Fusiform enlargement of the nasolacrimal canal: a rare anatomic variation

To determine the standard width and shape of the nasolacrimal canal (NLC) in the coronal plane, a retrospective review of 950 coronal paranasal CT sections was undertaken. The coronal diameter of NLC was measured at its upper and lower ends and anomalies in its configuration noted. The mean diameters of the NLC were 4.8 ± 1.2 mm and 4.7 ± 1.1 mm on the right and left sides, respectively. There was no difference in the mean NLC diameter between the right and left sides, upper and lower portions or males and females. In two cases, an abnormal dilation of the NLC at its inferior portion was encountered. A marked enlargement of the NLC can occur in the absence of a neoplastic or obstructive process and may be detected as an isolated finding representing idiopathic or congenital enlargement. Segmental NLC dilatation is not always an indicator of pathology, particularly in asymptomatic cases, and should be considered a rare anatomic variation.     

Imaging of the facial canal by means of multiplanar angulated 2-D-high-resolution CT-reconstruction

Summary The facial canal containing the intratemporal portion of the facial nerve is very important for the otologist and radiologist concerning fractures and other lesions of the temporal bone. Axial and/or coronal standards are sufficient for imaging of the labyrinthine and the mastoidal segment of the facial canal. The sensitivity of visualization (sensitivity = number of identified structures per number of examinations) of the tympanic segment, however, is low and particularly the pyramidal segment (elbow, posterior knee) is not visualized in these standards. Based on anatomical considerations a new plain for imaging both the tympanic and mastoidal segment in continuity was obtained. The pyramido-longitudinal plain is achieved by a twice angulated 2-D-reconstruction based on axial high-resolution CT-scans.

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Imagerie du canal facial par reconstruction TDM en deux dimensions multiplan avec angulation à haute résolution

Résumé Le canal facial, où chemine la partie intra-temporale du n. facial, est très important pour l'ORL et le radiologue s'intéressant aux fractures et aux autres lésions de l'os temporal. Les incidences standard axiales et/ou coronales sont suffisantes pour l'imagerie des segments labyrinthique et mastoödien du canal facial. Cependant la sensibilité (rapport du nombre de structures identifiées au nombre d'examens) de ces incidences pour le segment tympanique est faible, en particulier le segment pyramidal (coude ou genou postérieur) n'est pas visualisé sur ces incidences standard. Sur la base de considérations anatomiques, un nouveau plan est défini pour l'imagerie simultanée des segments tympanique et mastoïdien. Le plan pyramido-longitudinal est obtenu par une reconstruction en deux dimensions angulée dans deux plans de l'espace, basée sur des examens tomodensitométriques (TDM) axiaux en haute résolution.

     

Functional anatomy of human lacrimal duct epithelium

 Resorption of tear fluid in the lacrimal ducts has hitherto been controversial; one reason for this has been insufficient knowledge of the anatomical structure and function of the lacrimal duct epithelium. The present study analyzes the structure of lacrimal duct epithelium by means of histological, histochemical, immunohistochemical and electronmicroscopical methods and draws a conclusion about its physiological function regarding its role in immunodeficiency. Investigations were performed on 31 lacrimal systems of 17 male and 14 female individuals (aged 54–88 years). Lacrimal ducts are surrounded by a wide-ranging cavernous system, which is embedded in an osseous canal between the maxilla and the lacrimal bone. The internal wall of the lacrimal canaliculi is lined by a stratified epithelium. The lacrimal sac and nasolacrimal duct contain a double-layered epithelium, which rests on a broad basement membrane. In their apical part epithelial cells contain large lipid droplets and secretory vacuoles. Epithelial cells are faced by microvilli and some tufts of kinociliae are also visible. Goblet cells are integrated in the epithelium as solitary cells or in a characteristical arrangement of several cells. The secretory product of these cells contains carbohydrates including fucose and sialic acid. Inside the surrounding cavernous system serous glands are found that open their excretory ducts into the lacrimal sac and nasolacrimal duct. Some T- and B-lymphocytes and macrophages may be demonstrated immunohistochemically in the submucosa partly penetrating the epithelium. Synthesized mucins of goblet cells form a specialized protective layer on the epithelium of the lacrimal ducts, which functionally serves for a simplified drainage of tear fluid into the inferior meatus of the nose. Together with immunocompetent cells, the protective layer plays a role in antigen defense and prevents invasion of pathogenic agents. The facing of epithelial cells by microvilli gives hints of reabsorption of lacrimal fluid inside the lacrimal ducts. Accepted: 13 January 1998     

鼻泪管的临床应用解剖

目的为临床开展内窥镜鼻窦手术及泪囊手术提供解剖学依据.方法在20具40侧经防腐处理的完整成人尸头标本上观测鼻泪管骨壁的厚度及其相关临床数据.结果测得鼻泪管内骨壁的厚度为(0.9±0.2)mm(0.4～1.4mm);后骨壁的厚度为(0.2±0.2)mm(0.1～0.8mm).结论鼻泪管内骨壁较厚而坚硬,经鼻内窥镜行泪囊鼻腔造孔术时以使用电钻开窗为宜;鼻泪管后骨壁较薄,内窥镜下行上颌窦口扩大时不宜过于向前以免损伤鼻泪管.     

Anastomosis between the inferior alveolar artery branches and submental artery in human mandible

The mental artery displays several branches internal to the anterior region of the mandible as confirmed by macroscopic observation and computed tomography. The inferior alveolar artery formed complex branches and divided into mental and incisive branches, which were found in the right internal side of the mandible of one male cadaver (88 years old). The branches of these two arteries ran through the bony lingual canal to the lingual foramen between the canine and premolar region of the inner surface of the mandible body, where they emerged to enter the mylohyoid and anterior belly of the digastric muscles and communicate with the submental artery. The observation of the anastomotic artery is considered important for surgical placement of dental implants in the mandibular region.     

Evaluation of the temporal bone by anatomic sections and computed tomography

Summary Serial Computed Tomography (CT) scans of isolated temporal bones have been obtained in transverse planes at 1.5 mm intervals. Then gross anatomic sections of same temporal bones were taken at 3 mm. intervals in planes parallel to the CT scans. These CT and anatomic sections were evaluated comparatively.

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Evaluation de l'os temporal par coupes anatomiques et coupe TDM

Résumé Les coupes sériées au scanner d'os temporal isolé ont été faites dans le plan transversal tous les 1,5mm. Le même os a ensuite été coupé tous les 3mm dans des plans parallèles à ceux du scanner. Les deux séries de coupe sont ensuite analysées de façon comparative.

     

利用螺旋CT确定面神经管锥段位置

目的为临床医生提供面神经管锥段位置关系的信息。方法取15例开颅取脑后颅底标本,对面神经管锥段与外半规管凸、后骨半规管、锥隆起、鼓索隆起之间的直线距离进行直接测量与64层螺旋CT测量;对118例患者头颅CT扫描图像进行相同项目的测量。对颅底标本两种方法测量结果和男女患者头颅CT扫描资料测量结果分别进行t检验。结果尸骨直接测量与CT测量结果（（x珚±s）mm,以下同）分别是1.49±0.61与1.55±0.60,2.27±1.02与2.19±1.07,3.31±1.31与3.39±1.28,3.78±1.26与3.87±1.42;两种方法测量值差异无显著统计学意义（P〉0.05）。活体测量男女性的测量值分别为1.68±0.86与1.34±0.69,2.49±1.44与1.95±1.35,3.60±1.24与3.13±1.23,3.96±1.21与3.47±1.32;两性的测量值差异有显著统计学意义（P〈0.05）。结论 CT测量方法可靠,测得值可信;CT扫描除可助医生明确诊断外,CT测量和面神经管的三维重建还可助临床医生术前、术中对面神经管锥段及其他解剖结构的定位与保护。在术中可以外半规管凸、后骨半规管、锥隆起对锥段定位;相反亦可以面神经定位骨半规管。     

泪小管前壁切除逆行置管术治疗扩张型泪小管炎的效果

目的 观察泪小管前壁切除逆行置管术治疗扩张型泪小管炎的临床疗效。方法 选择2016年5月~2018年8月在我院行手术治疗的70例扩张型泪小管炎患者,按手术方式分为对照组和实验组,各35例。对照组采用泪小管切开引流术,实验组行泪小管前壁切除逆行置管术。比较两组手术效果及术后复发情况。结果 实验组治愈率为94.29%,高于对照组的60.00%,差异具有统计学意义（P＜0.05）;实验组复发率为0,低于对照组的28.57%,差异具有统计学意义（P＜0.05）。结论 采用泪小管前壁切除逆行置管术可恢复扩张型泪小管炎患者的泪道引流功能,远期临床疗效较高,同时可降低术后复发率。     

多层螺旋CT三维成像行国人气道径线分析

目的探讨国人气管和主支气管各种解剖径线的长度与角度.方法用多层螺旋CT三维成像法测定300例成年健康体检者锁骨胸骨端水平气管内径、锁骨胸骨端水平到隆突的气管长度,左、右主支气管和右中间支气管内径与长度,以及左、右主支气管长轴与矢状面的夹角.结果男性气管、左、右主支气管、右中间支气管内径与长度,以及右上肺叶支气管开口内径均大于女性,而女性左、右主支气管长轴与矢状面夹角均大于男性(p<0.05或0.01).成年人与老年人上述各解剖径线值差异无显著(p>0.05).左主支气管内径值与右主支气管内径值呈高度相关,且分别与气管内径值和身高呈高度相关(p<0.01).结论通过多层螺旋CT三维成像法测定国人气管、左和右主支气管径线值,获左、右主支气管内径值与患者身高和气管内径测量值的回归方程,可预测其左、右主支气管内径值.     

肝外胆管供血动脉数字化三维重建图像与传统解剖学图像的比较

目的：对比观察肝外胆管供血动脉3D重建图像与传统解剖学图像,评价其各自的优缺点。方法2012年1—12月,对来自南方医科大学珠江医院肝胆一科的10例肝外胆管梗阻性疾病患者病例进行回顾性研究。将10例患者的上腹部亚毫米CT扫描数据导入腹部医学图像3D可视化系统(MI-3DVS)程序化构建肝外胆管供血动脉3D重建图像,并与传统解剖学图像进行对比分析。结果肝外胆管供血动脉3D重建图像真实,立体感强,可以从不同角度进行3D空间的解剖关系观察;传统解剖学图像只能显示平面的解剖结构,表现手法单一,但可根据手术显微镜所观察的尸体标本灌注情况,还原绘制胆管周围血管丛等3D重建图像无法显示的血管。结论3D图像真实直观,能真实还原组织器官结构的本来面貌,便于学习和理解,是解剖学研究和学习的新途径,也可以为个体化胆道外科手术方案提供指导,但不能完全替代传统解剖图像。     

Measurements of the normal lumbar spinal canal by computed tomography

Summary Computed tomography measurements of the main diameters and cross section areas of the lumbar vertebral canal and the lower end of the dural sac at the L3–L4 and L4–L5 levels were made in 34 young male adults who were free of symptoms. This study shows a statistically significant correlation between the height of the subject and the cross sectional area of the canal and the dural sac, and the interpedicular diameter. The determination of regression coefficients enabled an estimate to be made of the mean values of these parameters in relation to height, the actual values having a normal distribution around these means. This study suggest that the areas, when narrowing is suspected, should be interpreted as a function of the height of the subject.

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Mensurations tomodensitométriques du canal vertébral lombaire normal — Etude segmentaire en L3–L4 et L4–L5 rapportée à la taille des sujets

Résumé Les mesures TDM des principaux diamètres et surfaces du canal vertébral lombaire et du cul-de-sac dural en L3–L4 et L4–L5 sont effectuées chez 43 adultes jeunes, de sexe masculin, strictement asymptomatiques. Cette étude montre l'existence d'une corrélation statistiquement significative entre la taille des sujets et certaines mesures : surface du canal, surface du fourreau dural, diamètre interpédiculaire. La détermination d'une droite de régression permet d'apprécier la valeur moyenne de ces paramètres en fonction de la taille, les valeurs normales se répartissent autour de cette moyenne dans les limites de l'écart-type. Cette étude suggère que les valeurs de surface, mesurées lors de l'étude des canaux rétrécis, doivent être interprétées en fonction de la taille des sujets.

     

面动脉穿支蒂颊黏膜瓣重建泪道的解剖学基础

目的为面动脉穿支蒂颊黏膜瓣重建泪道提供解剖基础。方法在10个20侧动脉内灌注红色乳胶的成人头标本上解剖观测:①面动脉穿支的起源、分支与分布;②颊动脉的起源、分支与分布;③面动脉与颊动脉的吻合。另在1侧新鲜标本上进行摹拟手术设计。结果颊黏膜的血供为多源性,主要由面动脉、颊动脉和上牙槽后动脉发出的穿支供养。①面动脉自颈外动脉发出,行至咬肌前缘越过下颌骨底达面部后,再斜向内上至内眦处与鼻背动脉吻合,沿途除发出分支营养颈、面部相应区域外,在口角外侧(1.10±0.31)cm处分出1～3支颊支,支配颊肌与颊黏膜前中部,并与颊动脉颊支、上牙槽后动脉颊支形成吻合;②颊动脉发自上颌动脉的翼肌段,行于颞肌下部深面前下方向,沿途发支分布于颊黏膜后中部,并与面动脉穿支相互吻合。当上颌动脉分出颊支细短时,则由粗大的上牙槽后动脉颊支(占5%)代偿。结论颊黏膜瓣血供丰富,可形成以面动脉穿支为蒂颊黏膜瓣转位重建泪道。     

耳内窥镜经鼻观察泪囊前泪道阻塞鼻泪管下口的形态

目的　应用30o斜耳内窥镜镜头经鼻观察泪囊前泪道阻塞患者鼻泪管下口的形态,总结内窥镜下泪囊前泪道阻塞患者鼻泪管下口的影像解剖形态特征,为临床开展经鼻泪管下口逆行插管造影检查打下基础。  方法　选取患有泪囊前泪道阻塞性疾病患者54例（75眼）,上下泪点闭锁3例（5眼）、上下泪小管阻塞15例（24眼）、泪总管阻塞18例（28眼）、陈旧性上下泪小管断裂18例（18眼）,均应用30°斜耳内窥镜镜头观察鼻泪管下口,总结活体泪囊前泪道阻塞患者鼻泪管下口的形态特点。  结果　54例（75眼）,66眼鼻泪管下口开放,开放率88%,其中1例鼻泪管下口开放者,受刺激后,Hanser瓣膜完全遮盖鼻泪管下口,导致其呈线形关闭;9眼鼻泪管下口闭锁,占12%。根据鼻泪管下口开放的形态将其分为椭圆形宽大状（30眼,45.45%）、三角形裂隙状（12眼,18.18%）、条形裂隙状（24眼,36.36%）三种类型。21例（42眼）双眼患病的患者,双侧鼻泪管开口形态不同者15例（30眼,71.42%）,双侧鼻泪管开口形态相同者6例（12眼,28.57%）。  结论　应用30°斜耳内窥镜镜头经鼻观察泪囊前泪道阻塞患者的鼻泪管下口的可行性好,对于鼻泪管下口开放的患者有进行内窥镜引导下的逆行插管造影检查的解剖基础。     

Intercoccygeal angle and type of coccyx in asymptomatic patients

PURPOSE: To assess the intercoccygeal angle of asymptomatic patients (without coccydynia), to study if there is a difference of angle between types of coccyx and between genders with the same type of coccyx. MATERIALS AND METHODS: Ninety-two patients (42 females, 50 males, range of ages 8-86, mean 50) who underwent computed tomography (CT) angiography and colonoscopy were included in the study. CT images with slice thickness of 1 or 1.5 mm were evaluated with 3D sagittal reformats and intercoccygeal angle, type of coccyx were examined. RESULTS: Twenty-one females and 18 males had type 1 coccyx with mean intercoccygeal angle 36.4 degrees +/- 10.56 (33.29 degrees for females and 40.05 degrees for males) and the difference of the angles between genders is statistically significant (P = 0.044). Among 36 patients (14 were females and 22 were males) with type 2 coccyx demonstrated mean intercoccygeal angle of 56.36 degrees +/- 10.8. 15 patients were shown to have type 3 coccyx and the mean intercoccygeal angle was 72.1 degrees +/- 31.86. No significant difference of angles was seen between genders. Type 4 coccyx was not seen and two coccyx could not be classified. There was a significant difference of intercoccygeal angle between the groups overall. CONCLUSION: Type 1 is the most common coccyx type in asymptomatic patients. Significant difference of intercoccygeal angle was defined between the types of coccyx. These values may be reference for the patients underwent surgery for the coccydynia and a new classification may be needed since exceptional shape of coccyx exists that could not be defined according to the known classification.     

CT evaluation of cervical pedicle in a Chinese population for surgical application of transpedicular screw placement

The lower cervical pedicle size differs between the Chinese and the non-Chinese population. Knowledge of pedicle dimensions and surface landmarks is crucial for the safe placement of screws, but few quantitative data concerning the lower cervical pedicle using CT scan and multiplanar reformations (MPR) in a Chinese population exist. The aim of this study was to evaluate lower cervical pedicle (C3-C7) dimensions in a Chinese population by computed axial tomography for surgical application. The dimensions of the pedicles (C3-C7) were determined in 60 patients from CT images of cervical spinal lesions. Measurements of pedicle height, width, pedicle axis length, effective length, and two angles of the pedicles, the distances from the projection point of the pedicle axis to the lateral edge of the lateral mass and to the inferior edge of the superior facet were measured. The smallest outer pedicle width was found at C3 among the female and C4 among the male. This measurement was significantly different between male and female patients in the outer pedicle width (P < 0.05; independent samples t test) at C3 and C4. The mean values of the outer pedicle width ranged from 5.4 to 6.7 mm in males, and 4.4 to 6.3 mm in females. The projection point of the pedicle axis in the lateral-superior area of the cervical lateral mass was the most important. There were significant correlations (P < 0.01; Kendall's W test) between the vertebral level and both pedicle angles (PTA and PSA). The smallest pedicle transverse angle was at C7 in males and females. The cervical spinal cord or vertebral artery may be at risk of injury if the angulation of the screw insert is over-medial or over-lateral in the transverse plane. Therefore, preoperative CT evaluation of pedicle transverse angle is very important. Considering the amount of variation among individuals, our data on CT measurements of pedicle in a Chinese population in conjunction with evaluation of the results of preoperative CT may enhance the safety of transpedicular screw fixation in the lower cervical spine.     

胆总管探查后内置鼻胆管与T管的比较研究

目的 探讨胆总管探查后内置鼻胆管(BD管)与T管对胆总管的影响。方法 选择同龄猪为实验对象，行胆总管探查后观察内置BD管与T管对胆总管的影响。结果 两种内置管使胆总管呈现不同程度扩张。管壁增厚，粘膜和肌层呈现不同程度炎性变，BD管较T管对胆总管刺激和损伤小。结论 BD管内置可起到与T管类似的引流和支架功能，使胆总管探查后成功地进行一期缝合，克服了T管引流的许多问题，符合做创观念。     

人坐骨肛管横隔CT的解剖学特点

目的　探讨坐骨肛管横隔的CT表现。 　方法　回顾性分析172例非肛区疾患就诊者盆部CT图像,行1．5 mm薄层重建,利用多平面重建技术,在合适的窗技术下观察坐骨肛管横隔及其邻近脂肪组织的CT表现。 　结果　坐骨肛管横隔上方脂肪组织密度低于下方,两者间CT值差异具有统计学意义（P<0．05）。与女性比较,男性的下方肛管皮下间隙脂肪组织密度更高,导致上、下方脂肪组织密度差异肉眼可辨识的比例（88．37%）高于女性（38．37%）,该性别间差异均具有统计学意义（P<0．05）。坐骨肛管横隔CT直接显影率约23．26%,呈较对称线型全程、线型部分或分枝型软组织密度影,由肛门外括约肌皮下部和浅部之间发出,走向坐骨结节。统计直接显影者的最大厚径,左、右侧均值分别为（2．50±0．46）mm、（2．89±0．78）mm,其中男性与女性双侧厚度均值分别为（2．71±0．43）mm、（2．69±0．44）mm。 　结论　依据CT图像上坐骨肛管横隔上方坐骨直肠间隙与下方肛区皮下间隙脂肪密度差异,可以判定其位置,部分人可在CT上直接显影。     

Three-dimensional modeling of the anatomy of the heart and great vessels

Summary The anatomic constraints imposed on a total artificial heart (TAH) require specific anatomic studies. A thoracic anatomic study was performed with a scanning device equipped with three-dimensional (3-D) reconstruction software on 15 male patients, between the ages of 41 to 63 years (52 ± 6 years). All were candidates for heart transplantation. The 3-D reconstructions of the cardiovascular structures obtained from surgical anatomy data specific to TAH implantation allowed a volumetric measurement of these structures. A modeling diagram of these structures permitted reproducible quantitative measurements of the 35 geometrical parameters which characterized shape, orientation, and position of these structures within the thorax. Most of the measured parameters were characterized by low variability (coefficient of variation from 10 to 25%).

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Modélisation tridimensionnelle de l'anatomie du cur et des gros vaisseaux

Résumé Les contraintes anatomiques imposées au cur artificiel total (CAT) nécessitent des études anatomiques spécifiques. Une étude anatomique thoracique a été réalisée avec un scanner doté d'un logiciel de reconstruction tridimensionnelle (3-D) chez 15 patients, tous de sexe masculin, agés de 41 à 63 ans (52 ± 6 ans), et candidats à une transplantation cardiaque. Les reconstructions 3-D des structures cardio-vasculaires réalisées selon les données de l'anatomie chirurgicale propre à l'implantation du CAT ont permis la mesure volumétrique de ces structures. Un schéma de modélisation de ces structures a permis des mesures quantitatives reproductibles de 35 paramètres géométriques caractéristiques de la forme, de l'orientation, de la position de ces structures dans le thorax. Les résultats de ces mesures ont pu être exprimés en termes statistiques. La plupart des paramètres mesurés étaient caractérisés par une faible variabilité (coefficients de variations de 10 à 25%).

     

猪胆总管脱细胞基质构建组织工程胆管的生物力学评价

目的　用不同的脱细胞方法对猪胆总管进行处理,比较脱细胞前后的生物力学变化,筛选适宜的脱细胞方法,为组织工程胆管支架材料的应用提供理论依据。 方法　30例猪胆总管,随机分为5组,A组：对照组, B组：0.05 % 胰蛋白酶+核酸酶,C组：0.1 % SDS+核酸酶,D组：1.0 % Triton X-100+核酸酶,E组：1.0 % Triton X-100+0.1 % SDS +核酸酶。在Test Resources生物力学试验机上进行加载一卸载试验和极限抗张强度试验。计算出生物力学材料常数（α1、β1、α2、β2）、弹性模量、极限抗张强度和断裂伸长率等指标。 结果　Ｄ组、Ｅ组的生物力学材料常数（α1、β1、α2、β2）与A组的差异无统计学意义（F = 12.21, P = 0.06）,Ｂ组、C组比A组、D组和Ｅ组的小（P < 0.01）;Ｄ组、Ｅ组的弹性模量比A组的稍增大,但差异不明显（P > 0.05）,Ｂ组、C组比A组的小（P < 0.05）;Ｄ组、Ｅ组的UTS值和SOF值与A组差异不明显（P > 0.05）;B组、C组的UTS值明显小于A组（P < 0.05）,SOF值明显大于A组（P < 0.05）。 结论 应用1.0 % Triton X-100+核酸酶和1.0 % Triton X-100+0.1 % SDS +核酸酶的脱细胞效果好,且不会影响猪胆总管的生物力学特性,是一种比较理想的猪胆总管脱细胞方法。