针刀治疗枕大神经卡压综合征的应用解剖研究

目的 力针刀治疗枕大神经卡压综合征提供形态学依据.方法在20侧成人尸体头颈标本上,对枕大神经的行径、穿斜方肌腱膜和深筋膜以及易发生卡压的部位进行了解剖、观察和测量.结果①枕大神经在枕外隆凸的下方2.8cm±0.2cm,旁开2.6cm±0.1cm处穿斜方肌健膜和深筋膜至皮下;③穿斜方肌腱膜和深筋膜的部位约位于枕外隆凸到乳突尖连线中、上1/3交界点;③穿出点有大量腱纤维和筋膜束缠绕枕大神经及枕动静脉,是发生卡压的部位.结论 用针刀在枕神经穿腱膜和筋膜点的稍内侧进针,从外上向内下作分离松解,便可解除其卡压.     

腰椎手术Wiltse入路准确进入多裂肌与最长肌间隙的解剖学基础

目的　探讨腰椎手术Wiltse入路的解剖学基础,提高该入路的稳定性和可操作性。 方法　成人标本20具,通过解剖观察双侧竖脊肌腱膜与多裂肌的关系;最长肌与竖脊肌腱膜的关系;多裂肌和最长肌间隙是否清晰,是否存在稳定的解剖标志;竖脊肌腱膜表面及其深面是否还存在其它结构可作为多裂肌和最长肌之间隙的解剖标志。 结果　多裂肌虽有少许纤维与竖脊肌腱膜相连接,仍可视为在竖脊肌腱膜上无起点;在腰部,最长肌在竖脊肌腱膜形成起点,起点的内缘自内上向外下斜行,并发出筋膜向深部延伸副突、横突,由此形成多裂肌与最长肌之间的分隔;在所有20具标本的左右两侧,以此隔膜为解剖标志向深部钝性分离,直接、顺利到达关节突;在竖脊肌腱膜表面未发现任何可作为多裂肌和竖脊肌间隙标志的解剖结构,剥离竖脊肌腱膜后在最长肌和多裂肌表面亦未发现可定位二者间隙的解剖标志;在多裂肌和最长肌间隙内,最长肌的内侧面可见清晰的节段神经及伴随血管。 结论　竖脊肌腱膜在最长肌内侧向深部的延续是腰椎手术Wiltse入路准确进入多裂肌和最长肌间隙的可靠解剖标志。     

游离骨间后动脉3叶皮瓣设计的解剖学研究

目的　为临床设计以骨间后血管为蒂的游离3叶皮瓣提供解剖学依据。 方法　新鲜前臂标本8侧,以肱骨外上髁至尺骨茎突桡侧连线为轴线,将前臂划分为4个均等区间,解剖观察远端3个区间中骨间后动脉发出的穿支的位置、走形和分支数,在深筋膜浅层和深层的穿支蒂长度。选取1例标本进行3叶皮瓣设计切取模拟手术。 结果　骨间后动脉在前臂平均发出4~7个穿支,其中区间I穿支数为2~4个,区间II穿支数为2~3个,区间III穿支数平均为1~3个;区间I、II、III穿支起点到深筋膜的蒂长分别为0~0.6、0.2~1.2、0.5~1.8 cm, 穿支起点到浅筋膜层的蒂长分别为1.2~2.7、1.2~4.5、1.8~4.5 cm。 结论　以骨间后动脉为蒂,利用其不同部位的穿支组合,设计游离3叶皮瓣具有临床可行性。     

足底腱膜的解剖

目的观察足底腱膜的形态结构,为临床应用提供相关的解剖学资料。方法解剖50只10%甲醛固定的足,观察足底腱膜浅层的形态结构;测量足底腱膜中间部(跖腱膜)止于跖骨头处内、外侧纤维束的厚度与长度;跖腱膜中间部的厚度。结果足底腱膜浅层的纤维结构主要参与前外侧部足底脂肪垫的构成,并形成与足底皮纹相似的螺旋纤维板状结构,足跟部足底腱膜浅层的纤维结构较为稀疏。中间部的厚度为(2.168±0.1139)mm;跖腱膜于第1跖骨头处内、外侧纤维束的厚度分别为(1.33±0.08)mm、(1.46±0.07)mm,明显大于止于2~5跖骨头处的内、外侧纤维厚度,P0.05;第5跖骨头处的内、外侧纤维厚度分别为(0.29±0.02)mm、(0.37±0.04)mm,明显小于1~4跖骨头处的内、外侧纤维厚度,P0.05。结论足底腱膜浅层主要参与足前外侧脂肪垫的构成,足底腱膜深层对维持足部纵弓的稳定起着非常重要的作用,在足部受力时有效地避免足前部趾足底总神经、趾足底总血管受压。     

面部表浅肌肉腱膜系统(SMAS)的解剖学研究

目的 :深入探讨SMAS的形态学特点 ,为颜面部整形手术的开展提供翔实的形态学基础。方法 :对 6例新鲜和 8例固定头颈部标本进行大体和显微解剖以及组织切片观察。结果 :SMAS位于皮下脂肪深面 ,直接与颈阔肌延续 ,向前连于眼轮匝肌、颧大肌和蜗轴 ,向上与颞浅筋膜相连 ,向后与颈深筋膜浅层融合 ;SMAS分为肌性部和膜性部 ;SMAS与腮腺咬肌筋膜之间有脂肪组织存在 ,面神经在腮腺咬肌筋膜中行走。结论 :SMAS是面部皮下脂肪和腮腺咬肌筋膜之间的独立组织结构层次 ;SMAS与颈阔肌、颧大肌、颞浅筋膜 -枕额肌相连 ,构成头面颈部浅筋膜和深筋膜之间的连续而独立的组织结构层次。     

Deep fascia on the dorsum of the ankle and foot: extensor retinacula revisited

This study revisits the anatomy of the deep fascia over the distal leg, ankle, and dorsum of the foot. The arrangement of the deep fascia in these regions was recorded in 14 lower limbs of adult cadavers using photographs and drawings. The fascial layer from all three sites was subsequently removed in toto, and serial thickness measurements were made along its entire length. In addition, fiber disposition was studied under polarized light, and sections were stained to demonstrate collagen. The arrangement of deep fascia is complex. A common and novel finding at all levels is a crisscross, lattice-like arrangement of fibers. There was little evidence of the clearly defined sturdy band of the superior extensor retinaculum (SER) or of the Y-shaped inferior retinaculum (IER) commonly illustrated in topographical anatomy texts. The SER is a complex area with several thickenings commencing about 3 cm proximal to the tip of the lateral malleolus and gradually increasing to reach a maximum of 270 microm about 5 cm above the malleolus, then gradually returning to original thickness, about 9 cm above the malleolus. Fibers crossing diagonally to each other are a feature of the region. The IER characteristically has two forms: either a cross-shaped band (9 specimens) or a thickened "node" with small extensions radiating toward the malleoli (5 specimens), located about 1-2 cm distal to the lateral malleolus and centred over the common tendon of extensor digitorum where it has maximum thickness (430 microm). The deep fascia is thickened and firmly attached over both malleoli and to the tarsals and metatarsals along both borders of the foot. In general, the deep fascial structures were thicker in males than those in females.     

改良先天性肌性斜颈手术方法的解剖学研究

【摘要】目的：根据颈筋膜解剖特点,改进传统的先天性肌性斜颈的手术方法。方法：选取经福尔马林固定,颈部无肉眼病变的成人尸体标本12具。沿锁骨切开皮肤、颈阔肌,向上在颈筋膜浅层浅面（封套筋膜）进行仔细分离,观察封套筋膜和颈阔肌的相互关系,粘连程度。以锁骨上方1.5 cm水平为中心,在胸锁乳突肌内缘内侧0.5 cm纵行剪开封套筋膜约3 cm,在胸锁乳突肌后鞘深面进行分离达胸锁乳突肌外侧,感觉分离的难易程度,观察封套筋膜和颈动脉鞘的完整性。结果：封套筋膜在颈前完整、致密,将胸锁乳突肌完整套封,颈阔肌与封套筋膜可以轻易地完整分离;在颈中下部胸锁乳突肌后鞘与颈动脉鞘也无粘连,各自独立,很容易完整分离。结论：依据胸锁乳突肌前后筋膜鞘的结构特点,可以将先天性肌性斜颈传统手术加以改进,提高疗效。     

Detailed anatomy of the capsulopalpebral fascia

This study was designed to elucidate the detailed anatomy of the capsulopalpebral fascia (CPF) and capsulopalpebral head (CPH), and their relationships to the inferior rectus muscle (IRM). In this cohort study, 40 eyes from 20 cadavers were observed macroscopically. Dissection was carried out from the CPF origin to its insertion, and the CPF origin pattern was photographed in each specimen. The width, length, and tensile strength of the CPF were measured. The CPF originated 25.07 ± 1.07 mm laterally and 24.86 ± 1.10 mm medially from the origin of the IRM and extended to the lower border of the inferior oblique muscle, and it firmly adhered to the IRM surface and formed into the CPH. The CPH was 4.31 ± 0.86 mm laterally and 6.18 ± 1.94 mm medially in length and 7.47 ± 0.81 mm in width. The CPF originated from the total width or 3/4 temporal part of the IRM in 32 (80%) of 40 faces. There was asymmetry in the pattern of the CPF origin between the left and right eyes in 4 of 20 paired specimens (20%). The tensile strength of the posterior layer was 19.12 ± 11.22 N, which was significantly higher than that of the anterior layer (8.59 ± 3.88 N) (P = 0.001). This study provided a good understanding of the CPF structures conducive to performing IRM surgery.     

经皮椎弓根螺钉技术的解剖学基础及其临床意义

目的：为经皮椎弓根螺钉技术提供解剖学基础并在此基础上分析经皮植入椎弓根螺钉较常规开放植入椎弓根螺钉临床应用的优点。方法：选用10具经防腐固定，在解剖显微镜下对胸腰段脊柱后部结构进行逐层解剖，重点观测脊神经后支及其分支、脊柱节段动静脉的后支的来源、走行以及分布规律。结果：脊神经后支的内侧支经骨纤维管下行沿途支配横突棘肌，支配下方小关节突、筋膜和韧带。外侧支向外下行走，沿途支配背部深层肌肉。节段动脉的后支在椎间孔的上外方绕向后下方，走行于脊神经的下方和下位脊椎上关节突的外方，分为内外两支穿行于腰部深层肌肉。节段静脉后支与同名动脉伴行，并与对侧、相邻节段同名静脉在棘突和横突部位构成静脉丛。结论：避免损伤脊神经后支和节段动静脉的后支并运用可视化操作系统的经皮椎弓根螺钉植入技术，是微创脊柱外科一种新的技术手段。     

踝关节内侧韧带的解剖结构特点及其临床意义

目的　观察踝关节内侧韧带解剖结构特点,为临床微创修复踝关节内侧韧带手术提供解剖学基础。 方法　剥离解剖8例男性成人无病变下肢标本,对踝关节内侧韧带进行形态学观察,采集相关数据并进行统计学分析。 结果　踝关节内侧韧带分深、浅两层：浅层韧带束从内踝前侧至后侧分为胫舟韧带（长18.22~26.14 mm）、胫弹簧韧带（长6.24~10.40 mm）、胫跟韧带（长10.32~14.36 mm）和胫距后韧带浅层（长8.32~13.52 mm）。深层结构包括胫距前韧带（长11.32~15.62 mm）和胫距后韧带深层（长10.22~12.60 mm,宽6.72~9.84 mm,厚1.72~2.24 mm）。 结论　依据踝关节内侧韧带的走行有助于分辨其组成层数及束数,掌握踝关节内侧韧带的解剖特点,有利于设计合理的手术方案。     

An unusual flexor hallucis longus muscle

During the dissection of the posterior compartment of the left leg, an unusual flexor hallucis longus muscle of a fifty two years-old male cadaver was observed. On the medial side of the flexor hallucis longus, on its lower distal half, a prominent aponeurotic structure was observed. A small unusual muscle mass was attached to this aponeurotic structure. The muscular fibres of the unusual mass were arranged in form of bipennate muscle. It originated via a broad tendon from the muscular fibres of the tibialis posterior and the deep transverse fascia covering the same muscle. It inserted on the aponeurosis of the lower medial half of the flexor hallucis longus muscle. Having in mind the very different pathology in the region of the ankle and the foot, the significance of such a muscle mass could be of practical importance.     

Anomalous fascicle and high origin of latissimus dorsi compensating for absence of serratus anterior

The unilateral absence of the right serratus anterior muscle was found in a 78 year old white male subject. In addition, on the same side, a high origin (5th thoracic level) of latissimus dorsi with an accessory muscle fascicle which covered the inferior angle of the scapula and fused with teres major and with the deep fascia of infraspinatus was also found. The structural arrangement suggests that the absence of serratus anterior was compensated for by the anomalous latissimus dorsi.     

An anatomic investigation of the serratus posterior superior and serratus posterior inferior muscles

In classical anatomy textbooks the serratus posterior superior muscle was said to elevate the superior four ribs, thus increasing the AP diameter of the thorax and raising the sternum. However, electromyographic and other studies do not support its role in respiration. In order to help resolve this controversy and provide some insight into their possible functionality, the present study aimed at examining the morphology, topography and morphometry of serratus posterior superior and inferior muscles in both normal specimens and those derived from patients with a history of chronic obstructive pulmonary disorder (COPD). These muscles were examined in 50 human cadavers with an age range of 58–82 years. In 18 of the cadavers their histories revealed that they were suffering from COPD. There was no significant difference between right and left sides, race, gender and age and positive COPD history in regard to dimensions and nerves supply of serratus posterior superior and inferior muscles (P > 0.05). Based upon our findings that no morphometric differences exist between the of serratus posterior superior and inferior muscles of COPD patients versus controls, we are suggesting that no respiratory function be attributed to either of the serratus posterior superior and inferior muscles.     

新鲜标本的下胫腓联合韧带解剖特点及临床意义

目的： 研究新鲜标本下胫腓联合韧带的解剖学特点,为下胫腓联合韧带相关损伤及韧带重建提供解剖学依 据。方法： 选取新鲜胫腓下联合标本,剥离新鲜标本的下胫腓联合的肌、血管及筋膜组织,对下胫腓联合前、后、 横韧带进行解剖学测量,包括胫腓下联合前、后、横韧带的近端长度、远端长度、平均宽度、与水平面的夹角、 冠状面的夹角等相关解剖学数据。结果： 下胫腓联合前韧带近、远端平均长度为（8.51±0.70）mm、（19.03±1.35） mm,平均宽度（15.98±1.17） mm,与水平面、冠状面夹角分别为（42.27±3.43）°、（20.50±4.69）° ;下胫腓联 合后韧带近、远端平均长度为（9.32±0.62）mm、（16.92±1.76）mm,平均宽度（14.36±0.88）mm,与水平 面、冠状面夹角分别为（40.96±3.16）°、（13.10±1.99）°;下胫腓联合横韧带近、远端平均长度为（18.46±2.48） mm、（21.87±2.52）mm,平均宽度（4.56±0.17）mm,与水平面、冠状面夹角分别为（30.60±3.65）°、（13.48±1.60）°。 对左右、男女的下胫腓联合前、后、横韧带的解剖学数据进行对比,差异均无统计学意义。结论： 了解下胫腓联 合韧带各解剖结构及其特点,有助于指导下胫腓联合韧带损伤的修复和重建,帮助外科医生制定手术方案,改善 预后。     

The interpectoral fascia flap

Despite the great number of pedicled and free flaps that are available for defect and contour repair, the number of fascia flaps with an axial blood supply are sparse. Such flaps with their gliding function are mandatory, whenever coverage with very thin, well-vascularized tissue is necessary. To the currently established fascia flaps, (the temporoparietal fascia flap, the radial forearm fascia flap, the lateral arm fascia flap, and the serratus anterior fascia flap), we want to add a new fascia flap, the interpectoral fascia flap. We dissected the interpectoral fascia flap from 20 cadavers. In each of the 40 hemichests, the trunk of the thoracoacromial vessels was selectively injected with red polyurethane and the tissue containing the pectoral branches was separated from the overlying pectoralis major muscle and converted into an independent fascia flap. The maximum flap length was 13.5 cm and the maximum breadth was 10.3 cm. The length of the vascular pedicle before entering the flap was 3.9 cm +/- 1.4 cm with a range of 1.5-6.8 cm. Concerning the arc of rotation, all 40 flaps reached the posterior axillary fold, and 29 flaps (73%) reached the mandibular border. This new fascia flap has applications as pedicled and as free flap. The pedicled flap is used in the neck region, in the axillary region and as gliding tissue between the nipple-areola complex and the pectoralis major muscle. The usage of the fascia flap as a free flap has similar characteristics as the other fascia flaps.     

股后区主要穿支的形态学分析与皮瓣设计

目的：为股后区穿支皮瓣的临床应用提供解剖学依据。方法：6具（12侧）动脉灌注明胶．氧化铅混悬液的新鲜成人整尸标本，解剖观测股后区外径≥0．5mm的穿支，测量其管径及其走行、分支与分布情况等。取下整个下肢被覆组织拍摄X线片，观测皮动脉的数量以及彼此间的吻合情况等。利用Photoshop与Scion Image分析穿支供血的趋向性及每个分支的供血面积等。结果：股后区共有穿支（外径≥0．5mm）27支，其中65％为皮穿支，35％为肌皮穿支。平均外径为0．8mm，平均蒂长为2．93cm。自股深动脉之穿动脉发出者平均长度为6．81cm。每侧穿动脉在股后区供血面积平均为229cm^2，平均每个穿支供血面积为43cm^2。结论：股后区的皮肤穿支管径较粗，营养皮肤面积较大，以股后诸穿支为蒂设计的穿支皮瓣可为下肢或身体其它部位皮肤移植提供：①游离皮瓣；②近端蒂皮瓣；③远端蒂皮瓣。     

颈交感神经干与筋膜的关系及在颈椎前外侧手术入路中的临床意义

目的　了解颈交感神经干（cervical sympathetic trunks, CST）与颈筋膜的解剖关系,为颈椎前外侧手术入路中避免CST损伤提供更为可靠的方法。 方法　福尔马林固定的成人尸体标本42具,标本分为两组,第1组30具,观察CST与椎前筋膜浅层（Alar筋膜）的位置关系及联系的紧密程度。在第2组12具,观察CST与颈动脉鞘关系。 结果　在第1组中,CST在第7颈椎椎体水平距离椎体中线的距离最小,约20 mm,所有标本中CST在第7颈椎椎体以上均紧密黏贴于Alar筋膜后面,有的甚至可视为被颈筋膜浅层包裹,不易与Alar筋膜钝性分离,当Alar筋膜被向外侧牵开时CST被一并牵开。在第2组中,所有标本中CST均紧贴于颈动脉鞘后面。 结论　CST紧贴于椎前筋膜深面,可随Alar筋膜被自然牵开,在颈椎前外侧入路的手术中不需要辨认、分离CST,仅通过牵开颈筋膜浅层即可对CST进行有效保护。     

The clinical anatomy of the ligament of Barkow at the proximal tibiofibular joint

INTRODUCTION: Mention of the ligament of Barkow at the proximal tibiofibular joint is rarely found in the literature and it is not represented in most anatomical atlases. To our knowledge, quantitation of this structure has not been performed. As injury to the knee region is so common, a comprehensive knowledge of this regional anatomy is important to the clinician and surgeon alike. MATERIALS AND METHODS: Forty lower limbs from embalmed cadavers underwent dissection of the proximal leg with special attention toward the presence or absence of ligament of Barkow. When identified, measurements of this structure were made. RESULTS: The ligament of Barkow was identified in 95% of specimens. For right sides, the mean width was 1.5 cm and the mean length was 1.2 cm. For left sides, the mean width of this ligament was 1.2 cm and the mean length was 1.5 cm. The mean thickness of ligament of Barkow was 1.2 mm (range 0.9-1.4 mm). The upper edge of this ligament was on average 3 cm inferior to the inferior most aspect of the proximal tibiofibular joint. The lower edge of ligament of Barkow was a mean distance of 7 mm from the anterior tibial artery at its entrance into the anterior compartment of the leg. One ligament was found to be fully ossified; thereby, creating a bony bar superior to the anterior tibial vessels. CONCLUSIONS: Our hopes are these data will help further elucidate the ligament of Barkow. Imaging studies are now necessary to further elucidate functional and pathological involvement of this structure.     

甲状腺周围筋膜及筋膜间隙的应用解剖学观察

目的　从临床应用解剖角度重新认识甲状腺周围筋膜及筋膜间隙的解剖特点,为甲状腺癌中央区清扫术的手术范围、入路层面等提供可以借鉴的解剖依据。  方法　5具10侧标本,对甲状腺周围筋膜和筋膜间隙进行观察;10例甲状腺癌患者进行手术解剖验证观察。  结果　气管前筋膜分为前后两层,两层之间是脂肪淋巴组织及甲状腺下静脉等;气管前间隙是气管前筋膜后层与气管之间的无血管的间隙。气管旁脂肪组织与气管前脂肪组织相延续,甲状腺血管、淋巴系统走行其中。气管旁、气管前脂肪淋巴组织前后均有一层筋膜覆盖,前后筋膜在外侧与血管鞘相融合,并开口于甲状腺血管根部,内侧与甲状腺相连,其结构与功能均类似肠系膜。气管旁脂肪组织在前方与甲状腺之间存在一间隙,后方与椎前筋膜之间存在一间隙。  结论　甲状腺有系膜且呈“U”分布于气管前及气管旁。甲状腺系膜切除能达到彻底清扫中央区淋巴组织的目的。甲状腺系膜与脏器之间的筋膜间隙是进行手术操作的外科平面。