腰动、静脉在脊柱前路手术中的应用解剖学研究

目的：对腰动静脉的位置分布及变异进行描述和统计分析,以提高腰骶段脊柱手术手术的安全性和有效性。方法：对30具尸体标本进行解剖学研究,主要观察（1）腰动静脉的数量与缺失,各节段腰动静脉发出点位置的定性描述,（2）腰动静脉左右共干与上下共干的概率以及腰动静脉的其他变异。结果：腰动脉的数量以及位置相对固定,有5对腰动脉的一共有5例,腰动脉发出点的位置也不是完全与腰椎对应。腰动脉左右共干的占9.6%,未见上下共干。动脉中仅有65.3%的动脉有静脉伴行。腰静脉的数量变异非常大,最少一侧仅有1支腰静脉,最多有5支,最常见的情况是3支,占36.7%。腰静脉的位置变异也较大,与椎体没有特别的规律。腰静脉的左右共干的概率要大于动脉,为38.5%,而上下共干也是腰静脉的独有的现象,总共有26支,占总数的12.5%。另外,腰静脉的其他变异多见。结论：当脊柱手术选择腹主动脉左侧入路或者腹主动脉下腔静脉之间入路时,腰动脉和腰静脉的解剖特点尤为重要。动脉的位置相对较恒定,而静脉则变异较大,缺失常见,左右共干,上下共干,静脉之间的大的交通支常见,与腰椎的对应性不如动脉,且其与动脉并非严格伴行,这些原因都造成了静脉容易损伤的原因,在手术中应该特别注意。     

高频超声检测腕管段正中血管神经束解剖变异及其临床意义

目的探讨高频超声对腕管段正中血管神经束解剖变异的检测价值及其在腕管综合征诊治中的临床意义。方法对500例健康志愿者的1000只手腕部腕管结构及前臂行高频超声检查,记录腕管段正中神经分叉、永存正中动、静脉的位置及分布,测量腕管段永存正中动、静脉的直径,于豌豆骨水平测量正中神经的横截面积。结果①共检出正中神经分叉者34例(41处),检出率4.1%,且均分为两支,其桡侧支横截面积均大于尺侧支[(0.075±0.015)cm2vs.(0.023±0.005)cm2],差异有统计学意义(P0.05);27例单侧正中神经分叉者分叉侧两分支横截面积之和与健侧同一位置横截面积比较,差异无统计学意义;②共检出永存正中动脉者15例(20处),检出率2.0%;永存正中动脉直径0.04～0.19 cm,平均(0.11±0.04)cm,其中13例伴有永存正中静脉,检出率1.3%;③在34例正中神经分叉和15例永存正中动脉阳性者中,正中神经分叉合并永存正中动脉者均为16处,占比为39%、80%,差异有统计学意义(χ2=9.050,P=0.003)。结论高频超声可以清晰显示正常成人腕管段正中血管神经束的解剖变异,有助于临床医师准确诊断腕管综合征,具有较好应用价值。     

兔腰动脉阻断建立脊髓缺血再灌注动物模型的实验研究

目的：了解兔腰动脉解剖学特点及存在的变异情况；为腰动脉阻断法脊髓缺血再灌注动物模型的制作提供解剖学依据。方法：采用经胸主动脉乳胶灌注方法对7只兔的腰动脉间距、外径及长度进行测量；同时观察其发出、走行及变异情况。结果：兔腰动脉共有7支，均为单支；肾动脉上方2支，下方5支，呈节段性地从腹主动脉后侧向后发出。腰动脉间距平均(1．72&;#177;0．58)cm：外径(1．191&;#177;0．161)mm；长度(0．71&;#177;0．12)em；肾动脉下方第5支(下，支)腰动脉比较特殊；腰动脉还存在一些变异情况。结论：兔腰动脉呈单支便于动物模型的制作，但其下，支存在吻合支及一些变异情况应值得注意。     

腰5骶1椎间盘前入路髓核摘除术的应用解剖学研究

目的为L5/S1椎间盘经腹穿刺入路提供解剖学依据.方法在30具成人尸体标本上观测L5/S1椎间盘前方的解剖结构和毗邻关系.结果①L5/S1椎间盘前方仅见部分下腔静脉[(3.33±3.28)%]和左髂总静脉[(6.67±4.56)%]的主支走行,骶正中动脉位置恒定,骶正中静脉变异较大;②回肠和乙状结肠加压时可推移至穿刺靶区以外.结论在L5/S1椎间盘前方尤其在其正中偏右侧区域存在着穿刺入路的安全间隙.     

兔腰动脉阻断建立脊髓缺血再灌注动物模型的实验研究

目的:了解兔腰动脉解剖学特点及存在的变异情况;为腰动脉阻断法脊髓缺血再灌注动物模型的制作提供解剖学依据。方法:采用经胸主动脉乳胶灌注方法对7只兔的腰动脉间距、外径及长度进行测量;同时观察其发出、走行及变异情况。结果:兔腰动脉共有7支,均为单支;肾动脉上方2支,下方5支,呈节段性地从腹主动脉后侧向后发出。腰动脉间距平均(1.72±0.58)cm;外径(1.191±0.161)mm;长度(0.71±0.12)cm;肾动脉下方第5支(下5支)腰动脉比较特殊;腰动脉还存在一些变异情况。结论:兔腰动脉呈单支便于动物模型的制作,但其下5支存在吻合支及一些变异情况应值得注意。     

骶髂关节损伤与血管的应用解剖学测量

背景:骶髂关节部位骨折脱位可导致血管的严重损伤。目的:观察骶髂关节周围血管解剖学特征,明确各血管与周边组织的关系。设计、时间及地点:单一样本观察,于2007-10/2008-01在南通大学解剖教研室完成。材料:20具防腐成年尸体骨盆标本(南通大学解剖教研室提供),男16具,女4具,年龄在30～60岁。方法:40侧骨盆标本,依次选用不同的平面,采用前后双侧入路,观察血管的走行特点。主要观察指标:测量血管直径及到骨盆后壁的垂直距离。结果:①左侧髂总动脉距骨壁平均距离为(5.31±0.25)mm,右侧髂总动脉距骨壁平均距离为(5.47±0.23)mm。②髂外动脉自髂总动脉发出后于骶骨翼的前方向外下方走行,行程中于距起点(32.30±0.43)mm处斜跨骶髂关节的前方,其跨越骶髂关节处距骶髂关节的距离为(17.28±0.43)mm,于骶岬处距骶髂关节的距离分别为(2.20±0.21)cm和(2.95±0.25)cm。③髂内动脉左右侧口径无显著差别(P>0.05)。④左侧髂内动脉距骨壁距离大于右侧。⑤髂腰动脉至骨壁距离为(6.97±0.17)mm,小于10mm,距骨壁较近。结论:骶髂关节动脉解剖学特点决定了在骶髂关节骨折脱位中损伤的概率。根据测量结果可以得出:①骶髂关节脱位及骨折时,损伤髂总动脉的概率较小。②髂外动脉距骶髂关节的垂直距离较远,髂内动脉距骨壁距离较远,当发生骶髂关节部骨折时,骨折片直接刺伤血管的可能性较小。③髂内动脉距骶髂关节水平距离较小,故当发生骶髂关节脱位半骨盆移位时,有可能受到牵拉损伤。④骶外侧动脉距骨壁较近,所以骶骨I区骨折时易受损伤。⑤髂腰动脉至骨壁距离较近,故当发生骶髂关节脱位时半骨盆移位可能受到牵拉损伤。     

骶正中动脉和骶正中静脉的测量及临床意义

目的:为直肠癌全直肠系膜切除术(TME)提供形态学基础,进一步丰富形态学资料,为临床直肠癌手术提供指导。方法:取完整盆腔标本男11例、女9例,经直肠上动脉和两侧髂内动脉注入红色乳胶,分层解剖,观察骶正中动脉和骶正中静脉发源、走行、分支及吻合情况;并测量骶中动脉及骶中静脉的外径。结果:20例标本的盆腔结构辨认清楚,骶正中动脉的直径为:男(1.492±0.081)mm;女(1.338±0.069)mm。骶正中静脉的直径为男(5.240±1.725)mm;女(4.204±0.964)mm。结论:骶正中动脉参与直肠的血液供应;TME手术时,应于盆筋膜的脏、壁层之间进行分离,以保证直肠系膜切除的完整性及避免损伤骶前静脉丛。     

腕管内正中神经变异的声像图表现及其临床意义

目的 探讨腕管正中神经及伴行结构变异在人群中的发生率、超声表现及其在腕管综合征诊断中的意义.方法 对180位健康志愿者的360只手腕部腕管结构及前臂进行高频超声检查.检查前臂和腕部正中神经走行,先进行腕管结构的横断面扫查,确认正中神经位置后,采用连续横断面扫查法向近端前臂进行动态观察并适当结合纵断面扫查,记录图像资料.结果 腕管正中神经及伴行结构变异:①正中神经高位分叉2例(0.56％);②正中神经裂17例(4.72％);③腕部正中神经区发现永存正中动脉22例(6.11％),并且2例(0.56％)永存正中动脉周有静脉伴存.永存正中动脉出现伴随正中神经走形变异16例(4.44％).结论 腕部高频超声检查能够敏感地发现正中神经变异,认识这些变异,有助于正确诊断腕管综合征.     

腰骶部脊神经后支行经特点及骨纤维管道解剖测量

目的:探讨腰骶背神经后支的行径特点,并测量神经行径的骨纤维管道的位置。方法:解剖8具16侧成人尸体标本,观察测量神经走行经过的骨纤维管道位置。结果:腰神经后外侧支在行径中经过下位椎体横突背面的骨纤维管道,该点至后正中线的距离从L1至L5椎体依次为24.9±1.2,25.7±1.4,30.2±1.7,32.5±1.3,32.2±1.5 mm;所汇成的臀上皮神经分2~3束跨髂嵴入臀,最内侧的入臀点骨纤维管道至后正中线距离为68.4±11.8mm。后内侧支恒定地向后下沿下位椎体横突基部的骨纤维管。臀中皮神经主要由L5~S3的后外侧支组成,经过骶髂长韧带深面的纤维管道,管道内上口至髂后上棘的距离平均为32.4±6.2 mm;外下口至髂后上棘的距离平均为36.8±5.6 mm;髂后上棘至骶骨外侧角的距离平均为67.2±9.3 mm。结论:腰骶神经后支行经的几个骨纤维管道位置基本恒定。这些骨纤维管道是神经卡压的解剖基础,在疼痛诊断和治疗上有重要意义。     

胸腰段微创椎弓根钉置入的应用解剖

背景:椎弓根螺钉技术已经广泛运用于各种脊柱外科手术,其一般采用经典的背部正中线手术路入,但近年来发现该手术路入会引起一些并发症。目的:为棘突顶端定位法微创胸腰段椎弓根螺钉内固定技术提供解剖学基础。方法:选用5具甲醛固定的正常人胸腰段标本,在放大10倍的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。结果与结论:节段动脉主要分为肋间动脉,前支和后支。其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。微创椎弓根螺钉内固定时,入钉点的安全范围在5mm左右,连接棒经入钉点内侧置入为佳。说明棘突顶端定位法下的经皮椎弓根螺钉技术由于近似于垂直操作且无侧向牵拉,且从椎弓根中心点(入钉点)内侧插入已预弯的连接棒,损伤脊神经后支和血管的机会较少,是微创脊柱外科手术的一种重要技术手段。     

混合现实技术在骶骨肿瘤切除重建中应用价值

目的 应用混合现实技术对骶骨肿瘤患者进行骶骨肿瘤切除重建手术,探讨其在骶骨肿瘤切除重建中的临床应用价值.方法 20例骶骨肿瘤患者随机分为观察组和对照组各10例,对照组根据影像学资料的肿瘤边界进行骶骨肿瘤切除重建术,观察组在对照组的基础上联合采用混合现实技术进行骶骨肿瘤切除重建术,比较2组手术时间、术中出血量、切口长度、...     

Sacral Neuromodulation for the Treatment of Chronic Functional Anorectal Pain: A Single Center Experience

Introduction:   Treatment of functional anorectal pain disorders remains a challenge. The purpose of this study is to describe a single center experience with sacral neuromodulation for the treatment of chronic functional anorectal pain.
Methods:   This is a retrospective study based on prospectively collected data of patients treated with sacral neuromodulation for functional anorectal pain from April 2005 to August 2008. Symptoms were analyzed using a visual analog scale pain score (0 to 10). A 7-point Likert scale was used to rate global perceived effect. All patients had a percutaneous nerve evaluation and subsequent test stimulation to assess sacral neuromodulation outcome prior to permanent implantation. Patients were eligible for permanent sacral neuromodulation in case of a pain score <3 during test stimulation and/or >50% decrease in the pain score compared to baseline.
Results:   Nine patients (2 males) were included in this study. Mean age was 53.8 years (27.6 to 74.0). Four patients (1 male) had successful test stimulation and were eligible for permanent implantation. Median pain score decreased from 8.0 (6.0 to 9.0) to 1.0 (0 to 2.0). All patients experienced a lasting improvement during the follow-up till 24 months. Global perceived effect in successful patient was 1 (completely recovered) in one patient and 2 (much improved) in three patients.
Conclusion:   This study showed that sacral neuromodulation can be a successful treatment for functional anorectal pain not responding to other treatments. Improvement obtained during test stimulation is a good predictor (diagnostic) for sustained success of permanent sacral neuromodulation.     

A randomized controlled trial to measure the effectiveness of a sacral wedge in preventing postoperative back pain following trans-urethral resection of the prostate (TURP) in lithotomy position

Background. Postoperative back pain is a common, yet under reported, complication of surgery. Previous studies, although small in number, have indicated that the use of a sacral wedge is effective in reducing the incidence of postoperative back pain. Aim. The aim of the study was to test the hypothesis that the intra‐operative use of a sacral wedge would decrease the incidence of postoperative back pain in patients undergoing trans‐urethral resection of the prostate in lithotomy position. Methods. The design of the study was a randomized controlled trial involving the use of a sacral wedge intra‐operatively in a male population undergoing trans‐urethral resection of the prostate. A total of 236 participants was recruited to the study and allocated to the control or intervention group by block randomization. All patients selected one of three different sized sacral wedges for use during surgery. Data were collected preoperatively, intra‐operatively and at postoperative days 2 and 4 and the tools included a structured questionnaire, Oswestry Disability Questionnaire, a visual analogue scale to measure pain intensity and a body map to record its location. Results. Fifty‐two per cent of participants reported having a history of back pain and point prevalence on admission to hospital was 27%. Twenty‐eight per cent of participants experienced back pain on day 2 postoperatively and this decreased to 14% on day 4. There was no significant difference between the control and intervention groups. The severity of back pain increased after surgery. Postoperatively there were reports of back pain from participants who had not reported a history of back pain before their admission for surgery. Conclusions. In contrast to other studies we found no evidence to support the use of a sacral wedge intra‐operatively to reduce the incidence of postoperative back pain. Relevance to clinical practice. Despite the non‐significant results, the high level of postoperative back pain stills draws attention to the need to develop strategies to reduce its incidence.     

40例原发性骶骨肿瘤病人围术期的护理

[目的]总结原发性骶骨肿瘤病人围术期的护理。[方法]对40例原发性骶骨肿瘤病人行手术治疗,术前加强心理护理、数字减影血管造影(DSA)栓塞术后护理、肠道护理,术后严密观察生命体征,加强伤口及引流管、脑脊液漏、脊髓神经功能的观察及护理。[结果]40例病人均安全度过围术期,康复出院。[结论]加强原发性骶骨肿瘤病人围术期的护理是手术成功的保证。     

FES for Bladder: Direct or Indirect Means?

Efforts to restore function to the neuroiogically disabled lower urinary trad by direct electrical stimulation of the bladder wall have met with only very limited success. This has been due to pain and cocontraction of bladder outlet mechanisms caused by presumed spread of the large currents required to effectively directly stimulate the detrasor muscle. Stimulation at the four anatomical sites of the sacral neural outflow on the other hand has been more successful. Conus medullaris stimulation has resulted in "good results" in just over half of the 28 patients so treated. Acceptance of this technique has been limited by the poor selectivity of the intramedullary electrodes in stimulating only the target motor neurons and the resultant clinical problems with the consequent stimulus current spread. Sacral anterior root stimulation has been used in at least 88 patients with generally good results. Cocontraction of the detrusor and external urethral sphincter are circumvented by the use of an intermittent pattern of stimulation. The primary disadvantage of this technique is the obligatory placement of the electrodes within the cerebrospinal fluid compartment. Clinical experience with stimulation of the extradural sacral mixed nerves is limited. Experimental studies indicate that success with this technique requires dorsal rhizotomy and pudendal neurotomy. Preliminary clinical experience suggests that these surgical manipulations may not be necessary for a successful outcome. The literature on clinical application of pelvic nerve stimulation is too limited for detailed comment on this technique. A definitive technique for restoration of bladder function by electrical stimulation remains to be developed.     

前后联合入路局部刮除置管灌注化疗及放疗术治疗高位骶骨肿瘤

Fortheelevationsacraltumorstoobtainthesurgicalsafemarginbyresectionisverydifficult.Thereportsaboutthecasesofsacrec-tomypointedoutthecomplications,includingcomplexsurgery,tremendoustraumaandsacralnervalfunctionalbereavement,wereserious犤1-3犦.Weusedthealternativesurgicalprocedurewhichwasapproachinanteriorwithposteriortocurettageandlocalpouringchemotherapywithradiotherapytotreat24casesofthehighlevelsacraltumorsandtheresultsofclinicaluseaboutthissurgicaltechniquewasfine.1Materialsandmethods1.1Gen…     

Sonography in the diagnosis and management of anterior sacral meningocele

Four cases of anterior sacral meningocele (ASM) are described, with comparisons between radiological and sonographic findings. On plain films, 2 cases showed the classic scimitar sign, and 1 case showed a defect in the anterior sacrum. The other lesion appeared radiologically to be a purely intrasacral meningocele. Myelography outlined part of the ASM in two cases. Sonography demonstrated the anterior sacral cysts in all cases. Sonography is a noninvasive method of monitoring progress or contraction of a lesion, and it can be used to demonstrate any associated pathology. The combination of plain-film appearances and sonographic findings should be sufficient for diagnostic purposes. If an operative procedure is contemplated, then myelography may be performed in an attempt to outline the stalk.     

Anterior sacral meningocele simulating ovarian cyst

Anterior sacral meningocele is a rare condition characterized by the herniation of meningeal membranes and cerebrospinal fluid through a defect in the anterior aspect of the sacrum. We report a case of an anterior sacral meningocele that was mimicking an ovarian cyst.     

高位骶骨肿瘤前后联合入路局部刮除置管灌注化疗放疗术对骶神经功能影响的评价

Thesacrectomyisthemostimportantsurgicalproceduretotreatthesacraltumors犤１，２犦．Weusedthealternativesurgicalprocedurewhichwasapproachinanteriorwithposteriortocurettageandlocalpouringchemotherapywithradiotherapytotreat２４casesofthehighlevelsacraltumorsandtheresultsofclinicaluseaboutthissurgicaltech－niquewerefine．１Materialsandmethods１．１GeneralinformationBetween１９９３and２０００，２４casesofhighlevelsacraltumorsweretreatedbythesurgicaltechniqueofapproachinanteriorwithposteriortocuretta…