神经肌蒂移植至环杓后肌的应用解剖

在21具成尸标本上,针对喉返神经损伤后的有关问题观察了支配舌骨下肌群和环甲肌的神经.从解剖学角度认为神经肌蒂移植时首选肩胛舌骨肌上腹肌支、胸骨舌骨肌上肌支或环甲肌肌支。暴露环(?)后肌的手术层次是咽下缩肌、咽肌、梨状隐窝和环(?)后肌筋膜。     

恢复环甲肌功能的实验研究

<正> 本文通过对狗颈部诸喉外肌与环甲肌肌电的对照研究证明,胸骨舌骨肌和环甲肌在发音、呼吸时基本呈同步放电,为用神经肌蒂移位恢复环甲肌功能的手术提供了理论依据。同时介绍带舌下神经袢分支的胸骨舌骨肌肌蒂移植恢复环甲肌功能的治     

家兔半膜肌肌构筑、肌内神经和运动终板分布

目的探究家兔半膜肌的肌构筑与肌内神经和运动终板分布的关系。方法用肌构筑法、改良SihlerWs染色法、乙酰胆碱酯酶染色法对家兔半膜肌肌构筑、肌内神经和运动终板可分布进行观察。结果家兔半膜肌为长肌。肌重(3.31±0.03)g,肌长(5.45±0.09)cm,肌纤维长(3.00±0.01)cm,肌生理横切面积(1.04±0.01)cm2,FL/CSA为2.88,CSA/MW为0.31。支配家兔半膜肌的神经分3条干入肌,即上、中、下干。上干主要支配上1/3的肌束;中干分布到肌的中上部;下干沿途发出的分支最多,司中下部的肌束。中干和下干的分支之间有吻合。肌表面上、中、下部都有线状排列的运动终板短带,尤以肌下部较密。结论家兔半膜肌是长肌,倾向于速度型构筑设计;肌内神经分支密集区,运动终板分布密集;肌内神经和运动终板的分布与肌纤维排列有关。     

舌下神经肌蒂移位治疗面瘫的解剖学基础

解剖了46侧成尸颈部和28侧面部标本,针对面神经损伤后的有关问题观察了舌下神经袢前降支及面神经下颌缘支。认为神经肌蒂移位时应选择肩胛舌骨肌上腹肌支和胸骨舌骨肌上肌支。受区选择在口角外侧1.5cm 处的面肌为宜。当不适宜作神经肌蒂移位时,可用前降支与下颌缘支缝合。     

家兔趾长伸肌肌内神经、运动终板和肌梭的分布

目的：探究家兔趾长伸肌肌内神经、运动终板与肌梭的分布。方法：改良Sihler’s染色法、乙酰胆碱酯酶染色法及HE染色法。结果：趾长伸肌是短肌束构成的长肌,肌束起点高的,止点相应亦较高。连于第2趾的肌纤维占据了肌腹上1／3,止于其余3趾的肌纤维位于下2／3。趾长伸肌的神经来自2条肌外神经干,上支及其分支支配第2趾的肌纤维,下支司其余3趾。运动终板分布除冠状切面上为弥漫的黑色颗粒外,其余各切面均为一条连续的运动终板带。各部的肌梭密度分别是：起端33.95个／g、肌腹中部44.76个／g、止端为零。结论：家兔趾长伸肌内,肌梭分布不均匀。肌内神经分支密集的部位,运动终板集聚、肌梭密度亦高。家兔趾长伸肌具有划分亚部的特征。     

家兔跖肌肌内神经、运动终板及肌梭的分布

目的 :探究家兔跖肌肌内神经、运动终板及肌梭的分布。方法 :改良Sihler’s染色法、乙酰胆碱酯酶染色法及HE染色法。结果 :肌的起端 ,神经主干上发出若干细小分支 ,尤以内侧部为多 ;肌的中上部 ,可见 2～ 4条“L”形初级支 ,分布到内侧部肌纤维 ;3～ 5条初级支 ,穿越肌内腱膜板后司外侧部肌纤维。运动终板呈线状排列于跖肌两缘 ,矢状和冠状切面上可见“V”形终板带 ,横断面上呈“S”型。肌梭密度为 (16 .94± 1.72 )个 / g。 结论 :家兔跖肌的肌内神经、运动终板和肌梭分布与肌纤维排列有关 ;肌内神经分支密集的部位 ,运动终板聚集呈带状 ,肌梭密度高 ;跖肌具有划分亚部的特征。     

腹直肌肌皮瓣的应用解剖及其肌内神经分布

目的:研究腹直肌肌皮瓣的血管、神经支配及其肌内神经分布与走行,为临床应用腹直肌肌皮瓣修复重建功能提供详尽的解剖学资料。方法:在新鲜成人尸体标本,完整取下腹直肌,观察测量肌外神经及血管支配,并采用改良Sihler肌内神经染色法观察肌内神经的分支分布。结果:腹直肌血液供应来自腹壁上、下动脉;神经支配来源于第8～12肋间神经,节段性支配腹直肌各个肌腹。结论:应以腹直肌内侧作为切取腹直肌肌皮瓣的手术入路,避免神经损伤;第9～12肋间神经是理想的供肌神经蒂;在利用腹直肌进行亚部游离移植时,宜选择腹直肌的上半部、下半部或者第3、第4肌腹。     

家兔腓肠肌亚部神经切断对其肌内神经、运动终板和肌梭的影响

目的　切断家兔腓肠肌外侧头肌亚部神经后 ,观察肌内神经、肌梭、运动终板带、肌湿重等的形态学变化。方法　 4 0只家兔随机分成对照组和神经切断组。用Sihler s肌内神经染色法染肌内神经 ;用乙酰胆碱脂酶整肌染色法染肌运动终板 ;用HE染色法染肌梭。结果　 (1)术后 2周亚部肌湿重明显下降 (P <0 0 5 ) ,肌运动终板带模糊不清 ,肌内神经染色变浅 ,三级分支消失 ,但肌梭形态及梭内肌纤维尚无明显改变 ;(2 )术后 4周肌湿重进一步下降 (P <0 0 1) ,运动终板带完全消失 ,肌内二级分支染色无 ,肌梭形态及数量有改变 ;(3)术后 12周肌肉明显萎缩 ,发生纤维化 ,运动终板带无 ,肌内神经染色无 ,仅留有鞘管样结构 ,未见神经再生 ,肌梭形态、数量明显改变 ;(4)术后 16周各参数与 12周相比差异无显著性。邻近正常肌未见有侧支神经支配失神经的亚部。结论　 (1)家兔腓肠肌外侧头各亚部在神经切断术后 4周 ,运动终板、肌梭的数量和形态有改变 ;(2 ) 12周后肌内神经染色仅有神经外膜鞘管样结构残存 ;(3)术后 16周末见原位的神经再生和相邻亚部神经侧支的再支配。     

家兔胸大肌肌内神经、运动终板与肌梭的分布

目的 :探究家兔胸大肌肌内神经、运动终板与肌梭的分布。方法 :改良的Sihler染色法、乙酰胆碱酯酶染色法及HE染色法。结果 :家兔胸大肌接受胸前神经和胸后神经支配。胸前神经主要支配横行纤维 ,并在其中部形成一“U”形的神经襻。胸后神经主要司斜行纤维 ,与胸前神经间存在吻合 ;胸大肌表面可见多条运动终板短带 ,弥散分布 ,似“虎皮样”外观 ;胸大肌的肌梭密度为 1 2 .98± 1 .85个 /克 ,但各部位的肌梭密度不同 ,以横行纤维中部最高。结论 :在家兔胸大肌内 ,肌内神经分支密集的部位 ,运动终板与肌梭分布密度亦高 ;该肌内肌梭的分布不均匀。     

腓肠肌神经肌蒂移位修复小腿前外侧肌瘫的解剖

在２５侧成人下肢标本上，观测了腓肠肌外侧头的神经及其伴行血管。腓肠肌外侧头的神经血管蒂可游离长度达１１．７ｃｍ以上。经临床应用证实，设计以神经肌支及其伴行血管为蒂的排肠肌外侧头神经血肌蒂，可转位修复小腿前外侧肌群的瘫痪。     

Vascular pedicles of infrahyoid muscles: an anatomical study

This study was designed to determine the entering sites of vascular pedicles of the infrahyoid muscles. The neck regions of 12 cadavers were investigated bilaterally. The vascular pedicles of the infrahyoid muscles (except the thyrohyoid and inferior belly of the omohyoid muscle) were dissected and measurements taken with a caliper in reference to the attachments of the muscles. For the sternothyroid muscle, two vascular pedicles were found bilaterally in all cadavers. Two vascular pedicles were found bilaterally for the sternohyoid muscle in 11 cadavers; in one cadaver the inferior vascular pedicle was absent bilaterally. One vascular pedicle was found bilaterally for the superior belly of the omohyoid muscle in all cadavers. These data regarding the vascular pedicles of the infrahyoid muscles might be useful for preserving the vascular supply of the infrahyoid muscles during flap preparation.     

The afferent innervation of two infrahyoid muscles of the cat

1. The afferent innervation of the straplike muscles of the infrahyoid region were investigated in two ways. The morphology of spindles and counts of tendon organs were investigated by the gold chloride technique in ten muscles. Spindle counts were made in forty pairs of thyrohyoid and infrahyoid muscles. De-efferenting of the nerves to these muscles was done in three cats and the calibre spectra of the afferent innervation investigated. These were compared with the total counts of fibres in intact nerves.2. In the thyrohyoid, spindles are frequently absent. No tendon organs were seen. In the large infrahyoid (combined sternohyoid and sternothyroid), spindle counts varied from 0 to 20 and the mean spindle count per gram of muscle was 3.5. A maximum of five tendon organs were seen in the muscle. Both spindle and tendon organ counts are low when compared with a limb muscle of similar weight and size.3. In the infrahyoid muscle complex spindles were about equal in number to simple spindles.4. Counts of spindles in the infrahyoid muscle in families of three or more siblings suggest that some families of kittens tend to have higher spindle counts than other families.5. The afferent innervation of the two muscles varied between 21 and 42% of the total fibre population and the fibre diameter spectrum is in keeping with the low counts of encapsulated endings.     

The distribution of infrahyoid motoneurons in the cat: a retrograde horseradish peroxidase study

Summary The distribution of cell bodies and the peripheral course of axons of infrahyoid motoneurons were examined in the cat by the retrograde horseradish peroxidase method after application of the enzyme to the peripheral nerve branches supplying the infrahyoid muscles. Infrahyoid motoneurons were observed to constitute a slender cell column, which extended from a level of the caudal part of the hypoglossal nucleus usually to the most caudal level of the C1 cord segment, or occasionally to the lower levels of the C2 cord segment. The cell column was located immediately lateral to that of motoneurons of the spinal accessory nerve. In the cell column, thyrohyoid motoneurons were distributed in the medulla oblongata; sternohyoid motoneurons were located somewhat more cranially than sternothyroid motoneurons in the medulla oblongata and cervical cord. However, the level of craniocaudal distribution of thyrohyoid, sternohyoid or sternothyroid motoneurons highly overlapped. The experiments involving severance of the hypoglossal and/or cervical nerves indicated that axons of thyrohyoid and sternohyoid motoneurons passed via the roots of both hypoglossal and C1 nerves, that axons of sternohyoid motoneurons passed via the C1 nerve roots, and that axons of infrahyoid motoneurons innervating the conjugated part of the sternohyoid and sternothyroid muscles passed usually via the C1 nerve roots, or occasionally via the roots of both C1 and C2 nerves.     

The sartorius muscle: anatomic considerations for reconstructive surgeons

To evaluate the sartorius muscle as an alternative donor site for functional transfer, the neurovascular anatomy of the muscle was studied in 42 human sartorius muscle specimens (22 fresh and 20 preserved). Eleven adult fresh cadavers were injected with a mixture of lead oxide, gelatin and water (200 ml/kg) through the common carotid and femoral arteries. The sartorius muscle with its neurovascular pedicles was dissected, and radiographed. The sartorius muscle was also dissected out in 10 preserved cadavers. The neurovascular anatomy was thus analyzed in 42 sartorius muscles. The results show that each nerve supplying the sartorius muscle is accompanied by one vascular pedicle, forming a neurovascular hilum. Within the muscle, most of the nerves and vessels divide early, and their branches run parallel to each other and to the muscle fibers. Many of the vessels anastomose with each other to form an intricate vascular network. We conclude that it is possible to subdivide the muscle into functional units to harvest a segmental muscle flap with a neurovascular pedicle for transfer.     

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。     

Main trajectories of nerves that traverse and surround the tympanic cavity in the rat

To guide surgery of nerves that traverse and surround the tympanic cavity in the rat, anatomical illustrations are required that are topographically correct. In this study, maps of this area are presented, extending from the superior cervical ganglion to the otic ganglion. They were derived from observations that were made during dissections using a ventral approach. Major blood vessels, bones, transected muscles of the tongue and neck and supra and infrahyoid muscles serve as landmarks in the illustrations. The course of the mandibular, facial, glossopharyngeal, vagus, accessory and hypoglossal nerves with their branches, and components of the sympathetic system, are shown and discussed with reference to data available in the literature. Discrepancies in this literature can be clarified and new data are presented on the trajectories of several nerves. The course of the tympanic nerve was established. This nerve originates from the glossopharyngeal nerve, enters the tympanic cavity, crosses the promontory, passes the tensor tympani muscle dorsally, and continues its route intracranially to the otic ganglion as the lesser petrosal nerve after intersecting with the greater petrosal nerve. Auricular branches of the glossopharyngeal and of the vagus nerve were noted. We also observed a pterygopalatine branch of the internal carotid nerve, that penetrates the tympanic cavity and courses across the promontory.     

骨折稳定性对梯形加压钢板疲劳强度的影响

目前对骨折内固定术后负重状态下钢板疲劳强度缺乏了解。本文选用新鲜成人尸体股骨制备７种股骨干骨折模型，以梯形自动加压钢板固定。在靠近骨折线的中央螺孔边缘贴应变片。通过模拟负重电测试验及疲劳强度计算，认为骨折失稳是导致钢板疲劳强度下降的内在原因。骨折断端之间牢固固定，依据钢板的工作安全系数合理地指导负重功能练习，有助于增加现有内固定钢板使用的安全性。临床实践表明，骨折部位骨缺损－尤其是压力侧－在负重状态下可导致钢板破坏［１］。尽管失效分析认为钢板破坏属疲劳破坏［２］，由于对加压钢板固定骨折后负重状态下的疲劳强度知之较少，人们不能肯定固定长骨骨折后负重时钢板是否安全。本文采用模拟电测试验与疲劳强度计算相结合的方法，对梯形加压钢板（ＴＣＰ）的疲劳强度做一初步分析。     

经颅开眶球后入路的应用解剖

目的：给眶内手术入路提供详细的形态学依据和显微解剖参数，分析经颅手术入路的优势及其易损伤结构。方法：用32例(64侧)成人头颅湿性标本，通过模拟额颞眶颧手术入路，在放大5—25倍手术显微镜下，运用显微解剖方法，通过颅前窝眶板开眶，观测开眶后球后结构在不同手术视野下的位置、毗邻、走行、变异、分支、分布等关系。结果：上内侧入路是经上斜肌与上睑提肌之间的问隙入路，暴露从球后到视神经管之让的视神经。上中央入路是经上直肌与上睑提肌之间的间隙入路，根据不同情况向内侧或外侧牵开额神经，暴露视神经眶内段的中部。上外侧入路是通过上直肌与外直肌之让的肌间膜入路，对眶尖深部上外侧区的暴露效果与经眼眶外侧壁的外上方入路基本相同，但前者能兼顾眶上裂与海绵窦，而后者则不能。经外下方入路可暴露肌锥间隙的下外侧区。结论：对于眶内肿瘤应根据病变在眶内的具体位置选择相应的最佳手术入路，有助于克服盲目的破坏性手术。