经鼻入路处理斜坡病变的虚拟影像解剖研究

目的 在虚拟现实(VR)环境下观察经鼻入路虚拟解剖,并建立斜坡区虚拟解剖模型,探讨该方法的临床应用价值.方法 选择20例无鞍区及斜坡区病变者,其中男11例,女9例,年龄25 ～ 70(43.0±0.3)岁,行16排螺旋CT头部薄层扫描血管造影及MRI薄层扫描检查,数据导入Dextroscope图像工作站,进行斜坡区三维重建及经鼻人路虚拟解剖观察.结果 20例均成功实现了斜坡区相关结构的虚拟重建,并进行了相关解剖数据的测量.同时应用VR系统模拟经鼻人路,明确经鼻人路斜坡骨质磨除界限,斜坡骨质开窗侧方的扩展受到斜坡旁颈内动脉的限制,上方受到鞍底的限制,下方受到上颌骨及硬腭的限制而无法完全显露下斜坡.结论 VR技术可精确重建斜坡区解剖模型,并可模拟手术入路,为经鼻人路处理斜坡病变提供影像解剖学依据.     

经鼻蝶入路显微技术垂体瘤切除术后并发症及影响因素

目的探讨经鼻蝶入路垂体瘤切除术术后的相关并发症及其影响因素。方法回顾性分析辽阳市中心医院2010—2015年确诊垂体瘤并接受经鼻蝶入路显微技术垂体瘤切除术的32例患者的临床资料,对其术后并发症及相关可能影响因素进行Logistics回归分析。结果切除程度是术后尿崩的重要影响因素。垂体瘤的大小是术后低钠血症和垂体功能低下发生的重要影响因素。结论经鼻蝶入路行垂体瘤切除术的术后并发症影响因素较多,临床工作中应尽量避免,可有效降低并发症发生风险,使患者受益。     

经鼻入路显露鞍旁结构的三维可视化研究

目的 采用虚拟现实(VR)技术模拟经鼻入路显露鞍旁结构,提高对术中解剖结构的认识水平.方法 搜集28例自发性蛛网膜下隙出血患者,均无蝶筛区和海绵窦区病变.经肘静脉注入造影剂,采用16排螺旋CT行头部薄层扫描.将数据导入Dextroscope图像工作站,模拟经鼻人路手术,进行解剖观察.结果 应用VR系统模拟经鼻人路手术,解剖结构可得到立体化呈现,操作者可进行动态观察并处理.术中显露颈内动脉海绵窦段的外侧缘时,须切除中鼻甲,开放后组筛窦,打开蝶腭孔,控制蝶腭动脉,适当磨除翼突,显露翼管前口.结论 经鼻入路显露鞍旁结构,须切除中鼻甲、钩突,尽量向侧方扩大蝶窦前壁区的开窗范围,妥善处理蝶腭动脉.颈内动脉海绵窦段是关键结构,应增加显露,给予良好保护.     

经鼻蝶入路垂体瘤切除术的应用效果及并发症初步研究

目的：探究经鼻蝶入路切除垂体瘤手术的临床应用效果,并观察围术期并发症的发生情况和治疗护理结果。方法择取2011年2月～2016年2月行经鼻蝶入路切除手术的垂体瘤病患16例,术后随访12个月,观察患者的治疗结果、并发症发生情况以及并发症的护理治疗结果。结果患者的手术时间为（87．19±11．05）min,术中出血量为（47．66±8．62）mL,住院时间为（14．15±3．33）日,1例（6．25％）患者发生脑脊液漏,1例（6．25％）患者发生尿崩,在7～14日的保守治疗后恢复正常。结论在显微镜下取鼻蝶为入路为患者切除垂体瘤可以取得显著的治疗效果,且术后并发症少,可谓是安全有效。     

颞下经小脑幕入路切除岩斜区肿瘤

目的介绍颞下经小脑幕入路切除岩斜区肿瘤的手术操作体会。方法从2008年7月─2009年11月采用颞下经小脑幕入路切除岩斜区肿瘤4例,对比术前、术后症状和头颅MRI检查。结果全切除1例,次全切除2例,部分切除1例。术后动眼神经损伤1例,短暂动眼神经和滑车神经麻痹各1例。结论颞下经小脑幕入路结合娴熟的显微外科技术可较好切除岩斜区肿瘤,降低病残率。     

经桡动脉入路外周介入中国专家共识

经桡动脉入路（transradial access,TRA）行介入手术具有安全、舒适的特点,是冠脉介入的首选入路。但TRA在外周介入中应用不足。目前对如何选择合适的患者、合适的器械、降低TRA并发症及提高TRA使用率尚认识不足。为了更好地推广TRA在外周介入中的应用,指导TRA临床患者选择、技术操作规范和医师技能训练,中国抗癌协会肿瘤介入学专业委员会于2022年组织全国范围内的介入专家成立《经桡动脉入路外周介入中国专家共识》工作小组,并共同制定本共识。本文主要聚焦TRA外周应用现状、优势及局限性、桡动脉解剖学特征、患者选择、操作规范、常见并发症预防与处理、辐射剂量及学习曲线,并通过文献评价结合专家组意见达成共识。     

鼻蝶入路手术切除垂体腺瘤的手术方法和技巧探讨

目的通过观察和分析探讨经鼻蝶入路手术切除垂体腺瘤的手术方法和技巧。方法采用随机数字袁法将58例有垂体腺瘤的患者分为两组,观察纽采用鼻蝶入路手术法,对照组采用传统手术法。对比两种手术的手术灵活性,疼痛指数和手术后的痊愈时间。结果经过对两组患者手术时间的记录,观察组与对照组相比灵活性更高（P〈0．05）,差异明显,有统计学意义。对照组术后愈合时间长于观察纽,观察组对患者的伤害程度更小（P〉0．05）,差异不明显,无统计学意义。结论两组手术方法都能有效切除垂体腺瘤,经鼻蝶入路手术法的手术灵活性更好,出血少,痛苦少,没有疤痕,对患者的损伤程度更小。     

经鼻-蝶入路垂体瘤切除术中配合的体会

垂体瘤是一种常见的生长缓慢的颅内良性肿瘤。垂体瘤的手术途径大体可分为经颅垂体瘤切除和经蝶垂体瘤切除两种。随着显微外科的发展,显微镜下经鼻蝶窦入路垂体瘤切除术被认为既能切除肿瘤又能完好保存垂体功能,手术和麻醉时间短、并发症少、不良反应少、恢复快、死亡率低,所以经单鼻腔蝶窦入路垂体瘤切除是目前国内外治疗垂体瘤的首选方法,收集自2002-02～2010-03对25例垂体瘤经鼻-蝶入路手术切除效果满意,现将手术中配合报告如下。     

显微镜下经鼻蝶入路手术在不同类型垂体瘤患者中的应用效果对比

目的 探讨显微镜下经鼻蝶入路手术在不同类型垂体瘤患者中的应用效果.方法 分析2018年8月-2020年8月收治的70例垂体瘤患者临床资料,将61例功能腺瘤患者纳入功能腺瘤组,将9例无功能腺瘤患者那纳入无功能腺瘤组.所有入选者均采用显微镜下经鼻蝶入路手术治疗,对比不同类型垂体瘤患者的治愈率及生活质量.结果 皮质激素腺瘤、...     

神经内镜经枕下乙状窦后入路切除桥小脑角区肿瘤23例临床经验总结

目的 总结神经内镜下切除桥小脑角区肿瘤的经验与方法。方法 回顾性分析自2019年3月至2021年1月北部战区总医院神经外科收治的23例桥小脑角区肿瘤患者的临床资料。患者均采用改良乙状窦后入路,全程神经内镜下切除肿瘤。评价患者术后面神经功能,观察手术相关并发症及临床结局。结果 本组患者手术时间120～300 min,中位时间180 min;住院时间7～10 d,平均8.5 d。完全切除22例(95.6%),次全切除1例(4.4%)。术后面神经功能H-B分级：Ⅰ级20例,Ⅱ级2例,Ⅲ级1例。所有患者中,症状和体征完全消失15例,症状减轻6例,颅神经损害同术前2例,所有患者面神经解剖保留。随访结果：无后组颅神经障碍;出现永久面神经损害1例;出现三叉神经障碍1例和面神经障碍1例,半年后完全恢复。随访期间无肿瘤复发,无迟发性颅神经功能障碍。结论 神经内镜下经乙状窦后入路切除桥小脑角区肿瘤具有明显的优势,可缩短手术时间,减少对血管神经的牵拉,提高肿瘤的全切率。     

经口咽前入路寰枢椎手术的解剖学研究

目的　为经口咽前入路处理寰枢椎腹侧病变提供解剖学依据。方法　对 10例新鲜的成人头颈部标本经口咽前入路进行逐层的显微外科解剖 ,观察咽后壁的层次、椎动脉的走行、寰枢椎的解剖毗邻关系和寰枢椎前路钢板内固定的相关解剖参数等。结果　咽后壁分两层(黏膜层、椎前筋膜层)和两个间隙 (咽后间隙、椎前间隙 ) ;经口咽前入路可显露从枕骨大孔前缘至C3 椎体的范围 ;椎动脉距寰椎和枢椎中线的距离分别为 2 5 2± 2 3mm(2 0 4～ 2 9 7mm)和 18 4± 2 6mm(13 1～ 2 3 0mm) ;寰椎和枢椎可显露宽度分别为 39 4±2 2mm(36 2～ 4 2 7mm)和 39 0± 2 1mm(35 8～ 4 2 3mm) ,寰椎进钉点 (侧块中点 )间距 (a)为 31 4± 3 3mm(2 5 4～ 36 6mm) ,寰椎进钉点连线与枢椎进钉点 (椎体中线旁开 3～4mm)连线的垂直间距 (b)为 18 7± 2 7mm(14 9～ 2 3 2mm) ,a/b比值为 1 5～ 1 7。结论　经口咽前入路寰枢椎手术是安全可行的 ,适合做寰枢椎前路钢板内固定 ,钢板的设计应以上述测量数据为依据     

Relationship between the surgical epicondylar axis and the articular surface of the distal femur: an anatomic study

Many authors presented the epicondylar axis as the fixed axis of rotation of the femoral condyles during flexion of the knee. Positioning of the femoral component of a total knee arthroplasty (TKA) based on the epicondyles has been proposed. This work is a critical analysis of this concept. Metallic bodies were inserted at the level of collateral ligament insertions on 16 dried femurs, allowing us to locate the surgical epicondylar axis. The dried femurs were studied using standard radiographs and CT-scan. CT cuts were made perpendicular to the epicondylar axis. The medial mechanical femoral angle and the epicondylar angle were measured on the radiographs. The posterior and distal epiphyseal rotations relative to the epicondylar axis (Posterior Condylar Angle, PCA, and Distal Condylar Angle, DCA, respectively) were measured on the CT-scans. PCA and DCA values were compared. The centre of the posterior femoral condyles was located on sagittal reconstructions using the tangent method and was confirmed with circular templates, and then compared to the location of the epicondyles. Circle-fitting of the entire femoral condylar contours centred on the epicondyles was also tried. The mechanical femoral axis was nearly perpendicular to the epicondylar axis but with important variations. The average PCA and DCA were 1.9 degrees +/- 1.8 degrees and 3.1 degrees +/- 2.1 degrees , respectively. No relationship could be established between the mechanical femoral angle and the PCA. The individual differences between the PCA and the DCA averaged 2.2 degrees . A significant distance was found between the centre of the condylar contours and the epicondyles: 6.5 mm in average on the lateral side (range 2.3-11.3 mm) and 8.4 mm on the medial side (range 4.0-11.6 mm). Circle-fitting of the entire medial or lateral femoral condylar contours centred on the epicondyles was not possible. The centre of the posterior femoral condyles is significantly different from the epicondylar axis, thus refuting the conclusions of previous authors. Furthermore, considering the differences between the distal and posterior condylar angles shown here, as well as the difficulty of repeatably locating the epicondyles during surgery, using the epicondylar axis as the only landmark to position the femoral component during a first intention TKA is not recommended. The surgical epicondylar axis does not appear to be an adequate basis for the understanding of the shape of the distal femur.     

Hip instability: anatomic and clinical considerations of traumatic and atraumatic instability

Hip instability is uncommon because of the substantial conformity of the osseous femoral head and acetabulum. It can be defined as extraphysiologic hip motion that causes pain with or without the symptom of hip joint unsteadiness. The cause can be traumatic or atraumatic, and is related to?both bony and soft tissue abnormality. Gross instability caused by trauma or iatrogenic injury has been shown to improve with surgical correction of the underlying deficiency. Subtle microinstability, particularly from microtraumatic or atraumatic causes, is an evolving concept with early surgical treatment results that are promising.     

A combined radiologic and endoscopic approach to removal of occluded double-mushroom biliary endoprosthesis: Technical note

A combined radiologic and endoscopic approach to the removal of an occluded double-mushroom biliary endoprosthesis was successfully performed in a patient with terminal pancreatic carcinoma. The present technique is beneficial when there is limited percutaneous and endoscopic access to the biliary system.     

The anterior diaphragmatic attachments: an anatomic and radiologic study with clinical correlates

A study of the anterior attachments of the respiratory diaphragm was performed using gross anatomic specimens, plain radiography, and computed tomography with multiplanar image reformatting. The anterior portions of the diaphragm are affixed to the lower six ribs and the sternum. The line of attachment of each hemidiaphragm begins at the anterior axillary line and extends cranially and medially to meet at the xiphoid process. These structures can be visualized along with contiguous pathologic subdiaphragmatic and/or infradiaphragmatic air collections. In the semierect patient, free intraabdominal air may preferentially collect in the anterior subdiaphragmatic regions rather than below the domes of the diaphragm, providing a subtle but reliable indication of pneumoperitoneum. An understanding of the normal anatomy of the anterior diaphragmatic attachments is valuable in assessing a variety of anterior paradiaphragmatic air collections.     

经膜髓帆入路四脑室病变切除术的临床研究

目的探讨经膜髓帆入路切除第四脑室病变的手术方法及优点。方法17例第四脑室及周围占位病变,男7例,女10例,年龄5～49岁,平均26．6岁。其中髓母细胞瘤5例,室管膜瘤5例,表皮样囊肿2例,脑囊虫病2例,脉络丛乳头状瘤3例。手术采用小脑延髓裂膜髓帆入路,显微镜下分离两侧小脑延髓裂,游离小脑扁桃体,根据病变大小切开脉络膜和下髓帆,显露四脑室,将病变切除,严密缝合硬膜,骨瓣复位。结果17例病变均全切除,术后早期恢复良好,无重残及死亡。11例术后随访3～21个月,无重残及死亡,其中8例行CT或MRI检查,无复发。结论经小脑延髓裂膜髓帆入路切除四脑室肿瘤不需切开小脑蚓部,且可扩大四脑室的显露,减少术后并发症的发生。     

Imaging review of groin pain in elite athletes: an anatomic approach to imaging findings

OBJECTIVE: Groin pain in elite athletes is a common yet challenging diagnostic and management dilemma for the sports clinician, accounting for a significant proportion of athletic injuries. It is often debilitating and, if severe enough, may compromise an athlete's career. Traditionally, groin pain has been poorly understood by radiologists. CONCLUSION: A major reason groin pain has been misunderstood is the complexity of the anatomy of this region, which this article discusses in detail in an effort to inform the reader.     

Peribursal fat plane of the shoulder: anatomic study and clinical experience

A comprehensive anatomic and radiographic analysis of the peribursal fat plane in 12 cadavers confirmed that the fat plane seen on radiographs represents extrasynovial fat lining the subacromial bursa and documented the anatomic relations of the bursa. A three-part retrospective clinical evaluation of rotator cuff tears, calcific tendinitis, and rheumatoid arthritis was performed. Two osteoradiologists blindly graded the appearance of the peribursal fat plane with the shoulder in external versus internal rotation in 21 patients with arthrographically intact rotator cuffs and 21 patients with disrupted rotator cuffs. The peribursal fat plane was seen better with disrupted rotator cuffs. The peribursal fat plane was seen better with the shoulder in internal rotation and was seen in 60% of control subjects but only 21% of patients with rotator cuff tears. Partial or complete obliteration of this fat plane is a sensitive (79%) but less specific (60%) indicator of rotator cuff tears. Obliteration of the peribursal fat plane by inflammatory processes in adjacent tissues, including calcific tendinitis and rheumatoid arthritis, occurred with a high frequency.