骶管的应用解剖学研究

目的为骶管阻滞麻醉提供解剖学依据。方法对180个成人干燥骶骨和30具成人尸体标本的骶管及骶骨背面邻近区域的有关结构进行形态学观察,并测量骶管裂孔及有关结构的径线。结果在干燥标本上,骶管后壁完整的有106例,占58.89%,骶管后壁有裂或孔约为39.44%,骶管裂孔形态以三角形多见,为41.11%,其次是长方形。不规则形或马蹄形;骶管裂孔高为(24.52±2.74)mm,底宽为(14.91±1.07)mm,孔尖矢径为(5.71±1.01)mm,孔尖至S2下缘距离为(32.41±0.59)mm;在成人尸体标本上,尾骨尖至两骶角连线中点的距离为(44.38±0.95)mm,裂孔尖至两髂后上棘连线中点的距离为(48.58±1.25)mm。结论根据解剖特点,骶管裂孔穿刺法明显优于骶管上端穿刺法和骶管后壁裂孔穿刺法。由于年龄。性别和个体差异等因素不相同,故临床上综合各种因素灵活运用麻醉方法。     

骶管裂孔的观测及临床意义

目的为骶管阻滞麻醉提供解剖学依据。方法随机选取40例正常成人骶骨标本,观察骶管和骶管裂孔的形态,测量两侧骶角与后正中线之间的距离、测量第二骶椎下缘水平与两骶角连线的垂直距离。结果①骶管裂孔的形态变异较大,首先两侧骶角并不都是对称位于后正中线两侧,其中较多的是左侧骶角比较靠近后正中线,40例中有13例,约占32.5%;骶管裂孔的形态以三角形和长尖形居多占57.5%;其次是马蹄形、正方形以及长方形占42.5%;②测得左侧骶角与后正中线之间的距离平均为(0.78±0.06)cm,右侧骶角距后正中线的距离平均为(0.94±0.06)cm;测得第二骶椎下缘水平与两骶角连线的垂直距离平均为(2.73±0.22)cm。结论①骶管裂孔的形态变异较大,其中较多的是左侧骶角比较靠近后正中线,所以对骶角不对称的病人,作骶管麻醉时,可考虑左侧卧位。②根据我们测得的数据,为了达到较为理想的麻醉范围和麻醉效果,骶管麻醉进针的部位可以考虑在两骶角连线的中点偏左0.1cm处,进针的深度正常成人在不超过2.4cm的范围是比较安全的。     

骶管阻滞麻醉的解剖学研究

针对临床骶管阻滞麻醉所提出的问题,对100例成人干燥骶骨和20具成人尸体标本骶管及骶骨背面邻近区域的有关结构进行了观测。S_2棘突中点至两骶角连线中点长度平均为66.2±9.3mm.在干燥骨标本上,用薄乳胶膜囊直接灌水法测量了骶管容积,平均为16.1±3.6ml。骶管容积(Yml)与 S_2棘突中点至两骶角连线中点长度(Xmm)的关系,呈抛物线回归,方程为:y=15.1867-0.3454x+0.0053x~2。因两侧髂后上棘连线过S_2棘突中点,临床可以此定位,测出 X,估算注药量。经临床100例骶管阻滞麻醉应用,效果满意,初步证明了本研究的实用意义。     

经骶后孔骶管阻滞的临床应用解剖

目的:探索适合骶后孔骶管阻滞的精确定位方法及其进针角度和深度,为临床骶管阻滞和注射提供解剖学依据。方法:选取28例尸体标本,层次解剖并测量骶后各结构,对半劈开或打开骶管后壁,观测骶管各结构。以通过两侧髂嵴最高点连线为X1轴,以通过两骶角连线为X2轴,以骶后正中嵴垂线为Y轴进行定位。结果:①第2、3骶后孔的精确定位X1轴坐标分别为:男(68.45±5.78)、(86.91±6.14)mm,女(60.44±6.30)、(78.60±7.23)mm,X2轴坐标分别为:男(52.46±5.24)、(31.00±4.62)mm,女(48.26±4.32)、(30.20±4.27)mm,Y轴坐标分别为:男(20.76±2.53)、(19.20±2.50)mm,女(19.58±2.10)、(17.45±2.32)mm。②硬膜囊下端一般平对第2骶椎,与第2骶后孔上缘水平的距离为(13.07±5.50)mm。结论:第2、3骶后孔均可作为经骶后孔进针骶管阻滞麻醉的理想部位,推荐采用倒"工"形双重坐标法定位,穿刺角度宜向内、下偏斜矢状轴30°～40°,进针深度分别为9.3mm、6.4mm为宜。     

经骶管裂孔进行骶管囊肿穿刺的应用解剖学

目的 探索通过骶部骨性标志快速定位识别骶管裂孔,并阐明其与骶神经节和硬脊膜的位置关系,为从骶管裂孔进行骶管囊肿穿刺治疗的进针位置、角度和深度提供解剖学指导。 方法 取成人尸体标本15例。测量骶管裂孔到硬脊膜下界及骶神经节的距离,对骶角、骶管裂孔以及左右髂后上棘与骶角中点的位置关系进行了研究,对矢状切面进行了多种解剖学测量,记录穿刺针插入的角度和深度。结果 两侧骶角中点到尾骨末端的平均距离为(5.73±0.81)cm,两侧髂后上棘与骶角中点构成等腰三角形,3条边的尺寸在女性偏小,从骶管裂孔进针的平均俯角是60.4°,两侧骶角中点到达硬脊膜下界的距离大于到达第3骶神经节中点的距离,小于到达第1、2骶神经节中点的距离。 结论 总结出骶管裂孔的体表定位方法,阐明了骶管裂孔在体表的准确位置、深度及其与骶神经节和硬脊膜的位置关系,骶管裂孔进针的最佳角度,这些测量研究结果可帮助临床医师对骶管囊肿进行更安全的诊断和治疗,也可为骶管麻醉、骶前后区射频神经切断术,以及超声检查提供有用的参考。     

骶管阻滞的解剖学观测

<正> 作者对246块骶骨和100例带软组织的骨盆进行了观测。一、骶管骶管的高度X±SD为68.24±0.92(16.04～108.35)mm;管的后壁完整者146,占59.35±3.13％,后壁出现不同程度缺损者100,占40.65±3.13％。二、骶裂孔骶裂孔的形状多样,三角形占47.56±3.18％,长方形占20.73±2.58％,尖长形占6.91±1.69％,方形占5.29±1.13％,梯形占8.13±1.74％,马蹄形占3.25±     

骶后孔(八髎穴)的临床应用解剖学

目的 :为八穴的针灸推拿以及骶后神经和骶管麻醉提供解剖学依据。方法 :我们测量了 30例骶骨标本 ,将骶后中线定为Y轴 ,将通过两骶角的连线定为X轴 ,测定骶后孔中点至两轴的距离 ;并测量骶后孔的口径 ,骶后孔中点至相应骶前孔中点的间距以及每侧 1～ 2 ,3～ 4骶后孔中点间距。结果 :根据统计分析 ,我们确定了两种骶后孔定位方法 ,取得了 1～ 2 ,3～ 4骶后孔中点间距的数值 ;4对骶后孔口径的大小顺序是 :1孔 >2孔 >4孔 >3孔。结论 :两种定位方法可帮助医生对骶后孔进行更为准确的定位 ,避免一些给患者带来的损伤 ,可使一些医疗麻醉等措施得以成功实施 ,有助于提高临床疗效     

骶外侧静脉的应用解剖研究

目的 通过骶外侧静脉的解剖研究,为临床提供形态学资料。方法 选用50具新鲜尸体,经乳胶灌注后,在体视显微镜下观察。结果 骶外侧静脉多为2支型,占51.9％,其中以直接注入髂内静脉的最多见 骶外侧静脉管径左侧为(1.03±0.33)mm,右侧为(1.04±0.28)mm。骶外侧静脉脊支在第1骶前孔多为2支型,在第2～4骶前孔以1支型为多见。在第1骶前孔内脊支多位于外上象限,占52.11％ 在第2～4骶前孔内多位于内上象限,各占63.33％,64.71％和80％。结论 骶前出血是多源性出血,骶外侧静脉出血时要依据其解剖学特点进行有效地止血     

经皮骶髂螺钉内固定术的应用解剖学研究

目的:为骶髂关节骨折脱位经皮螺丝钉固定提供解剖学依据。方法:50块干燥成人骶骨及30个骨盆防腐标本,测量S1、S2侧突、侧块厚度等指标,观察骶髂关节周围神经血管分布,定位进针点;通过标本断层及正常骨盆CT片测量螺钉进针方向及深度。结果:S1侧突高度为(22.1±4.6)mm,厚度为(27.8±3.1)mm,S2侧突高度为(13.4±3.6)mm,厚度为(20.9±2.2)mm。S1进针点位于髂前上棘-髂后上棘连线中后1/3交点附近,S2进针点位于髂结节-髂后上棘连线前4/5与后1/5交点附近。S1侧突中轴与矢状面夹角约为55°,S2则约为80°,S1侧突中轴与冠状面的夹角约为36°,S2则约为15°。结论:(1)S1侧突能容纳直径为6.5～7.0mm的螺丝钉2枚,S2侧突可容纳1枚。(2)S1侧突螺丝钉进针方向与矢状面夹角约为55°,与冠状面夹角约为36°;对S2则分别约为80°和15°。S1进针深度为68mm,S1为55mm。(3)经皮骶髂螺丝钉固定手术应严格限制在骨折精确复位的病例。     

骶管阻滞麻醉在新生儿腹部手术中的应用

目的:探讨新生儿采用骶管阻滞行腹部、会阴部手术的麻醉可行性和安全性.方法 全麻喉罩通气下,左侧卧位,用7号针头行骶管穿刺,局麻药0.5%利多卡因+0.75%罗哌卡因混合液,给试验量,观察无全脊髓麻醉后将余药注1ml/kg,改平卧住,10分钟后可达麻醉效果,开始手术,连续监测ECG、HK、RR、SPO2、BP,并记录其麻醉前、麻醉后10min,术中、术毕的变化,记录术后并发症的发生.结果 与麻醉前相比,HR、RR、SPO2、BP差异无显著意义.结论 新生儿在骶管阻滞复合全麻下,镇痛完善,肌肉松驰,对呼吸、循环干扰小,全麻药物用量减少,同时应用喉罩通气可避免全麻插管引起的气道损伤和水肿,满足手术要求,是一安全可行的麻醉方法.     

患有肝脏疾病成人骶静脉丛的解剖及临床意义

目的:为患有肝病的直肠癌的外科治疗提供解剖学基础。方法:在20具患有肝脏疾病的成人尸体上解剖观测骶静脉丛的组成及结构特点。结果:①骶静脉丛吻合丰富,呈网状弯曲如蚓。②管壁薄,管腔大、充盈扩张,缺乏静脉瓣。③骶静脉丛与直肠静脉丛、骶管椎内静脉丛有直接交通。结论:。本研究结果为直肠癌根治术的开展提供解剖学基础与参考数据。     

骶骨耳状面倾斜度及相关径线

对36具成人骶骨耳状面倾斜度及相关径线测量结果,显示男性耳状面长轴的前倾度显著大于女性;耳状面上部的侧倾度和后倾度显著大于下部;耳状面中间部的宽度及后倾度在男、女性间有显著性差异。     

Surgical Strategy for Sacral Tumor Resection

PurposeThis study aimed to present our experiences with a precise surgical strategy for sacrectomy.Materials and MethodsThis study comprised a retrospective review of 16 patients (6 males and 10 females) who underwent sacrectomy from 2011 to 2019. The average age was 42.4 years old, and the mean follow-up period was 40.8 months. Clinical data, including age, sex, history, pathology, radiographs, surgical approaches, onset of recurrence, and prognosis, were analyzed.ResultsThe main preoperative symptom was non-specific local pain. Nine patients (56%) complained of bladder and bowel symptoms. All patients required spinopelvic reconstruction after sacrectomy. Three patients, one high, one middle, and one hemi-sacrectomy, underwent spinopelvic reconstruction. The pathology findings of tumors varied (chordoma, n=7; nerve sheath tumor, n=4; giant cell tumor, n=3, etc.). Adjuvant radiotherapy was performed for 5 patients, chemotherapy for three, and combined chemoradiotherapy for another three. Six patients (38%) reported postoperative motor weakness, and newly postoperative bladder and bowel symptoms occurred in 5 patients. Three patients (12%) experienced recurrence and expired.ConclusionIn surgical resection of sacral tumors, the surgical approach depends on the size, location, extension, and pathology of the tumors. The recommended treatment option for sacral tumors is to remove as much of the tumor as possible. The level of root sacrifice is a predicting factor for postoperative neurologic functional impairment and the potential for morbidity. Pre-operative angiography and embolization are recommended to prevent excessive bleeding during surgery. Spinopelvic reconstruction must be considered following a total or high sacrectomy or sacroiliac joint removal.     

Sacral and presacral lesions: cytopathologic analysis and clinical correlates

Although percutaneous biopsies of the spine at thoracolumbar levels have proven value, the benefit in the sacrococcygeal region has not been presented thoroughly in the literature. This region has unique anatomic and oncologic properties. The cytopathologic files at The Johns Hopkins Hospital over a 20-year-period were searched. Imaging studies and medical records were also reviewed. Ninety-one cases of sacral/presacral FNA were identified. There were 46 males and 45 females; 62% had a prior history of malignancy. The most common presentation was lower back pain (44%). Imaging revealed lytic and/or soft tissue lesions masses from 1 to 12 cm (mean = 5.0 cm). Of the 71 (78%) diagnostic cases, 19 (27%) were nonneoplastic, 2 (3%) were suspicious for neoplasm, while 50 (70%) cases were neoplastic. Of the nonneoplastic cases, 10 (53%) showed nonspecific inflammation. Two (4%) of the 50 neoplastic lesions were benign tumors (schwannoma and neurofibroma), and of the malignant cases, 11 (23%) were primary, and 37 (77%) were metastatic/secondary. The most common primary malignant tumor was chordoma (four cases, 36%). Of the 37 secondary tumors, the most common were colorectal carcinoma (8, 22%) and plasmacytic tumors (5/9, 56%). The overall accuracy, sensitivity and specificity of FNA were 96, 95, and 100%, respectively. Sacral and presacral lesions represent rare targets for FNA. Benign tumors are rare (2%). Most cancers are metastatic (41%), with colorectum being the most common primary site (9%). Primary malignancies are uncommon (14%), with chordomas being the most frequent of these entities (4%).     

Sacral edema: Computed tomographic and anatomical observations

Sacral edema is a widely recognized clinical sign. Hitherto there has been no method of radiological confirmation, nor has the anatomy of this sign been well described. In a prospective study of 100 patients referred for abdominopelvic computed tomography (CT), 17 showed radiological evidence of sacral edema. It was demonstrated clinically in 12 of these 17 patients, leaving five patients with apparent CT evidence of sacral edema in whom this was not demonstrated clinically. In two patients with clinical evidence of sacral edema, their tissue planes in this region appeared normal on CT. The edema fluid accumulates in an intermediate plane of fibrous tissue within the subcutaneous fatty layer of the trunk. In those 17 patients with CT evidence of edema, the center of the fluid accumulation was situated over the lumbar rather than the sacral spine, suggesting that the term “sacral” edema is something of a misnomer. © 1995 WiIey-Liss, Inc.     

骶外侧血管蒂髂骨瓣在腰骶椎不稳定治疗中的应用

目的:探讨骶外侧血管蒂髂骨瓣转位治疗腰骶椎不稳定的新术式。方法:在对骶外侧血管进行解剖学研究的基础上,设计并应用骶外侧血管蒂髂骨瓣转位治疗腰骶部不稳定患者25例。结果:随访1～5年,全部病例均植骨融合成功,获得满意的疗效。结论:骶外侧血管蒂髂骨瓣转位植骨融合治疗腰骶部不稳定,创伤小,融合率高,是一种疗效可靠的新手术方法。     

骶二椎弓根钉外进钉固定拧紧力与骶骨应变分布规律的研究

研究骶二椎弓根钉固定拧紧力与骶骨应变分布,为临床骶二椎弓根钉固定术提供生物力学参数。取正常国人新鲜尸体骶骨标本,以椎弓根钉内进钉法固定于骶二椎弓根,以小型力传感器与椎弓根钉固定装置连接,测量椎弓根钉的拧紧力,同时以动静态电阻应变仪对预先粘贴在四个椎弓根螺栓固定边缘部位和骶骨不同部位的应变片进行应变电测量。得出了椎弓根钉的最大拧紧力和S1,椎体、S2椎体、S3椎体正中线左侧和右侧应变值,还得出了s,左侧、S,右侧上关节突关节面部位及S1、2左侧,S1、2右侧骶后孔连线与骶中间嵴交点处应变值。说明骶二椎弓根钉术式符合生物力学原理。     

骶二椎弓根钉内进钉固定拔出力与骶骨应变分布规律的实验研究

目的研究骶二椎弓根钉固定拔出力与骶骨应变分布规律,为临床骶二椎弓根钉固定术提供生物力学参数。方法取正常人新鲜尸体骶骨标本,以椎弓根钉内进钉方法固定于骶二椎弓根,于电子万能试验机上进行相应力学测试,并利用动静态电阻应变仪对预先粘贴在四个椎弓根螺栓固定边缘部位和骶骨不同部位的应变片进行测量。结果得出了椎弓根钉的最大拔出力为（514．5±9．4）N,发生在2号钉位置;最大应变发生在1号钉,其最大应变为（168．5±5．8）X10一。结论骶二椎弓根钉内进钉固定应变分布合理,有利于平衡和稳定。     

Sacral protuberance with cleft lip and palate: Prenatal presentation of 3MC syndrome

3MC syndromes are rare heterogeneous autosomal recessive conditions previously designated as Mingarelli, Malpuech, Michels, and Carnevale syndromes, characterized by dysmorphic facial features, facial clefts, growth restriction, and intellectual disability. 3MC is secondary to mutations in the MASP1, MASP3, COLEC11, and COLEC10 genes. The number of patients with 3MC syndrome with known mutations in the COLEC11 or MASP1 is, to date, less than 50. At the time this case presented (2015), the only gene identified in Online Mendelian Inheritance in Man to be associated with 3MC syndrome was MASP1. We present, to the best of our knowledge, the first prenatal report of 3MC syndrome, secondary to a homozygous variant in MASP1. Fetal findings included bilateral cleft lip and palate, abnormality of the sacral spine, a right echogenic pelvic kidney, and brachycephaly. 3MC syndrome should be considered as part of the differential diagnosis when fetal ultrasound detects facial clefts and spinal defects, as the risk of recurrence is significant and a molecularly confirmed diagnosis allows for alternate reproductive options.     

Median Sacral Artery,Sympathetic Nerves,and the Coccygeal Body: A Study Using Serial Sections of Human Embryos and Fetuses

To examine how the median sacral artery (MSA) is involved with the coccygeal body or glomus coccygeum, we studied serial frontal or sagittal sections of 14 embryos (approximately 5–6 weeks of gestation) and 12 fetuses (10–18 weeks). At five weeks, the caudal end of the dorsal aorta (i.e., MSA) accompanied putative sympathetic ganglion cells in front of the upper coccygeal and lower sacral vertebrae. At six weeks, a candidate for the initial coccygeal body was identified as a longitudinal arterial plexus involving nerve fibers and sympathetic ganglion cells between arteries. At 10–18 weeks, the MSA exhibited a highly tortuous course at the lower sacral and coccygeal levels, and was attached to and surrounded by veins, nerve fibers, and sympathetic ganglion cells near and between the bilateral origins of the levator ani muscle. Immunohistochemistry demonstrated expression of tyrosine hydroxylase and chromogranin A in the nerves. However, throughout the stages examined, we found no evidence suggestive of an arteriovenous anastomosis, such as well‐developed smooth muscle. An acute anterior flexure of the vertebrae at the lower sacrum, as well as regression of the secondary neural tube, seemed to induce arterial plexus formation from an initial straight MSA. Nerves and ganglion cells were likely to be secondarily involved with the plexus because of the close topographical relationship. However, these nerves might play a major role in the extreme change into adult morphology. An arteriovenous anastomosis along the MSA might be an overinterpretation, at least in the prenatal human. Anat Rec, 299:819–827, 2016. © 2016 Wiley Periodicals, Inc.