马尾近端SPR的临床应用解剖学

目的：为限制性椎板切除的ＳＰＲ提供解剖学依据。方法：在２０例成人防腐灌注红色乳胶的脊柱标本上，对近端马尾神经进行巨—微解剖学观察。结果：马尾近端，Ｌ１前后根之间有最下一对齿状韧带，前根位于相应后根的前内侧。各节段后根在马尾近端呈冠状位的内外平排，从内向外依次为Ｓ２～Ｌ１的后根；各节段后根进脊髓处，Ｌ５和Ｓ１后根之间有明显分界线，相邻节段后根之间，均有恒定小静脉分隔。以终丝起点为定点，各节段后根与终丝之间的距离和成角从Ｓ２到Ｌ１逐渐增加。结论：在限制性椎板切除的ＳＰＲ术中，前、后根的鉴别主要依靠脊髓的外侧索和Ｌ１前后根之间的最下一对齿状韧带；后根节段的鉴别主要依靠后根连脊髓处，Ｌ５和Ｓ１之间有明显分界、相邻节段后根间有恒定小静脉来定性鉴别。也可根据终丝起点水平，各节段后根与终丝之间的距离和成角来鉴别后根节段     

颈部SPR术中脊神经后根节段定位的临床解剖学研究

目的：为颈部ＳＰＲ提供可靠的后根鉴别的形态学依据，探讨颈部限制性椎板切除ＳＰＲ的可行性。方法：在２０例防腐灌注红色乳胶的成人颈椎标本上，对Ｃ４￣Ｔ１节段后根的位置、粗细和长度进行形态学观测，另１具男性脊柱标本采用限制性椎板切除，摹拟临床颈部ＳＰＲ术式，观察各了段脊神经后根的暴露情况。结果：各节段的后根在齿状韧带后的后方向外下方斜行。Ｃ４￣Ｔ１各节段后要主面呈近似平排，自上而下信次为Ｃ４￣Ｔ１的后根     

腰骶部脊神经根解剖变异及其临床意义

目的：为腰骶部脊神经根解剖变异的临床手术提供参考。方法：术中观察腰骶部脊神经根解剖变异情况。结果：在临床１２４０例选择性脊神经后根切断术中发现１５例双根脊神经共干，共硬脊膜鞘变异。变异率为１．２１％。此类变异有一定的类同性和有一定的规律：共干的双脊神经在共硬脊膜鞘前有约１．５～２．０ｃｍ段被蛛网膜共同包绕，近脊髓神经根部及前、后干为游离状态。脊神经的前、后根结合部无交叉联系，可钝性分离。变异侧神经出口少于对侧，前根和后根的直径比值为１．２±０．４０．６±０．８ｍｍ。结论：了解和认识腰骶部脊神经根变异特点，对ＳＰＲ手术及腰骶部脊神经部位的手术有重要的参考价值。     

脊髓圆椎部SPR和SAR手术脊神经根辨认的应用解剖学

目的：为脊髓圆椎部进行ＳＰＲ和ＳＡＲ手术提供定位、入路和辨认神经根的解剖学依据。方法：选１４具儿童脊柱标本,显露脊髓圆椎及其马尾神经。观测该区域神经根位置、形态及其与周围组织的关系。结果：脊髓圆椎末端大多数平对Ｌ１椎板,Ｌ１椎板根硬膜出口亦位于Ｌ１椎板范围内,神经根在该区域按顺序排列。Ｓ１后根最粗,Ｓ２明显变细,Ｓ３～５最细,神经后根进入脊髓角度以Ｌ５最大,Ｓ１其次,Ｓ２角度骤然变小,与脊髓接近平     

L_4脊神经前后根硬膜内混合1例

患者,女,7岁,以痉挛型脑性瘫入院,于1998年4月9日行腰骶段选择性脊神经后根切断术(ＳＰＲ),术中切开硬脊膜解剖右侧Ｌ4脊神经前后根时,见前根在前较细小、后根在后较粗大与其它无异,但分离后根时发现在出硬脊膜前0.5ｃｍ处后根约分出1/4神经束走行至前根,与前根相混合,手术显微镜下见两者神经纤维排列紧密,不易分离,且在此处前根有蛛网膜包裹伴行(附图),刺激前根时有明显踝背屈,证明为前根无误,常规手术切断Ｌ2～Ｓ1脊神经后根,总切断率为54%,术后4周复查,肌痉挛解除,肌张力由Ⅲ级降为Ⅰ级,髌、踝阵挛消失,经步态训练后已能步行上学。脊神经…     

颈部SPR术中前后根定位的应用解剖学研究

目的 :为颈部选择性脊神经后根切断术 (selectiveposteriorrhizotomy ,SPR)提供可靠的前后根鉴别的解剖学依据。方法 :在 2 0例 (男 14 ,女 6 )防腐灌注红色乳胶的成人尸体的颈椎标本上 ,对C4 ～T1节段的脊神经前、后根的位置、粗细和长度进行观察和测量。结果 :颈部前、后根之间有齿状韧带相间隔 ,颈部前、后根以C6的前、后根最为粗大 ,后根恒定粗于相应的前根 ,前后根之间有恒定的动脉血管。相应的颈部前、后根分别穿出硬脊膜 ,分别被硬脊膜包绕形成双神经根。结论 :在SPR中 ,前后根的形态学鉴别主要依靠齿状韧带 ,后根位于齿状韧带的后方 ,直径较为粗大。     

选择性脊神经后根切断术对脊柱稳定性影响的研究进展

选择性脊神经后根切断术（ＳＰＲ）是当前治疗痉挛性脑瘫主要的手术方法。近十几年来，ＳＰＲ在国内外得到广泛的应用和推广。但ＳＰＲ术中需要切除４～５个椎板，手术创伤性较大，且病人多以儿童和青少年为主。多椎板切除是否对脊柱的稳定性产生不利影响？本文扼要综述了ＳＰＲ的术式类型及ＳＰＲ对脊柱稳定性影响有关的实验和临床研究进展     

可复式椎板截骨显露法在SPR术中的应用

目的：设计可复式椎扳截骨显露椎管开展选择性脊神经后根切断术(SPR),探讨其临床应用的可行性。方法：自L2～S1各棘突、椎板的上1/3水平截骨,小关节突内缘两侧椎板向上凿开,将棘突、椎扳、黄韧带向上掀起,显露椎管,节段切开硬脊膜行SPR术。结果：治疗下肢痉挛性瘫17例,经7～18个月随访,无并发症发生。结论：该术式不破坏脊柱的完整性,又便于SPR术的操作,能避免脊柱不稳和硬脊膜粘连等并发症的发生。     

L_5与S_1脊神经根共干并神经节近端融合变异1例

Ｌ５与Ｓ１脊神经根共干并神经节近端融合变异１例毕秀梅①代加平②近几年脊神经根共干的变异常见报道，而共干并两个神经节近端融合远端分开的变异则少见。作者在制作脊神经根及神经节标本时发现此类变异１例，现报道如下：男性标本，脊柱下胸段及腰段稍向后凸。当从脊柱...     

齿状韧带的形态观测及临床意义

目的　为临床SPR和SAR提供可靠的脊神经前、后根鉴别和定位的形态学依据。方法　对 30例 (6 0例 )成人尸体的齿状韧带进行了解剖学观测和测量。结果　齿状韧带位于椎管内脊神经前、后两神经根之间。颈部脊神经前、后根之间有恒定的齿状韧带。两侧形成平均 2 0个锯齿状齿尖 ,以齿尖在上、下脊神经根之间附着于硬脊膜。结论　在选择性脊神经根切断术中 ,齿状韧带可作为一标志 ,脊神经前、后根可通过齿状韧带加以鉴别和定位 ,特别在颈部。     

Symptomatic posterior mediastinal angioleiomyoma

We report a case of a symptomatic angioleiomyoma in the left posterior mediastinum. A 66-year-old woman presented with left back and flank pain for 6 months. Chest computed tomography (CT) and magnetic resonance imaging (MRI) revealed a well-circumscribed 4.3 cm round mass. The mass was initially diagnosed as nerve sheath tumor, because of her symptoms and its close location to the sympathetic trunk and intercostal nerve. It was uneventfully removed through video-assisted thoracoscopic surgery. The pathology revealed an angioleiomyoma.     

Posttraumatic posterior knee instability

At the department of the sport and ballet trauma new methods of arthroscopic management of posterior posttraumatic knee instability (posterior static stabilization of knee joint with using of single-banded and double-banded transplants) in dependence on the kind, degree and form of instability, were worked out and implemented into clinical practice. Such methods permit to attain a compensated or subcompensated form of knee joint stability. Ad hoc methods of management were used in 23 patients (20 males and 3 females). A total of 62 patients (51 males and 11 females) got operative treatment at the department, that permitted us to estimate fairly different methods of operative treatment of posttraumatic posterior knee joint instability. An operational intervention was performed in average 6 month after trauma. We received data in patients which had been treated with use of new methods of operative treatment as follows: good results were drawn in 93.3% (22 patients), satisfactory results--in 6.7% of cases (1 patient).     

Interactive effect of femoral posterior condylar offset and tibial posterior slope on knee flexion in posterior cruciate ligament-substituting total knee arthroplasty

Background

This work aimed to evaluate the changes in the femoral posterior condylar offset (PCO) and tibial slope after posterior cruciate ligament (PCL)-substituting total knee arthroplasty (TKA), and to address the presence of any interactive effect between the two on knee flexion.

An anatomic investigation of the serratus posterior superior and serratus posterior inferior muscles

In classical anatomy textbooks the serratus posterior superior muscle was said to elevate the superior four ribs, thus increasing the AP diameter of the thorax and raising the sternum. However, electromyographic and other studies do not support its role in respiration. In order to help resolve this controversy and provide some insight into their possible functionality, the present study aimed at examining the morphology, topography and morphometry of serratus posterior superior and inferior muscles in both normal specimens and those derived from patients with a history of chronic obstructive pulmonary disorder (COPD). These muscles were examined in 50 human cadavers with an age range of 58–82 years. In 18 of the cadavers their histories revealed that they were suffering from COPD. There was no significant difference between right and left sides, race, gender and age and positive COPD history in regard to dimensions and nerves supply of serratus posterior superior and inferior muscles (P > 0.05). Based upon our findings that no morphometric differences exist between the of serratus posterior superior and inferior muscles of COPD patients versus controls, we are suggesting that no respiratory function be attributed to either of the serratus posterior superior and inferior muscles.     

经后纵裂-胼胝体入路治疗丘脑后部肿瘤的MRI解剖学研究

目的　利于MRI测量经后纵裂-胼胝体入路处理丘脑后部肿瘤解剖学数据,以助于规范和优化该手术入路。 方法　选取120例无颅内异常的头颅MRI正中矢状位头颅核磁共振T2加权序列（少儿组25例,成人组95例）,以人字点为参考点,分别设手术方案一和方案二,并在正中矢状位头颅MRI上模拟经后纵裂-胼胝体入路到达丘脑后部的两种手术路径,测量与该入路相关的解剖结构。 结果　(1)方案一与方案二所得的骨窗位置分别为（少儿组人字点前≤29.89±4.36 mm,人字点后≤37.04±3.22 mm;成人组为人字点前≤(31.20±7.36) mm,人字点后≤43.05±10.36 mm）,（少儿组人字点后37.04±3.22 mm;成人组人字点后43.05±10.36 mm）。 (2) 测量人字点至丘脑后部长度的平均值少儿组为（82.71±3.92）mm,成人组为（87.42±9.24）mm。(3)方案一与方案二所得手术视角分别为（少儿组≤44.56°±4.15°,成人组≤55.02°±7.42°）,（少儿组为24.28°±3.25°,成人组为31.33°±8.25°）。 结论　充分的MRI评估有助于更好的掌握该入路,利于选择及优化该手术入路,提高手术效果。     

阴道后壁改良式紧缩术与传统手术的比较

阴道后壁膨出是已育妇女的常见疾病,常造成患者反复感染阴道炎、阴道松驰及排便障碍等,约有11%的患者需行手术治疗[1]。传统手术只是将阴道粘膜切除一部分后再予缝合,术后容易复发,阴道后壁改良式紧缩术较之有许多优势。自2003年8月至2005年2月,我院共对56例阴道后壁膨出患者进     

In-situ forces in the human posterior cruciate ligament in response to posterior tibial loading

Although some investigators have referred to the human posterior cruciate ligament (PCL) as the center of the knee, it has received less attention than the more frequently injured anterior cruciate ligament (ACL) and medial collateral ligament (MCL). Therefore, our understanding of the function of the PCL is limited. Our laboratory has developed a method of measuring thein-situ forces in a ligament without contacting that ligament by using a universal force-moment sensor (UFS). In this study, we attached a USF to the tibia and measuredin-situ forces of the human PCL as a function of knee flexion in response to tibial loading. At a 50-N posterior tibial load, the force in the PCL increased from 25±11 N (mean±SD) at 30° of knee flexion to 48±12 N at 90° of knee flexion. At 100 N, the corresponding increases were to 50±17 N and 95±17 N, respectively. Of note, at 30° knee flexion, approximately 45% of the resistance to posterior tibial loading was caused by contact between the tibia and the femoral condyles, whereas, at 90° of knee flexion, no resistance was caused by such contact. For direction of thein-situ force, the elevation angle from the tibial plateau was greater at 30° of knee flexion than at 90° of knee flexion. The data gathered on the magnitude and direction of thein-situ force of the PCL should help in our understanding of the dependence of knee flexion angle of the forces within the PCL.     

Double posterior inferior cerebellar artery

Posterior inferior cerebellar artery (PICA) is one of the cerebellar arteries which originates from the vertebral artery and has the most complex and variable course. It usually originates from the vertebral artery intracranially and as a single trunk; however, absent, double trunk, extracranial, and extradural PICA may exists although very rare. In a collection of 50 cerebellar specimens (100 hemispheres) injected with colored gelatin, we have encountered unilateral double PICA in 2 specimens. In both the cases (both male, aged 45 and 65 years) double trunks of PICA were observed on the right side. Double-trunk PICA may signal an improved blood supply to the corresponding cerebellar hemisphere; however, the second trunk, which may also be called an accessory trunk, is usually smaller than the first (main) trunk of PICA.