尺侧腕伸肌-拇短伸肌腱移位重建拇对掌功能的应用解剖

目的:研究拇对掌肌、拇短展肌的解剖学特点,探讨符合人体生物力学的拇对掌功能重建的方法。方法:对20侧新鲜成人上肢标本,解剖拇对掌肌、拇短展肌,并建立尺侧腕伸肌-拇短伸肌移位重建拇对掌功能的手术模型。结果:拇短展肌肌纤维方向沿第1掌骨纵轴方向,拇对掌肌肌纤维方向与第1掌骨成一定角度。尺侧腕伸肌-拇短伸肌移位后,测量拇指远侧横纹中点到第3掌骨长轴与掌远侧横纹交点之间的最大距离可达(5.9±0.7)cm。结论(:1)尺侧腕伸肌长度、肌力足以重建拇对掌功能,拇短伸肌腱止点恒定,联合移位后其作用方向与拇短展肌方向一致,且旋前角度足够。(2)以尺侧腕伸肌-拇短伸肌移位重建拇对掌功能是一种符合拇对掌功能生物力学的简单有效的方法。     

掌指关节的三维解剖及形态分析

目的：观测掌指关节关节面的几何形态,为人工关节的设计和应用提供解剖学依据。方法：10只成人手标本,解剖掌指关节,测量侧副韧带起点距掌骨头关节面的直线距离,三维数据检测仪获得关节面三维坐标数据,应用SPSS软件进行统计分析和成像。结果：掌骨头有双髁结构,桡侧髁略大,第1掌骨头形态特殊;各掌骨头高度的比较无显著差异;其掌侧关节面大于背侧,第2、3掌骨头关节面面积明显较大。近节指骨底在形态、高度和面积方面各序列相似;各序列侧副韧带起点桡侧较尺侧距离掌骨头关节面远。结论：手指人工关节的设计应符合解剖形态,并根据各序列形态的差异进行个体化设计,尤其拇指更应区别对待;手指人工关节的设计和应用中应注意软组织保护,关节的切除范围应注意保留侧副韧带的起止点。     

拇指腕掌关节面形态及运动分析

拇指如同一个悬臂系统，拇指腕掌关节是这个系统的支点，该关节由大多角骨远侧端和第一掌骨底组成，是双凹型鞍状关节，除能做简单的角运动外，尚可沿拇指的纵轴做旋转以完成对掌功能。拇腕掌关节复杂的运动由关节面的特殊形态决定，深入研究其形态学和生物力学，对探讨拇指伤病致残机理、手术修复与再造及人工关节设计有重要意义。     

拇指腕掌关节面形态及运动分析

拇指如同一个悬臂系统，拇指腕掌关节是这个系统的支点，该关节由大多角骨远侧端和第一掌骨底组成，是双凹型鞍状关节，除能做简单的角运动外，尚可沿拇指的纵轴做旋转以完成对掌功能。拇腕掌关节复杂的运动由关节面的特殊形态决定，深入研究其形态学和生物力学，对探讨拇指伤病致残机理，手术修复与再造及人工关节设计有重要意义。     

带血管蒂第5腕掌关节移位的应用解剖学

目的 :为带血管蒂的第 5腕掌关节移位修复和重建手的功能性关节提供解剖学基础。方法 :2 2侧冷冻成人上肢标本 ,显微解剖观测第 5腕掌关节的结构特点、关节面的形状、血供来源、神经支配、韧带的构成及长、宽、厚度 ,并测量关节的活动度。模拟设计以腕背动脉网及其分支为蒂的第五腕掌关节移位术。结果 :①第 5腕掌关节为鞍状关节 ,具有屈伸 3 9.16°± 4.2 4°的活动范围。②第 5腕掌关节的血供来自掌深弓尺侧返支、第 4掌背动脉近端的关节支和尺动脉手背支、腕掌网和腕背网的分支。③第 5腕掌关节由尺神经支配 ,掌侧为尺神经深支的分支 ,背侧为尺神经手背支分支。结论 :可设计以掌背血管筋膜为蒂的逆行和以桡动脉腕背支筋膜为蒂的顺行第 5腕掌关节移位 ,用于修复和重建拇指腕掌关节和第 2～ 5掌指关节     

桡神经浅支的观察

教科书均述桡神经浅支与尺神经手背支二者以不同的交通或呈不同类型布于手背指背皮肤。布于关节囊骨膜者见于桡尺神经深支的分支。仅有个别报道桡神经浅支布于拇、示、中指的掌指、指间关节,以及桡侧腕短伸肌。但未见桡神经浅支布于骨间背侧肌的报道。最近我们于9具尸体的双侧手和3支单手,共21只手(左侧10只、右侧11支)中发现,由桡神经浅支发出的手背皮神经的分支,其经过第一掌骨间隙的皮神经支,在近腕掌关节处发出长约0.5cm的小支至深部。     

带血管蒂管5腕掌关节移位的应用解剖学

目的为带血管蒂的第5腕掌关节移位修复和重建手的功能性关节提供解剖学基础.方法22侧冷冻成人上肢标本,显微解剖观测第5腕掌关节的结构特点、关节面的形状、血供来源、神经支配、韧带的构成及长、宽、厚度,并测量关节的活动度.模拟设计以腕背动脉网及其分支为蒂的第五腕掌关节移位术.结果①第5腕掌关节为鞍状关节,具有屈伸39.16°±4.24°的活动范围.②第5腕掌关节的血供来自掌深弓尺侧返支、第4掌背动脉近端的关节支和尺动脉手背支、腕掌网和腕背网的分支.③第5腕掌关节由尺神经支配,掌侧为尺神经深支的分支,背侧为尺神经手背支分支.结论可设计以掌背血管筋膜为蒂的逆行和以桡动脉腕背支筋膜为蒂的顺行第5腕掌关节移位,用于修复和重建拇指腕掌关节和第2～5掌指关节.     

肌腱移位治疗第1腕掌关节脱位的解剖学研究进展

第1腕掌关节（即拇指腕掌关节）脱位是临床骨科常见腕掌部损伤，其发生机理为第1掌骨受到轴向并尺侧暴力打击，致使第1掌骨向背侧、桡侧近端移位。常伴有第1腕掌关节周围韧带断裂。如果未得到及时正确的处理，愈后常有关节不稳定，影响拇指对掌及外展功能。经典的治疗第1腕掌关节脱位方法有手法复位加夹板外固定，手术切开复位克氏针内固定、术后石膏外固定。腕掌关节脱位基本上都伴有周围肌腱断裂，以上两类治疗方法修复后肌腱抗拉力也会显著降低，术后复发的可能性大，特别是在早期进行功能锻炼时容易发生。     

桡掌肌一例

<正> 尸解一成年女尸时,发现右前臂屈肌多一块桡掌肌(或称副桡侧屈腕肌),现报告如下: 桡掌肌属长肌,以腱性起于旋前圆肌止点下方,桡骨下1/3上份外侧的骨膜上,肌纤维由外上稍斜向内下,在桡侧屈腕肌腱和拇长屈肌腱的深面,经腕管后成腱膜止于拇收肌斜头深面第二掌骨底。肌全长9.5cm,肌腹长6.8cm,最宽1.55cm,厚0.6cm,止端腱长2.7cm,宽3.0cm(见图)。     

桡掌肌一例

解剖男性成人尸体标本,见其右前臂有桡掌肌,起于桡骨远侧段的掌面,前臂中点下0．2cm,穿腕管止于第2掌骨底、桡侧腕屈肌腱止点的内侧;肌腹呈梭形,中部最宽13mm,长6．2cm;肌健长7．0cm,宽1．6mm,肌总长13．2cm。在前臂掌面远侧部,肌的浅层有桡动脉,深层为旋前方肌。在腕管内,肌的浅层有桡侧腕屈肌腱和拇长屈肌腱越过,深层为桡腕韧带。     

Preferential direction of collagen fibrils in the sub-chondral bone bone and the hip and shoulder joint]

We hypothesised that--due to bending and tension--there should exist a preferential direction of the collagen fibrils in the subchondral bone of the concave components of the hip and shoulder joint that results from bicentric or eccentric loading, but there should be no preferential direction in the convex joint partners. We therefore examined 25 human hip and 27 shoulder joints, these being decalcified after maceration. To analyse the preferential direction of the collagen fibrils, we used the split line method. The subchondral plate was pierced at regular intervals with needles that had been previously dipped in diluted ink. In the acetabulum, we found a predominantly transverse direction of the split lines in the ventral and dorsal horn of the lunatic surface, and these usually continued through the acetabular fossa. In the ventral part of the acetabular roof, arch-like orientations of the split lines were observed. In the glenoid cavity, a clearly preferential orientation was found in anterior-posterior direction, usually in the middle third of the articular surface. In the femoral and humeral heads, no preferential direction of the split lines was observed in any of the specimens. We interpret the split-line patterns in the acetabulum as an expression of the tensile stress that is encountered during a "spreading open" of the socket upon bicentric (ventral-dorsal) loading in the physiologically incongruous joint. In the glenoid, the relatively weak bony support in the ventral and dorsal part of the articular surface may be responsible for bending and tensile stress, particularly in view of eccentric loading during dynamic activity, and this could explain the observed anterio-posterior split line pattern. The results support the idea that the subchondral bone of concave joint partners encounters tension, leading to a preferential direction of the collagen fibrils. This can be considered as a functional adaptation of the subchondral bone on a microstructural level.     

In-situ imaging of articular cartilage of the first carpometacarpal joint using co-registered optical coherence tomography and computed tomography

Conventional imaging modalities are unable to depict the early degeneration of articular cartilage in osteoarthritis, especially in small joints. Optical coherence tomography has previously been used successfully in high-resolution imaging of cartilage tissue. This pilot cadaver study demonstrates the use of intra-articular optical coherence tomography in imaging of articular cartilage of the first carpometacarpal joint, producing high resolution images of the articular surface in which cartilage thickness and surface characteristics were assessed. Findings on optical coherence tomography were confirmed with histology. Furthermore, co-registration of optical coherence tomography and computed tomography was used to accurately determine the scanned trajectory and reconstruct a true-scale image overlay.     

Computer-assisted design of the sagittal shapes of a ligament-compatible total ankle replacement

The poor results of total ankle replacement have been attributed to the inability of designers to restore adequately the critical mutual function of the ligaments and the articular surfaces. The purpose of this study was to design sagittal shapes of the articular surfaces for a new ankle prosthesis to be compatible with the geometry of the reticular surfaces for a new ankle prosthesis to be compatible with the geometry of the retained ligamentous structures. Several ligament-compatible pairs of articular surfaces were tested using a computerised version of a four-bar linkage model. The kinematics of the ankle when replaced by non-conforming two-component and by fully conforming three-component designs with either flat, concave or convex tibial surfaces were assessed by the model. A ligament-compatible convex-tibia fully-congruent three-component prosthesis showed the best features. The three-component prosthesis allows complete congruence over the entire range of flexion. A convex shape for the tibial are was preferred because of the better degree of entrapment of the meniscal bearing. A 5 cm convex-tibia arc radius gave 2 mm entrapment together with 9.8 mm of tibial bone cut. Ligament elongation imposed by full congruence of the articular surfaces was less than 0.03% of the original length. The original patterns of joint kinematics and ligament tensioning are closely restored in the joint replaced by the proposed prosthesis.     

Fibre-optic array for curvature assessment: application in otitis diagnosis

A contact-free sensor consisting of two parallel optical-fibre arrays was designed to assess surface shapes of diffusely scattering media. By sequentially illuminating objects using one fibre array and detecting the diffusely back-scattered photons by the other, a source-detector intensity matrix was formed, where the matrix element (i, j) was the intensity at detector j when light source i was excited. Experimental data from convex and concave polyacetal plastic surfaces were recorded. A mathematical model was used for simulating source-detector intensity matrices for the surfaces analysed in the experiments. Experimental results from the system were compared with the theoretically expected results provided by the mathematical model. The shape and relative amplitude showed similar behaviour in the experiments and simulations. A convex/concave discriminator index D, representing the detected intensity difference between two source-detector separations, was defined. The relative dynamic range of D, defined as the difference between the maximum and the minimum divided by the mean of the index, was 1.37 for convex surfaces and 0.68 for concave surfaces, at a measuring distance of 4.5 mm. The index D was positive for convex surfaces and negative for concave surfaces, which showed that the system could distinguish between convex and concave surfaces, an important result for the diagnosis of otitis media.     

基于裂隙扫描图像的角膜表面三维重建

角膜是人眼的重要组成部分，眼外科中对角膜表面检查一般采用基于Placido盘的角膜地形图法和裂隙扫描角膜地形图法，但这两种方法的结果都未能获得直观的角膜表面三维模型。本研究设计的一种基于裂隙扫描图像的角膜表面三维重建算法，实现了对角膜前后表面的重建，并能快速地计算出角膜前后表面的几何参数以及转换成传统的等高线图和地形图，方便了医生的诊断。该算法首先采集角膜的裂隙扫描图像序列，然后在图像集中提取出每层角膜的轮廓，进而采用轮廓线重构算法得到角膜表面模型。在对裂隙图像提取闭合轮廓线时，根据角膜区域的颜色差异，采用了色彩分割的算法；针对角膜轮廓线是凹的特点，对轮廓线重构算法做了改进，以便能构造出正确的角膜表面三角形网格。     

寰枢椎侧块关节面形态的影像解剖学研究

目的:探究寰枢椎侧块关节面解剖形态的影像学参数,为临床寰枢椎侧块关节间融合器的设计提供支持。方法:回顾性研究。选取2019年1月—2020年6月在宁波市第六医院行颈椎CT检查的100名成人健康体检者的影像资料,其中男57人、女43人,年龄26～61(40.9±6.4)岁。受检者均行C 1～C 7...     

肋横突关节关节面的形态特点及其意义

目的　通过对成人肋横突关节骨性关节面的形态学测量,探讨其形态特征规律为临床诊疗、置钉设计及相关生物力学研究提供理论依据。 方法 选取40套（80侧）成人胸廓干骨标本,进行相关指标观测,并按不同节段统计分析。 结果　横突肋凹横槽形仅见于T1和T2,凹面形T1~4渐增,平面形T5~9渐增,T11、T12基本无肋凹;横突肋凹上位T4~8渐增,中位T1~4渐增,T5~9由63.7%渐减到11.3%,下位T1~7渐减;肋结节关节面平面型呈正态分布,凸面型除R7外,均占23.0%~50.0%,凹面型R1、R2分别为27.5%、33.8%,其余分布极少,R11、R12基本无关节面;肋结节关节面仅R1出现上位,占10.0%,中位R1占80.0%,R3~11占3.8%~26.3%,下位R2~10占60%~96.2%。 结论　椎骨横突肋凹由凹到平、位置逐渐上移;肋结节关节面由凸变平位置逐渐下移;临床应用应根据1~12肋的相关参数选取适合的治疗方案。     

肋骨肋头关节面的解剖学观测及其临床意义

目的观测成人肋头关节形态特征,填补国人人类学数据,并为临床诊治脊柱胸段疾患提供解剖学依据。方法观测成套肋骨标本,描述肋头关节形态学特征。结果肋头关节面48．7％为双关节面,按面积大小分型,上小下大型占41．7％,上下相等型占6．5％,上大下小型仅占0．5％;按凸凹形态分型,上平下凹型占32．1％,上下双凹型占13．9％,上凹下平型仅为2．7％。构成单关节面的肋头关节占51．3％,可分为平面型和凹面型两种,分别为平面型24．1％、凹面型27．2％。结论肋头关节面多分为单、双两种形态,其中第3～10肋双关节面出现率更高,且形态变异较大,可能是双关节面更易出现肋头关节劳损与错位的重要原因。