部的纤维弓状结构进行观察、测量 ,对观测结果进行统计学处理。结果 :40侧中 3 7.5 % ( 15侧 )存在纤维弓状结构 ;其中呈膜性的 (A型 )占 73 .3 % ( 11侧 ) ;呈索带状(B型 )占 2 6.6% ( 4侧 )。肌纤维弓状结构长平均 3 .7± 0 .6mm。结论 :部分人手存在拇收肌起始部的纤维腱弓 ,形成神经血管腔隙 ,腔隙内压增高可导致尺神经终末运动支嵌压征。治疗是在第 3掌骨基底部切开腱弓减压。     

罗库溴铵对眼轮匝肌和拇收肌临床药效学比较

目的比较罗库溴铵对眼轮匝肌和拇收肌临床药效学的差异。方法选择心、肺、肝、肾和神经肌肉功能基本正常的30~50岁全麻普外及妇科手术患者男女各10例,丙泊酚和芬太尼维持麻醉。静注罗库溴铵0.3mg/kg后,记录同侧眼轮匝肌和拇收肌诱发颤搐反应的抑制过程和恢复过程。结果拇收肌的显效时间和达到最大抑制程度的时间[(41.0±8.3)s和(241.3±60.8)s]与眼轮匝肌[(42.0±7.9)s和(276.0±62.6)s]基本相同(P>0.05),而最大抑制程度(95.3%±5.2%)比眼轮匝肌(67.7%±15.3%)显著增高(P<0.01)。T1(4个成串刺激中的第1个肌颤搐反应)恢复到基础值50%和75%的时间,拇收肌[(19.8±5.1)min和(24.1±6.2)min]与眼轮匝肌的[(17.5±8.7)min和(27.3±8.6)min]差异无统计学意义(P>0.05),但T1恢复到基础值95%和100%的时间,拇收肌[(29.2±7.6)min和(31.1±8.3)min]明显比眼轮匝肌[(37.4±9.0)min和(40.0±9.1)min]快,差异有统计学意义(P<0.01)。TOFr恢复到基础值80%的时间,拇收肌[(30.2±8.1)min]和眼轮匝肌[(28.8±8.8)min]基本相同(P>0.05)。结论中青年患者给予1倍ED95罗库溴铵对眼轮匝肌和拇收肌阻滞过程的差异主要表现在眼轮匝肌最大阻滞程度显著比拇收肌低,以及肌肉松弛效应完全消除时间显著比拇收肌长,而起效时间则基本相同。     

Anatomical study of human adductor hallucis muscle with respect to its origin and insertion

The adductor hallucis muscle (ADH) is evolutionally and functionally important, but no detailed morphological data about this muscle in the human body is available. In the present study, we examined the origin and insertion of the oblique and transverse heads of the ADH. Forty-five feet (20 right, 25 left) of 34 cadavers (13 men, 21 women, average age of 80 years old) were used in the present study. The origin, insertion and nerve supplies of the oblique and transverse heads of the ADH were macroscopically examined in detail. Most commonly, the oblique head of the ADH arose from the bases of the 2nd, 3rd and 4th metatarsal bones, the plantar metatarsal ligaments spanned between the bases of the 2nd, 3rd and 4th metatarsal bones, the lateral cuneiform bone, the fibrous sheath of the tendon of the peroneus longus muscle and the long plantar ligament, and inserted into the lateral sesamoid bone of the great toe and the capsule of the 1st metatarsophalangeal joint. Most commonly, the transverse head of the ADH originated from the capsules of the 3rd and 4th (and occasionally 5th) metatarsophalangeal joint and the deep transverse metatarsal ligaments, and inserted into the lateral sesamoid bone of the great toe, the capsule of the 1st metatarsophalangeal joint and lateral surface of the base of the 1st proximal phalanx. This muscle was classified into four types based on the origin of its oblique head and was classified into three types based on the origin of its transverse head. The percent ratio of the weight of the oblique head to the total weight of all the intrinsic muscles of the foot was 9.4% ± 1.5, and the transverse head was 1.5% ± 0.6 (n = 14). The transverse head of ADH tends to be reduced in size in the human, but the oblique head is well developed with no sign of reduction.     

吻合血管大收肌腱复合组织瓣移植修复跟腱缺损的应用解剖

目的 :为吻合血管的大收肌腱复合组织瓣移植修复跟腱缺损新术式提供解剖学依据。方法 :在 40侧经动脉灌注红色乳胶成人尸体下肢标本上 ,对膝降动脉的起始、走行、分支和分布 ,以及大收肌腱的形态、血供等解剖观察。结果 :膝降动脉 95 %起于股动脉 ,起始处距收肌结节 7.8± 0 .8cm ,膝降动脉90 %发出隐支、股内侧肌支和关节支 ,膝降动脉和关节支起始外径分别为 :1.9± 0 .4mm和 1.4± 0 .4mm ,关节支伴大收肌腱下行 ,分支供养大收肌腱及股骨内侧髁。结论 :以膝降血管为蒂可形成大收肌腱骨皮复合组织瓣 ,吻合血管移植可修复不同类型的跟腱缺损 ,术式简便易行 ,供区损伤小。     

The clinical anatomy of accessory mandibular canal in dentistry

The mandibular canal is a conduit that allows the inferior alveolar neurovascular bundle to transverse the mandible to supply the dentition, jawbone and soft tissue around the gingiva and the lower lip. It is not a single canal but an anatomical structure with multiple branches and variations. The branches are termed accessory, bifid or trifid canals depending on their number and configuration. A bifid mandibular canal is an anatomical variation reported more commonly than the trifid variant. Because of these variations, it is of the utmost importance to determine the exact location of the mandibular canal and to identify any branches arising from it prior to performing surgery in the mandible. This article reviews the prevalence, classification and morphometric measurements of these accessory mandibular canals, emphasizing their clinical significance.     

A Study of Hypoglossal Canal in North Indian Crania

Studies of non metric cranial variants have been a field of considerable interest to research workers especially because of their racial and regional importance.40 north Indian skulls of U.P. were studied for the double hypoglossal canal, a cranial variant in the present study. Findings are discussed and compared with other global studies and are found to be of considerable regional and racial significance.