CT血管成像术在腘动脉陷迫综合征的应用

目的探讨CT血管成像术(CTA)在动脉陷迫综合征(PAES)诊断中的应用价值。方法回顾性分析8例经手术病理证实的PAES患者的CTA资料,其中4例行数字减影血管造影(DSA)检查。结果CTA图像可清晰显示8例患者动脉与周围组织之间的关系,均可见异常走行的腓肠肌内侧头及其肌腱或纤维组织束压迫动脉。CTA能清晰显示动脉狭窄闭塞的部位、范围、程度、侧枝循环形成情况及动脉与周围组织间的关系。结论CTA诊断PAES准确率100%,明确病因诊断优于DSA。     

CT血管成像术在胭动脉陷迫综合征的应用

目的探讨CT血管成像术（CTA）在动脉陷迫综合征（PAES）诊断中的应用价值。方法回顾性分析8例经手术病理证实的PAES患者的CTA资料，其中4例行数字减影血管造影（DSA）检查。结果CTA图像可清晰显示8例患者动脉与周围组织之间的关系，均可见异常走行的腓肠肌内侧头及其肌腱或纤维组织束压迫动脉。CTA能清晰显示动脉狭窄闭塞的部位、范围、程度、侧枝循环形成情况及动脉与周围组织间的关系。结论CTA诊断PAES准确率100％，明确病因诊断优于DSA。     

CT血管造影诊断脑动静脉畸形合并动脉瘤中应用价值研究

目的 探讨CT血管造影(CTA)对脑动静脉畸形(AVM)合并动脉瘤的诊断价值.方法 选择2016年6月至2019年9月中山大学附属第一医院经DSA确诊为AVM合并动脉瘤患者22例,其中男性16例,女性6例;年龄14～59岁,中位年龄43.5岁.行CTA扫描,分别比较DSA与CTA在AVM部位、大小、供血动脉、引流静脉及...     

腓肠神经-小隐静脉营养血管远端蒂复合瓣的解剖学研究

目的:为腓肠神经-小隐静脉营养血管远端蒂复合瓣设计提出解剖学依据.方法:30侧经动脉灌注红色乳胶成人下肢标本,解剖观测腓动脉肌间隔穿支、腓肠外侧动脉肌皮穿支与腓肠神经-小隐静脉、腓肠肌外侧头、比目鱼肌以及腓骨营养血管的关系;小隐静脉浅深交通支.结果:腓动脉肌间隔穿支6～10支,外径0.5～1.6 mm,最远的动脉穿支距外踝尖上(1.0±1.3)cm,外径(0.6±0.2)mm.穿支分出骨膜动脉、肌支,营养腓骨和比目鱼肌外侧半.穿支穿深筋膜时,发深筋膜支、皮支、皮神经浅静脉血管,构成腓肠神经-小隐静脉营养血管链.腓肠外侧动脉发2～5支外径0.2～1.2 mm肌皮穿支,营养腓肠肌外侧头及相应区域皮肤.小隐静脉浅深交通支距外踝尖上(3.4±0.9)cm,外径(1.7±0.5)mm.结论:腓肠神经-小隐静脉营养血管与肌、骨、皮营养血管同源,以腓动脉的肌间隔动脉终末穿支远端蒂复合瓣,旋转点近外踝尖平面,可覆盖前足创面.     

320排容积CTA对颅内动脉瘤的诊断价值

目的探讨320排容积cT血管成像（CTA）对颅内动脉瘤诊断价值。方法选取医院2010年2月-2013年12月间具有完整颅脑数字减影血管造影（DSA）资料的63例颅内动脉瘤患者,所有患者均于起病3d内完成320排容积CTA检查。以DSA检查结果作为诊断金标准,分析病变的影像学特点,并评价320排容积CTA对颅内动脉瘤诊断的准确性。结果颅脑动脉瘤阳性63例,CTA漏诊1例,病灶位于大脑后交通动脉。320排容积CTA对颅内动脉瘤的诊断敏感度及阳性预测值分别为98．41％、100％。按部位统计动脉瘤数量结果如下：颈内动脉海绵窦段4例,大脑前动脉26例,大脑中动脉4例,大脑后动脉8例,大脑前交通动脉10例,大脑后交通动脉5例,基底动脉6例。动脉瘤瘤径为2～22mm。在CTA上,动脉瘤的瘤体位置、大小、瘤颈、瘤顶指向、载瘤动脉及动脉瘤与邻近血管分支和骨性结构的空间关系均能较满意的显示,均与DSA结果相符。结论320排容积CTA诊断颅脑动脉瘤具有较高敏感性,能准确检出颅内的微小动脉瘤,对动脉瘤的空间解剖关系显示更具优势。因此,在临床工作中,320排容积CTA可以成为颅脑动脉瘤的首选影像学检查方法。     

Anatomical observation of origins of the gastrocnemius and its significance in total knee arthroplasty

目的:研究腓肠肌起点的解剖学特点,探讨其在严重屈曲挛缩畸形全膝关节置换术(TKA)中的意义.方法:常规解剖20侧防腐及2侧新鲜成人膝关节标本,观测腓肠肌起点的形态结构及其与周围结构的毗邻关系.结果:腓肠肌内、外侧头起点分为中间的肌性部分和两侧的腱性部分.外侧头起始部的腓后侧有股二头肌肌腱及腓总神经斜跨过,腓侧有腘肌腱及外侧副韧带.内侧头起始部的胫后侧有半腱肌和半膜肌肌腱.膝上内、外侧动脉从腓肠肌内、外侧头起点上方贴着骨膜绕过股骨内、外侧髁到前方.腓肠肌腱性部分周围无重要神经血管毗邻,为解剖安全区.结论:严重屈曲挛缩畸形TKA术中,常规经侧副韧带内侧的松解方式只能松解到肌性部分,可能是松解不够彻底的原因之一.     

64排螺旋CT血管造影术诊断脑动静脉畸形临床价值

目的通过与数字减影血管造影术（DSA）影像、手术所见和病理结果的比较,评价64排螺旋CT血管造影术（CTA）诊断脑动静脉畸形（AVM）的临床价值。方法17例脑AVM患者,其中男性12例,女性5例,年龄10～73岁,平均年龄35．8岁。对其行64排螺旋CTA．对畸形血管团的数目、位置、范围、供血动脉的分布及引流静脉的方向等进行统计分析。结果CTA共发现17个病灶,与DSA和手术所见比较,1个直径1．2cm的病灶被漏诊。CTA诊断脑AVM的敏感度、特异度及准确度分别为94．4％、100％、94．4％。CTA在显示细小供血动脉的清晰程度低于DSA,其判断脑AVM供血动脉的敏感度为83％。CTA对引流静脉的显示与DSA影像和手术所见一致。结论64排螺旋CTA能够清晰显示直径〉1．5cm的畸形血管团、供血动脉的主干及其主要分支和引流静脉。已接近并达到DSA的水平,能够作为诊断脑AVM的首选检查方法。但不能清晰显示供血动脉的细小分支。     

16层螺旋CT血管成像对Moyamoya病诊断价值（附30例报告）

目的探讨Moyamoya病的多层螺旋CT血管成像（CTA）临床应用价值。方法30例Moyamoya病病人,其中男性18例，女性12例，年龄14～62岁，平均年龄42．60岁。发病高峰中30～40年龄段为12例，40～50年龄段10例。做16层螺旋CTA，扫描参数为：250kV，250mA，螺距15，扫描层厚1mm。同时6例又行DSA检查，将其CTA结果与DSA图像进行比较。结果30例中病变累及颈内动脉者共27例，占总例数的90．0％，受累段均为颈内动脉末段。病变累及双侧者26例（占总例数86．7％）。30例CTA均清晰显示发生狭窄、闭塞的颈内动脉远端、大脑前中动脉近端及迂曲扩张的大脑后动脉、后交通动脉等代偿动脉，狭窄血管显示率100％；清晰显示脑底异常血管网者28例，异常血管网显示率93.3％。30例中有6例同时行DSA检查，两者检查结果完全一致。结论CTA可以清楚显示Moyamoya病脑血管改变特点，包括颅内血管狭窄及脑底异常血管网，可以考虑作为Moyamoya病诊断的重要影像学筛查方法之一。     

CTA与HR-MRI对青年脑卒中动脉夹层的诊断价值

目的 比较CT血管成像（CT angiography,CTA）与高分辨率磁共振血管壁成像（highresolution magnetic resonance angiography,HR-MRI）对青年脑卒中动脉夹层的诊断价值。方法 选择我院2016年1月至2021年12月青年卒中患者70例,通过数字减影血管造影（digital subtraction angiography,DSA）确诊为动脉夹层患者47例和非动脉夹层患者23例,所有患者进行CTA和HR-MRI检查,分析CTA与HR-MRI对青年卒中动脉夹层的诊断率及一致性。采用受试者工作特征曲线（ROC）分析CTA与HR-MRI对青年脑卒中动脉夹层的诊断价值。结果 与非动脉夹层患者比较,动脉夹层患者年龄更大、头颈疼痛症状者更多（P<0.05）;CTA和HR-MRI对该病的诊断阳性率分别为30.00%(21/70)和48.57%(49/70);以DSA结果为金标准,CTA和DSA的相关性Kappa=0.458,HR-MRI和DSA的相关性Kappa=0.829,HR-MRI和DSA的一致性较好;采用ROC曲线分析,CTA和HR...     

双蒂腓肠肌皮瓣下滑修复跟腱及皮肤缺损的应用解剖学

目的:为双蒂腓肠肌皮瓣下滑修复小腿下端皮肤及跟腱缺损和术前判断肌皮瓣能修复的范围提供解剖学理论依据。方法:30侧下肢标本,模拟腓肠肌皮瓣的切取,观察双蒂腓肠肌皮瓣中腓肠肌及其神经、血管的形态和毗邻关系,观测肌皮瓣能向下滑动的距离。结果:腓肠肌的动脉有4种类型:Ⅰ.腓肠内、外侧动脉单独发支,占56.7％;Ⅱ.腓肠内、外侧动脉单独发支,而一侧有来源于对侧动脉的分支直接人肌,占23.3％;Ⅲ.腓肠内、外侧动脉共干占10％;Ⅳ.腓肠内、外侧动脉单独发支,但有一侧为两支,占10％。神经分支形式有6种类型:Ⅰ.腓肠内侧皮神经、腓肠肌内外侧头肌支、比目鱼肌支单独发支,占36.7％;Ⅱ.腓肠内侧皮神经和腓肠肌内侧头肌支共干,占20％;Ⅲ.腓肠肌外侧头肌支与比目鱼肌支共干,占20％;Ⅳ腓肠内侧皮神经与腓肠肌内侧头肌支共干,腓肠肌外侧头肌支与比目鱼肌支共干,占13.3％;Ⅴ.腓肠内侧皮神经、腓肠肌内外侧头肌支、比目鱼肌支共干,占6.7％;Ⅵ.腓肠内侧皮神经、腓肠肌内、外侧头肌支共干,占33％。皮瓣向下滑动的平均最大距离为(9.2±0.9)cm。结论:双蒂腓肠肌皮瓣适合于修复跟腱及皮肤同时缺损,切取时需要注意神经、血管有不同的类型并做相应的处理,肌皮瓣能修复的平均最大长度为(9.2±0.9)cm。     

Popliteal vascular entrapment syndrome caused by variant lateral head of the gastrocnemius muscle leading to pulmonary artery embolism

A young man with popliteal vascular entrapment syndrome (PVES) presented with arterial occlusion, deep venous thrombosis (DVT), pulmonary artery embolism, and pulmonary hypertension. He received computer tomography (CT) and magnetic resonance imaging (MRI). Both CT and MRI showed that the left thrombosed popliteal vein and artery were entrapped by a variant lateral head of the gastrocnemius muscle. The anomalous slip originated from the lateral head of left gastrocnemius muscle and ended between the medial and lateral femoral condyles. PVES Type V was diagnosed. Compression of the popliteal vein without arterial compression can be explained by the more lateral location of the popliteal vein relative to the artery and its proximity to the lateral head of the gastrocnemius. Compression of the popliteal vein with arterial compression was found in this patient. Compression of popliteal vein and artery in this patient led to DVT and arterial occlusion. The case was the first reported case accompanied by popliteal vein and artery thrombosis caused by variant lateral head of the gastrocnemius muscle. Radiologists and doctors should continue to look for possible abnormalities in the popliteal fossa in young patients with peripheral vascular disease because early diagnosis of PVES allows better choices and outcomes of treatment. Clin. Anat. 25:986–988, 2012. © 2012 Wiley Periodicals, Inc.     

彩色多普勒超声对小腿三头肌内静脉扩张的诊断价值

目的探讨彩色多普勒超声对小腿三头肌内静脉扩张的诊断价值。方法选择72例疑为下肢深静脉病变的患者,其中男性32例,女性40例;年龄28-92岁,平均年龄56岁。应用彩色多普勒超声检查小腿三头肌内静脉（包括比目鱼肌静脉及腓肠肌静脉）,测量其管径,观察管腔内透声及血流情况,探查其交通支的情况。结果共检出小腿三头肌内静脉受累患肢72条,单纯小腿三头肌内静脉扩张32例（44．4％）,合并血栓16例（22．2％）,合并交通静脉扩张24例（33.3％）。结论彩色多普勒超声能够有效地检出小腿三头肌内静脉扩张及血栓、其交通支情况。是超声检查下肢深静脉时不容忽视的重要内容。     

脑静脉与静脉窦血栓形成累及的结构及其影像学特征研究

目的探讨脑静脉及静脉窦血栓形成(CVST)累及的结构及影像学特征。方法回顾性分析152例经临床及影像检查确诊为CVST患者的临床资料,观察CVST累及的结构,分析其影像学特征。结果152例CVST中,最常受累的静脉结构为横窦(57.2%),其次为上矢状窦(51.9%)、乙状窦(48%)、颈内静脉(12.5%),超过50%的CVST累及多个静脉窦,皮质静脉及深静脉血栓少见;上矢状窦血栓以中段血栓最为常见。39.5%的患者存在脑实质损害,最为常见的是脑水肿或脑肿胀,其次是静脉性脑梗死、颅内出血等;CVST最为常见的CT影像学特征依次是高密度三角征、条带征,而高密度点征、火焰征少见;MRI的特征性表现为静脉血管腔血液流空效应消失;DSA表现为静脉窦腔狭窄、显影变淡或完全不显影,侧支静脉异常扩张。结论CVST主要累及横窦及上矢状窦中段,常同时阻塞多个静脉窦;常见的直接影像学特征有条带征、三角征及血管充盈缺损;间接影像征象有脑水肿、脑出血、静脉性脑梗死等。了解脑静脉及静脉窦的结构及CVST影像学特征对CVST的早期诊断具有重要意义。     

An anomalous muscle in the superficial region of the popliteal fossa, with special reference to its innervation and derivation

An anomalous muscle was found in the superficial region of the right popliteal fossa in a 90-year-old Japanese female cadaver during dissection practice for medical students. The muscle ran transversely between the medial head of the gastrocnemius muscle and the tendon of the biceps femoris muscle, covering the nerves, vessels and muscle in the popliteal fossa. The muscle received its nerve supply from the common peroneal nerve. Based on the result of nerve fiber analysis, we speculated that the anomalous muscle might be close to the short head of the biceps femoris muscle in its derivation.     

指动脉静脉化在手指末节离断再植的疗效分析

目的　探讨指动脉静脉化重建手指再植血液回流的方法和疗效。 方法　应用离断手指远断端非优势侧指动脉与近断端指掌侧静脉或指侧方静脉吻合治疗手指末节离断病人18例,其中指动脉与指掌侧静脉吻合11例,与指侧方静脉吻合7例。 结果　成活16例,坏死1例,部分坏死1例。 结论　指动脉静脉化为断指再植提供了重建静脉回流的一种有效方法。     

A rare muscular variation in the superficial region of the popliteal fossa

We found a rare muscular variation in the superficial region of the popliteal fossa in a 61-year-old Korean male cadaver whose cause of death was laryngeal carcinoma during routine dissection course for medical students. The muscle ran transversely between the medial head of the gastrocnemius muscle and the tendon of the long head of biceps femoris muscle, covering the neurovascular structures in the popliteal fossa. The muscle received its nerve supply from the tibial nerve. Based on its innervation, we speculated that the anomalous muscle might be a very specific type of variation related to the gastrocnemius tertius rather than another superficial muscle in the popliteal fossa.     

An abnormal muscle in the superficial region of the popliteal fossa

An abnormal muscle was observed in the superficial region of the popliteal fossa during a dissection procedure conducted for medical students. This abnormal muscle originated from the biceps femoris tendon and inserted into the medial head of the gastrocnemius muscle. The innervating nerve branched from the lateral sural cutaneous nerve. The distributing artery arose from a branch of the sural artery. This abnormal muscle mostly comprised one sheet of muscle mass (not tendon type) and ran transversely.     

Bilateral persistent sciatic vein: report of a case with developmental,histological and clinical aspects

Objective

Bilateral large variant veins were encountered in the lower extremity. It was aimed to identify the structural characteristics of this rare case and then, regarding the structural features, to overview its formation process and denomination.

Material and method

During the routine dissection of a 93-year-old male cadaver, bilateral large variant veins were found at the thigh. Valves of the veins were examined and evaluated together with the vascular wall histology.

Results

The variant vein was loosely attached to the sciatic nerve by fibrous tissue and had anastomoses with the popliteal vein in the popliteal fossa on each side. The popliteal veins were hypoplastic on both sides. The right variant vein was passing through the fibers of the adductor magnus muscle 56.2 mm above the adductor hiatus, which corresponds to the third perforating branch of deep femoral vein. The left one was turning to the front over the adductor magnus muscle, at the lower border of quadratus femoris muscle. The left variant vein was corresponding to the descending branch of the medial circumflex femoral vein. Both variant veins had one incomplete and three well-developed valves.

Conclusion

In accordance with the findings, the variant vein was concluded to be an embryonic remnant, rather than an acquired one subsequent to any obstruction of the femoral vein. Regarding their connection with the popliteal vein but not with the internal iliac vein, both variant veins were denominated as “lower type persistent sciatic vein”. Such a variation would be important with respect to the risk of complication during popliteal sciatic nerve blockade.