拇展肌与拇收肌移位吻接术前、后黏弹性实验研究

研究了正常拇展肌、拇收肌拉伸黏弹性力学性质和模拟拇外翻拇展肌、拇收肌移位吻接术后拇展肌和拇收肌的拉伸黏弹性力学性质.取20个足标本,解剖后暴露拇展肌与拇收肌,得出拉伸应力松弛、蠕变等数据.对断裂后的拇收肌和拇展肌模拟临床手术进行移位吻接,对10个拇展肌和10个拇收肌标本做腱与腱吻接,另各取10个拇收肌、拇展肌标本做了腱与骨膜吻接.对吻接后的标本进行拉伸实验,得出了吻接术后各组拉伸应力松弛、蠕变曲线.以回归分析的方法处理实验数据,得出了归一化应力松弛、蠕变曲线及归一化应力松弛函数和归一换化蠕变函数.     

Anatomical variations of the flexor hallucis longus muscle and the consequences for tendon transfer. A cadaver study

The aim of this study was to evaluate the occurrence of anatomical variations of the musculotendinous junction of the flexor hallucis longus muscle. Eighty cadaver specimens preserved according to Thiels method were assessed. Following careful dissection, the distance between the musculotendinous junction and the bone–cartilage border of the distal tibia was determined. Three typical anatomical variations were found: (1) a long lateral and shorter medial muscle belly; (2) equal-length medial and lateral muscle bellies; (3) a long medial and shorter lateral muscle belly. As a special variation in two cases only one lateral muscle belly was found. When planning a flexor hallucis longus transfer, preoperative magnetic resonance tomography (MRT) should be carried out in order to guarantee sufficient coverage of an existing soft tissue defect. These anatomical characteristics have also to be considered when interpreting ultrasonic or MRT findings in this region.     

Intramuscular nerve distribution pattern of the oblique and transverse heads of the adductor hallucis muscles in the human foot

To understand which layer of the intrinsic muscles of the foot the adductor hallucis muscle belongs to, it is essential to investigate the innervation patterns of this muscle. In the present study, we examined the innervation patterns of the adductor hallucis muscles in 17 feet of 15 Japanese cadavers. We investigated the intramuscular nerve supplies of the adductor hallucis muscles in six feet and performed nerve fiber analysis in three feet. The results indicate that: (i) the oblique head of the adductor hallucis muscle is divided into three compartments (i.e. lateral, dorsal and medial parts) or two compartments (i.e. dorsal and medial parts) based on its intramuscular nerve supplies, but we could not classify the transverse head into any parts; (ii) the communicating twig between the lateral and medial plantar nerves penetrated the oblique head of the adductor hallucis muscle in 13 of 17 feet (76.5%); (iii) the penetrating twig entered between the lateral and dorsal parts of the oblique head, passed between the lateral and medial parts of this muscle and then connected with the medial plantar nerve; and (iv) the majority of the nerve fibers of the penetrating twig derived from the lateral plantar nerve. The present study demonstrated that only the lateral part of the oblique head of the adductor hallucis muscle had a unique innervating pattern different from other parts of this muscle, suggesting that the lateral part of the oblique head has a different origin from other parts of this muscle.     

Gross anatomical study of the human palatopharyngeus muscle throughout its entire course from origin to insertion

The palatopharyngeus (PP) extends throughout the entire length of the pharynx and probably plays an important role in deglutition, but its spatial distribution remains undefined in some respects. This study was designed to clarify the exact distribution of the PP indispensable for understanding its functions. Using 50 cadavers, the PP and its neighboring muscles were bilaterally exposed in both surfaces of the pharynx. The PP was composed of two divisions: longitudinal and transverse. It is already known that the longitudinal PP is divided into two fasciculi sandwiching the levator veli palatini (LVP) immediately after originating from the palatine aponeurosis. However, we newly discovered a fasciculus originating from the uvula, and further regarded the salpingopharyngeus as another fasciculus of origin. The four fasciculi united to descend through the palatopharyngeal arch and inserted into the thyroid cartilage and beneath the mucosa of the hypopharynx. The transverse PP occupied a location transitional between the PP and superior constrictor (SC), where it originated from the palatine aponeurosis and passed dorsally to encircle the pharyngeal isthmus and reach the pharyngeal raphe. Although whether it belongs to the PP or SC has remained controversial, we regarded it as a portion of the PP from the evolutionary perspective and proposed anatomical criteria for differentiating it from the SC. The wide distribution of the PP suggests that it acts not only to elevate the pharynx or depress the soft palate, but also as a nasopharyngeal sphincter when closing the pharyngeal isthmus.     

展肌转位修复跟腱的应用解剖

在30侧成人下肢标本上,观测了拇展肌形态和血供。设计了以足底内侧动脉或其深支为蒂的拇展肌或肌皮瓣转位修复跟腱和皮肤缺损的术式。并作了拇展肌肌腱和跟腱的拉伸破坏试验:拇展肌肌腱载荷平均为66.4kg,跟腱载荷平均为235.2kg。两者载荷之比为1∶3.5.     

An anatomical study of the human cardiac veins with special reference to the drainage of the great cardiac vein

Many case reports in which the main aim was to clarify the development of the superior vena cava (SVC) with persistent SVC have so far been published. However, there have only been a few systematic studies of the cardiac veins. Therefore, we macroscopically investigated the cardiac veins using 337 human adult hearts to obtain a detailed understanding of the morphology of the heart.

From our study, we obtained the following results.

1. The frequency of persistent left SVC including one case of bilateral SVC was observed to be higher 7 cases (2.1%) than in previous reports.

2. We observed a second case in which the great cardiac vein drained directly into the right SVC (the first case being reported by Bergman et al. 1988).

3. Variations in the drainage of the great cardiac vein (GV) were observed from the right SVC to the left SVC, while the middle cardiac vein (MV) showed less variations of the drainage and course.

4. The drainage boundary between the GV and MV was classified into 3 types: MV-dominant type in 123 cases (36.5%), intermediate type in 182 cases (54.0%), and GV-dominant type in 32 cases (9.5%).

From our results, we speculated that the MV did not generate any variations due to its short course before draining into the right atrium, while the GV had many variations due to its long course before draining into the right atrium. From the few GV-dominant types, the halfway boundary between the anterior (GV) and posterior (MV) route for drainage into the right atrium could be considered to be the anterior side rather than the Apex cordis.     

Anatomical variations of the plantar fascia's origin with respect to age and sex—an MRI based study

The plantar fascia (PF) plays a significant role in ankle movement and anatomical variations of this structure may significantly alter the biomechanical properties of the foot and lower extremity. The aim of this study was to evaluate the changes of the PF's origin point on the calcaneus (CB), and whether these changes are dependent on age and sex. Two independent observers evaluated two hundred and two foot and ankle MRIs and the following measurements was performed: (A) horizontal length of the AT insertion into the posterior aspect of the CB, (B) horizontal length of the CB and (C) horizontal distance from the most anterior point of the CB to the most posterior part of the PF. Statistical analysis was performed with the results obtained to evaluate both sex and age differences. Based on our results, we observed that: (1) changes of the PF's origin point on the CB is independent of age and sex and (2) the continuity between the PF and AT decreases during aging as a result from changes in the AT's insertion point into the CB. This study concludes that the PF's origin point does not change with respect to age or sex, but the continuity between the PF and AT decreases during aging. Knowledge regarding the biomechanical influences caused by changes in the relationship between the AT and PF may be important in terms of treatment and prophylaxis of both PF and AT pathologies. Clin. Anat. 32:597–602, 2019. © 2019 Wiley Periodicals, Inc.     

A case of muscle subclavius posticus with special reference to its innervation

Summary A subclavius posticus muscle was found in the left side of a Japanese male cadaver. This muscle arose from the first costal cartilage, inserted to the upper margin of the scapula, and was innervated by a branch from the nerve to the subclavius. This excess intermediary muscle between the subclavius and the inferior belly of the omohyoid appears to be more closely related to the subclavius, based on detailed examination of the innervation of this muscle. A possible schematic model of the origin of this muscle is proposed.

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Un cas de muscle subclavius posticus — Étude spéciale de son innervation

Résumé Un muscle subclavius posticus a été découvert du côté gauche d'un cadavre Japonais de sexe masculin. Ce muscle s'étendait du premier cartilage costal au bord supérieur de la scapula et était innervé par une branche du nerf du m. subclavier. Ce muscle accessoire situé entre le m. subclavier et le ventre inférieur du m. omo-hyoïdien semblait plus étroitement lié au m. subclavier en raison des conclusions de l'analyse détaillée son innervation. Une proposition de modèle schématique de l'origine de ce muscle est avancée.

     

长伸肌腱移位治疗外翻的应用解剖学

目的:探讨长伸肌腱移位治疗外翻的解剖学入路及手术的要点。方法:(1)100例正常足及100例外翻足,测量长伸屈肌腱的位置;(2)对20具尸体40足解剖,观察长伸肌腱、长屈肌腱、短伸肌腱、腓浅神经、腓深神经、隐神经及周围血管走行特点,并测量上述结构与解剖标志的相对位置。结果:正常长伸肌腱的位置在踝横纹处位于胫骨前肌外侧(9.44±4.26)m m,在跖附关节中点外侧(2.00±2.22)m m,跖趾关节中点外侧(1.32±1.46)m m,止点位于末节趾骨基底中点(2.22±2.42)m m范围内,长屈肌腱在跖趾关节中点外侧(0.44±2.42)m m。在外翻的患者中,长伸肌腱在踝横纹处位于胫骨前肌外侧(9.32±3.46)m m,在跗跖关节中点外侧(3.00±2.22)m m,跖趾关节中点外侧(4.22±2.26)m m,止点位于末节趾骨基底中点(2.02±2.32)m m范围内,长屈肌腱在跖趾关节中点外侧(3.24±2.32)m m。趾背侧皮肤由隐神经、腓浅及腓深神经支配。结论:(1)正常与外翻足的比较中,伸肌腱的位置在足横纹及止点处无明显的差异,在跖附关节及跖趾关节处,外翻足的伸肌腱明显外移(P<0.05)。长屈肌腱也明显外移(P<0.05)。(2)手术中隐神经终末支易受损伤。(3)伸肌腱内移并止点重建可矫正外翻。     

三维可视化重建 展肌上缘动脉弓为蒂的可移植岛状皮瓣

背景：目前以 展肌上缘动脉弓为蒂的岛状皮瓣设计依赖于临床医生的抽象思维,难以定量分析和交流学习,使其在临床上的推广使用受限。 目的：对 展肌上缘动脉弓为蒂的岛状皮瓣进行三维可视化重建,建立该皮瓣动脉的可视化模型。 方法：选取新鲜成人标本1具,经胫前动脉与胫后动脉行明胶-氧化铅混悬液灌注后,足部64排CT扫描,并通过mimics10.0软件重建内踝前动脉、跗内侧动脉、足底内侧动脉浅支及其吻合支,观察 展肌上缘动脉弓的形成、走形与分布情况。根据解剖结构的特点,对皮肤及其血管进行重建,获得立体形态的动脉皮瓣结构。 结果与结论：三维重建的各部位层次分明, 展肌上缘动脉弓显示良好、实体感强、皮肤和动脉的相互关系一目了然,在三维重建的图像中清楚的观察各解剖结构的形态,特别是 展肌上缘动脉弓的形成及其体表投影得到了很好的显示。结果表明 展肌上缘动脉弓为蒂的岛状皮瓣三维重建对基础研究、临床试验及手术规划具有重要价值,为临床个性化手术方式的选择提供直观的参考,从而提高手术成功率。     

同体两侧股前外侧皮瓣的解剖学对比

目的 探讨同体两侧股前外侧（ALT）皮瓣的解剖学差异,为术前进行供侧大腿选择的必要性提供解剖学依据。 方法 10具新鲜尸体标本（共20例）上行双侧ALT皮瓣制取,寻找皮瓣的营养穿支,记录穿支类型和数量,并逆向追溯到血管蒂;测量各穿支、血管蒂的长度和管径,统计学数据采用均值±标准差。 结果 10具标本中有3具两侧股前外侧皮瓣为肌间隔穿支和肌皮穿支双供血型;其余7具两侧穿支类型不同。7具标本两侧皮瓣的穿支数量不同,另外3具的穿支数量相同。肌间隔穿支走行于股直肌与股外侧肌之间的肌间隙内,肌皮穿支或垂直或斜形穿过股外侧肌,其穿支长度各异。皮瓣穿支全部发自旋股外侧动脉（LCFA）降支的有14例,另有6例（30%,源于5具标本）皮瓣既有降支又有斜支参与供血,其中1具标本两侧均由斜支与降支双重供血,其余4具标本均只有1侧为斜支与降支双重供血。10具标本共20例皮瓣的两侧主要穿支和血管蒂管径及长度差别不大(P>0.05)。 结论 同体两侧股前外侧皮瓣的营养穿支在类型、数量、走行、血管蒂来源上存在差异,穿支的种类及走行对于皮瓣制取的难易及操作时间有直接影响。术前进行供侧大腿的选择有助于股前外侧皮瓣精准、快捷的制取。     

Anatomical study of a left single coronary artery with special reference to the various distribution patterns of bilateral coronary arteries

A left single coronary artery of heart was observed during anatomy practice at Kumamoto University School of Medicine in a 73-year-old female cadaver who died from a thalamic hemorrhage. The left single coronary artery, having a single orifice in the left aortic sinus, bifurcated into the anterior interventricular (IVa) and circumflex (CIR) arteries. No orifice of the right coronary artery was found on the aortic wall. Giving off a branch which traversed the upper part of the infundibulum to supply the anterior upper region of the right ventricle, the IVa descended in the anterior interventricular sulcus to supply the apex of the heart. The CIR curved leftwards in the atrioventricular sulcus to reach the posterior surface, after which it continued to emerge again into the anterior surface. The atrial arteries showed no anomalous distribution pattern and histological observation revealed no pathological abnormality other than a slightly thickened tunica intima. Furthermore, we observed the distribution patterns of bilateral coronary arteries in 377 hearts dissected during anatomical practice over 13 years at Kanazawa University (1980–1986) and Kumamoto University (1993–1998). Although the reason why only the right coronary artery was absent is left unexplained, it was concluded that the left single coronary artery in this study, having the developed left conal and circumflex branches, was an extreme case of the left dominant series of coronary arteries. The formation of single coronary arteries can be explained embryologically by the change of flow in the capillary plexus established on the ventricle wall.     

骶骨骨折的解剖学观察及临床意义

目的:为提高骶骨骨折的诊断率及选择治疗方法提供依据。方法:选正常骶骨标本(50块),骶骨骨折标本(28块),测量这些骶骨标本每条横线中点距骶骨翼边缘的水平距离,测量骶前孔、骶后孔横径、骶孔的前、后径,将所有骶骨标本左右侧对应值进行比较。结果:正常骶骨每条横线中点距左右骶骨翼水平距离无显著差异,骶前孔、骶后孔左右侧无明显差异。侧块压缩性骨折、横行骨折引起骶前孔变形、变小,侧块压缩性骨折骨折侧横线中点距骶骨翼边缘水平距离较正常侧明显变小,位置越高两侧差异越大。骶后孔、骶管变形、变小在骶骨骨折标本不明显。结论:骶骨侧块压缩性骨折、横行骨折时骶骨失去对称性,骶前孔变形、变小是造成骶神经损伤原因之一,临床上应注意骶前孔的变化,检查骶神经功能,应将扩大骶前孔进行骶神经减压放在首位。     

XLIF入路相关的生殖股神经应用解剖及影像学研究

目的　通过标本解剖和影像学研究,找出生殖股神经（genitofemoral nerve,GFN）在各腰椎间隙的走行位置, 结合腰椎前大血管和腰神经根的位置,得出极外侧入路腰椎椎体间融合术（extreme lateral interbody fusion,XLIF）在各腰椎间隙的安全入路范围。 方法　解剖16例成人尸体标本,暴露GFN并观察其与腰大肌的位置关系。在36例腰椎磁共振扫描影像上观察腰大肌和腹部大血管的位置并测量相关解剖数据,通过分析计算得出各腰椎间隙GFN的走行位置和XLIF入路的安全范围。 结果　生殖股神经在腰大肌内段走行于GFN出椎间孔处与腰大肌穿出点连线上方,呈向前的抛物线或近似直线。GFN在L3/4椎间隙或以上位置穿出腰大肌的样本,GFN距椎体后缘的距离为（34.0±6.02）mm,位置分布在Moro分区位于A区和I区。GFN在L3/4椎间隙以下位置穿出腰大肌的样本,GFN距椎体后缘的距离不小于（16.0±2.16）mm,位置分布在I区、II区和III区。 结论　XLIF入路的安全区域在L2/3椎间隙为II区、III区,在L4/5椎间隙为II区。GFN穿出腰大肌的位置在L3/4椎间隙或以上者,L3/4椎间隙的安全区为II区;在L3/4椎间隙以下者,在L3/4椎间隙从任何分区进入都有损伤血管或神经的可能。     

Gemelli and obturator internus muscles: Different heads of one muscle?

Background: The superior gemellus, inferior gemellus, and obturator internus muscles were once regarded as a single muscle judging from their insertion and function. However, current textbooks of anatomy do not treat them as one muscle. In gross anatomy, the classification of muscles depends largely upon the nerve supply, so that the present author re-examined the nerve supply to the three muscles. Methods: Fourteen nerve-muscle specimens were taken from 12 cadavers (five males and seven females) and examined with the unaided eye and under a dissecting microscope. Results: (1) The modes of nerve supply to the superior gemellus, inferior gemellus, and obturator internus muscles differed; however, the nerves to the muscles shared the same spinal nerve components. (2) The gemelli formed a muscular pocket (“gemellus pocket”) through which obturator internus muscle passed. Conclusions: In light of this knowledge on nerve muscle relationships, the difference in the pattern of nerve supply to the superior gemellus, inferior gemellus, and obturator internus muscles cannot be the basis for stating that the muscle are independent. Rather, their fusion to form the gemellus pocket and their common insertion suggest that they are different heads of one muscle. © 1995 Wiley-Liss, Inc.     

Spatial relationships between masticatory muscles and their innervating nerves in man with special reference to the medial pterygoid muscle and its accessory muscle bundle

The relationships between the positional arrangement of the surrounding and innervating nerves of the muscles supplied by the mandibular nerve, in particular those medial to the main trunk of the nerve, were examined in 24 head halves from 12 Japanese cadavers by dissection from the inside after removal of the bony elements except for the mandible. In ten sides of five heads, the lingual nerve pierced the medial pterygoid muscle, and the bundle lateral to the nerve was found to be separated as an accessory muscle bundle. The accessory bundle was frequently attached to the mylohyoid muscle. In addition, the inferior alveolar nerve and the lingual nerve frequently communicated, and in four specimens a branch from the lingual nerve entered the mylohyoid to communicate with the proper nerve. The innervation pattern indicated that the medial pterygoid muscle consists of the anteromedial and the posterolateral main parts, and sometimes has an accessory bundle. Based on the present findings and the previous studies of the positional relationships between the muscles and nerves by our research group, we propose that the muscles innervated by the mandibular nerve could be classified as an inner group (the lateral pterygoid) and an outer group (the other muscles). A possible scheme of the positional relationships between the muscles and nerves is presented.     

Anatomical significance of the nerve to the pyramidalis muscle: A morphological study

Characteristics of the nerve to the pyramidalis muscle (NPy), including its origin, course and distribution, were observed (macroscopically) in detail in the present study. The spinal segments that give rise to the nerve vary considerably and involve Th12-L2. The course and distribution of the nerve also vary widely. The NPy is given off from one of the following: (i) the anterior cutaneus branch (Rca) of the intercostals nerve; (ii) the ilioinguinal (li) nerve; or (iii) the genital branch (Rg) of the genitofemoral nerve. The NPy can be classified into nine types according to features of the course and branching pattern of the Rca and li. In three of 67 cases, the pyramidalis muscle had two nerves. Double-innervated pyramidalis muscles received one nerve from a transitional-type Rca (Rcat) and a second nerve derived from one of the superficial Rca (Rcas), li or Rg. The NPy derived from the deep Rca (Rcap; Type 1), Rcat (Type 2) and containing their features as well as the Type 9 (Rcat + li + Rg) reach the muscle from behind. Types 3-8 (not containing features of the Rcap and Rcat) enter the muscle from its surface. The branch that gives off the NPy is determined by the level of segmental origin, with the segmental origin of branches from the Rca (Types 1-4), li (Types 5-6) and Rg (Types 7-9) getting lower in that order. The level of segmental origin of the NPy derived from different Rca becomes lower in the following order: Rcap (Type 1), Rcat (Type 2), Rcas (Type 3), Rcas' (Rcas entering the inguinal canal; Type 4). When the origin of the NPy is from a lower segment, the origin of the boundary nerve (Rcap/Rcas) is also deviated downward. The changes in the NPy are related to the deviation of the entire lumbar plexus.     

An unusually-wide human bregmatic Wormian bone: anatomy,tomographic description,and possible significance

Supernumerary ossicles (or Wormian bones) of the cranial vault are formations associated with insufficient rate of suture closure, and regarded as “epigenetic” and “hypostotic” traits. These bones rest along sutures and/or fill fontanelles of the neonatal skull. In this autoptic report of a 66-year-old Caucasian woman, a peculiar supernumerary bone is described, unusual size and shape, filling completely the bregmatic fontanelle. The skull was CT-scanned through coronal sections at 80 kV and 60 mA, with a slice thickness of 1.0 mm and a resolution of 0.35 mm/pixel. Segmentation and 3D rendering were computed using MIMICS 7.0 (digital endocast). The bone was pentagonal and remarkably large, more on the exocranial surface than on the endocranial one, involving both tables and diploe of the vault. This feature might represent a wedge to completion of the vault architecture. Considering the functional and structural matrix of cranial morphogenesis, this case displays the possibility of discrete diversification of the ossification centres, as well as the relative stability of the structural skull matrix in response to discrete changes. Study supported by Grants of “Ministero dell’Università e della Ricerca”, Italy. Results presented at the occasion of the 61° National Congress of the Italian Society of Anatomy and Histology.     

A histologic study of extralobar pulmonary sequestration and its anomalous artery as a clue to its development

In 1997, an anomalous small mass of soft tissue was found in the left thoracic cavity of a Japanese male cadaver during student dissection practice. It was linked only by branches from the thoracic aorta, hemiazygos vein and greater splanchnic nerve, with no connection to the normal lung by vessels or airway. Examination of cut sections clarified that this anomalous small tissue mass was an extralobar pulmonary sequestration (EPS). Many cases of pulmonary sequestration have been reported from the clinical aspect, but there are few from a purely anatomical viewpoint. In the present case, detailed gross anatomical and histologic observations clarified that the anomalous artery supplying the sequestration resembled an elastic artery. In view of the findings of other reports, the anomalous arteries are divided into two types, the elastic type such as the pulmonary artery and the muscular type such as the bronchial artery. So it is thought that the histologic observation of an anomalous artery in comparison with normal pulmonary and bronchial arteries may offer an important clue to consider in elucidating the origin and development of pulmonary sequestration.