颈深筋膜及筋膜间隙的薄层断面解剖及三维重建

目的　明确颈深筋膜的分层及筋膜间隙的位置、毗邻 ,为颈深筋膜间隙的影像识别与分析提供参考 ,为临床诊治感染蔓延、肿瘤侵润提供解剖学依据。　方法　采用低温冰冻和生物塑化技术用 17例标本 ,制作了颈部连续薄层横断面 ,对颈深筋膜及筋膜间隙进行了观测。从颈部薄层塑化断面标本上 ,用双线提取间隙轮廓的方法 ,在SGI工作站上对颈深筋膜间隙进行三维重建。　结果　 1.颈深筋膜应分为四层 ,颈深筋膜深层分为翼筋膜和椎前筋膜 ,颈深筋膜各层均参与颈动脉鞘的形成。 2 .颈动脉间隙是一开放的间隙 ,其后外侧与颈后间隙相通 ;证实了危险间隙的存在。 3.重建出咽后间隙、颈动脉间隙和内脏间隙的三维图像 ,并能同时显示间隙内的主要结构。结论　得出了颈深筋膜和筋膜间隙的模式图 ,并为筋膜间隙的三维重建提供了一种新的方法。     

手掌筋膜间隙与计算机三维重建

手部化脓性感染是手外科最常见的疾患之一。而手掌部筋膜间隙感染症状往往较重，并广泛蔓延，若不及时治疗或治疗不当，可能会造成严重后果。由于手筋膜间隙的解剖关系复杂，且一些文献对手筋膜间隙的描述很不一致，因此有必要对手的薄层断面标本进行观察，并对手掌筋膜间隙进行计算机三维重建，从整体上显示手筋膜间隙的结构毗邻，为手筋膜间隙感染及手筋膜间隙其它疾病的治疗提供详细的解剖学依据。本文拟对手掌筋膜间隙的解剖及有关的计算机三维重建进行综述。     

颈深筋膜间隙的薄层断面解剖研究及其临床意义

目的：为颈深筋膜间隙的影像和临床疾病的诊治提供解剖学依据。方法：应用低温冰冻技术，制作15套颈部连续薄层横断面标本，在断面上对颈深筋膜各间隙进行观测研究。结果：明确了各间隙的位置、毗邻及出现范围；证实了危险间隙的存在；得出胸骨上间隙应是由颈深筋膜浅层和舌骨下肌筋膜围成；发现颈动脉间隙不是一密闭的间隙，其后外侧与颈后间隙相通。结论：用横断层解剖方法能清楚显示各颈深筋膜间隙的形态结构。     

舌骨下区颈脏器周围的筋膜间隙

作采用断面解剖和间隙灌注方法观察了36具成年男尸的舌骨下区颈部脏器周围的筋膜间隙，结果表明，在颈部脏器的前方存在气管前间隙和舌骨下肌后间隙，在后方存在咽后间隙和危险间隙，本讨论了这四个间隙的延伸和相互通连情况，有助于颈深部感染的诊断和治疗。     

胰周筋膜及筋膜间隙CT影像的解剖观察及临床意义

目的　探讨腹部CT影像胰周筋膜及胰周的筋膜间隙与新鲜成人尸体标本胰周筋膜与筋膜间隙相互对应关系,从而对微创胰腺外科相关的手术提供指导意义。 方法　本研究选取惠东县人民医院经临床确诊的急性胰腺炎病例156例,对其腹部CT扫描的胰周影像特点进行归纳总结。同时选取南方医科大学解剖教研室提供的5具新鲜成人尸体标本进行解剖,明确腹部CT影像胰周筋膜及筋膜间隙与尸体标本的对应关系。 结果　在少数急性胰腺炎患者腹部CT扫描影像上和新鲜成人尸体标本上可同时观察到胰腺前筋膜、胰腺后筋膜、肾前筋膜,左右肾前筋膜是相互延续的。胰前间隙位于胰腺实质和其前方的胰腺前筋膜之间,胰后间隙位于胰腺实质和其后方的胰腺后筋膜之间,胰腺后融合筋膜间隙位于胰腺后筋膜和肾前筋膜之间。 结论　少数急性胰腺炎患者的腹部CT扫描影像上能观察到胰周筋膜与胰周的筋膜间隙,与新鲜成人尸体标本存在着相互对应关系。     

深筋膜的应力研究

先天性和后天性原因所致的肢体关节挛缩和畸形的治疗,一直是骨科和正在发展的康复医学领域的难题,关节挛缩和畸形涉及关节囊、韧带和深筋膜等结构的改变,而这些结构的主要成分为纤维结缔组织学上属纤维结缔组织,本文拟对深筋膜的力学性质以及张应力对其影响作一综述。     

腹腔镜下腹膜后筋膜间隙外科平面的解剖观察

目的 探讨在腹腔镜下升、降结肠或肾切除术相关的腹膜后筋膜和筋膜间隙的解剖学特点及毗邻关系,以便正确地寻找、识别和选择安全的筋膜间隙外科平面. 方法在腹腔镜下对5具成人新鲜腹部标本,30例腹腔镜下升、降结肠切除术和95例肾切除术中的腹膜后筋膜和筋膜间隙的位置、沟通和毗邻关系进行了观察.结果升、降结肠外侧缘的脏腹膜与壁腹膜之间有一条黄白交界线,沿此线切开腹膜、腹膜外组织,即可显露深面的融合筋膜.融合筋膜与肾前筋膜之间的潜在间隙为融合筋膜间隙.切开融合筋膜,沿此间隙向内分离,可将升结肠或降结肠及原始结肠系膜向内翻起,完成结肠游离;或显露后方的肾前筋膜.肾前筋膜、融合筋膜外侧部与侧锥筋膜之间的间隙为肾旁前筋膜间隙;肾后筋膜、侧锥筋膜与腰方肌筋膜之间的间隙为肾旁后筋膜间隙.肾旁前筋膜间隙与融合筋膜间隙和肾旁后筋膜间隙沟通,通过这些间隙分离,可将肾安全游离. 结论 黄白交界线为进入融合筋膜间隙的标志,融合筋膜间隙及肾旁前、后筋膜间隙内无重要血管,易于辨认和分离,为腹腔镜下升、降结肠或肾游离的理想外科平面.     

实验高压电烧伤深筋膜微循环动态变化及意义

目的研究肢体高压电烧伤后深筋膜微循环变化规律。方法将28只家兔随机分成实验组与对照组。实验组家兔的右下肢采用1万伏额定电压 ,77mA电流及通电5s的方法制作单侧后肢电烧伤模型 ,对照组采用假电的方法制作单侧后肢假电烧伤模型 ,两组均采用“滴水开窗法”制作左侧下肢远端深筋膜微循环观测窗 ,并采用WX -9B型多部位微循环显微仪及其图像处理系统在通电前、通电后即刻、通电后30min、2、4、6h观测微动脉、毛细血管、后微静脉、微静脉的形态、流态、管周状态。结果肢体高压电烧伤后 ,微血管形态在30min内可观测到显著性变化 (P<0.05) ,表现为血管密度减小 ,微动脉、毛细血管、微静脉收缩 ,后微静脉扩张 ,微动脉、毛细血管均在6min以后变得不清以致模糊(P<0.05)、后微静脉、微静脉分别在2h、30min以后变得不清(P<0.05)。微血管内的流态以白微栓的变化可见规律性 ,即白微栓在电后2h开始出现 ,4h迅速达高峰 ,6h又有快速下降的趋势。微静脉和后微静脉在通电30min后有渗出(P<0.05) ,只有后微静脉在通电后2h有出血(P<0.05)。结论电烧伤后存在全身性反应 ,其在肢端深筋膜微循环的表现是一个阶段性加重的过程 :第一阶段电烧伤后30min内为缺血型微循环障碍 ,第二阶段微循环障碍包含两个方面 :其一是微血管的出血     

腹膜后脏器计算机三维可视化

目的:建立腹膜后重要脏器的计算机三维可视化模型。方法:应用中国数字化可视人体数据集,选取从。肾上腺顶部到肾底部的连续断面图像,在计算机上对肾等腹膜后脏器的断面图像轮廓进行数据分割,并对其行三维重建的立体显示。结果:重建出了肾上腺、肾、输尿管等脏器的三维可视化模型,该模型既可进行单个器官的显示,也可进行多个器官的分色显示,同时也可以任意放大缩小和任意角度旋转观察。结论:该腹膜后脏器的三维可视化模型展示了这些器官的三维空间结构,给临床影像诊断和外科手术提供了形态学参考。     

Suprahyoid neck fascial configuration,especially in the posterior compartment of the parapharyngeal space: A histological study using late‐stage human fetuses

The fascial configuration in the suprahyoid parapharyngeal space was evaluated using semiserial sagittal sections of 15 late‐stage human fetal heads. The prevertebral fascia covered the longus colli, longus capitis, and rectus capitis lateralis muscles, but was most evident along the longus colli muscle. The carotid sheath and its extension were located around the internal and external carotid arteries and the lower cranial nerves. The superior cervical ganglion was also inside the sheath. Even near full term, the fetal suprahyoid neck was short, with the jugular foramen and hypoglossal canal located at the posterolateral side of the oropharynx. Thus, the glossopharyngeal and accessory nerves ran across the upper part of the carotid sheath. Fasciae of the stylopharyngeus, styloglossus, and stylohyoideus muscles were attached to and joined the anterosuperior aspect of the carotid sheath. All these neurovascular and muscle sheaths are communicated with the visceral fascia covering the pharynx at multiple sites, and, together, they formed a mesentery‐like bundle. This communication bundle was made narrow by the anteriorly protruding longus capitis muscle. The mesentery‐like bundle was covered by the posterior marginal fascia of the prestyloid compartment of the parapharyngeal space. The external carotid artery ran on the lateral and posterior sides of the posterior marginal fascia. Consequently, the typical carotid sheath configuration was modified by muscle sheaths from the styloid process, communicated with the visceral fascia and, anteriorly, constituted the posterior margin of the prestyloid space. Clin. Anat. 2013. © 2012 Wiley Periodicals, Inc.     

The versatile use of temporoparietal fascial flap

Background: The pedicled or free temporoparietal fascial has been used in many areas, especially in head and neck reconstruction. This thin, pliable, highly vascularized flap may be also transferred as a carrier of subjacent bone or overlying skin.Objective: The aim of this study is to report our experience in versatile use of temporoparietal fascial flap (TPFF) and discuss the surgical anatomy and technique.Patients and Methods: A total number of 57 TPFFs have been used in periorbital, mid-facial, auricular, and tracheal reconstruction due to tumor resection, trauma, and congenital ear deformities.Results: All the flaps were successfully transferred without any major complication. The cosmetic results were quite satisfactory to all patients.Conclusion: The advantages and minimal donor site morbidity of TPPF makes this flap a good choice in many reconstructive procedures.     

首例中国数字化可视人体脊柱区颈段的三维重建研究

目的 建立中国数字化可视人体男性脊柱区颈段的三维可视化模型。方法 应用首例中国数字化可视人体数据集，选取从寰椎上缘到第7颈椎下缘的连续横断面图像。在SGI工作站上对颈椎、脊髓、椎动脉、椎间盘、颈神经等结构进行计算机三维重建并立体显示。结果 建立了脊柱区颈段重要结构的三维可视化模型，重建后的结构可多彩色立体显示，既能单独显示，也能任意搭配或总体显示，可在三维空间位置上绕任意轴旋转任意角度观察。结论 脊柱区颈段的可视化数字模型，用三维图形方法显示该区结构的空间构形，将有助于解剖学教学，并可为颈部疾病的影像诊断和外科手术等提供参考。     

Plastination and computerized 3D reconstruction of the temporal bone

The purpose of this study was to generate a computerized 3D reconstruction of the temporal bone and intratemporal structures. A plastination technique was used to obtain equidistant serial thin sections of 1.2 mm thickness and, on an SGI workstation, a Contour-Marching Cubes algorithm was selected to reconstruct the temporal bone and intratemporal structures in three dimensions. All reconstructed structures can be represented individually or jointly and rotated in any plane. Any diameter and angle of a structure can be conveniently measured. The capability of reconstructing individual and combined images of intratemporal structures, viewing them from all surgical angles, and accurately measuring their spatial relationships gives skull base and otologic surgeons important guidance. The reconstructed model can also be used for resident education, rehearsal of an unfamiliar surgery, and for developing a new surgical approach.     

Fetal anatomy of the lower cervical and upper thoracic fasciae with special reference to the prevertebral fascial structures including the suprapleural membrane

The aim of this study was to find basic rules governing the fetal anatomy of the deep cervical fasciae and their connections to the mediastinal fasciae. We examined the histology of paraffin-embedded preparations of 18 mid-term fetuses (5 between 9 and 12 weeks of gestation, 3 between 15 and 18 weeks, and 10 between 20 and 25 weeks). The prevertebral lamina of the deep cervical fasciae (PLDCF) developed as an intermediate aponeurosis for the bilateral bellies of the longus colli muscles. In contrast, the alar fascia developed as a connecting band between the bilateral adventitiae of the common carotid artery. The retropharyngeal fascia became evident much later than the latter two fasciae. The fascia covering the thymus was thicker than the fascia for the strap muscles (the pretracheal lamina of the cervical fascia). The primitive suprapleural membrane, or Sibson's fascia, contained veins and fatty tissues, and was composed of the alar fascia rather than the PLDCF, tranversalis fascia, or endothoracic fascia. The prevertebral two-laminar configuration was rather evident in the early stages of development because, in the later stages, the fasciae together provided a multilaminar structure, especially in the lateral area in front of the longus colli, which suspended the cupula pleurae. To consider a continuation from the base of the neck to the upper mediastinum, the alar fascia seems to be a key structure for connecting the vascular sheath to the parietal pleura.     

三维重建上肢解剖结构的计算机模拟手术

探索三维重建后计算机模拟手术过程的实现。将上肢新鲜标本经ＣＴ扫描后连续切片,把ＣＴ图像和大体断面图像同时输入计算机,用Ｂｏｒｌａｎｄ Ｃ＋＋语言编制三维重建和模拟手术程序,建立上肢三维解剖数据模型,将临床实际手术操作过程转化为计算机可接受的指令,实现模拟手术操作。结果表明：上肢模拟手术可分三段进行,手术部位及切口方向可任意选择,逐层“切开”并三维显示,因此,模拟手术系统可运用于手术方案的设计、选择     

激光扫描多平面动态测量下颈椎椎间高度退变后椎间孔的变化

目的　激光扫描三维重建后动态测量下颈椎椎间高度退变时相应节段椎间孔的变化,为临床诊治神经根型颈椎病提供新的思路和参考。 方法 选用6具新鲜成人尸体颈椎标本,以C5/6单节段脊柱功能单位（FSU）作为研究对象。椎间盘切除后将C5/6椎间高度置于基准高度状态,激光扫描仪扫描收集该状态下C5/6 FSU的空间关系信息,再对骨性单椎体进行全面扫描,在Geomagic Studio8.0软件中再现　C5/6基准状态,并模拟6种椎间高度退变模型,即C5椎向C6椎椎体面趋于平行移动基准高度的10%、　20%、30%、40%、50%和60%。多平面动态测量方法（MPDM）分别测量椎间孔容积、中间面积、内口以及外口面积。 结果 测量数据显示随着椎间高度持续的下降,椎间孔的容积和面积逐渐减小,当椎间高度丢失基准高度30%时,椎间孔中间面积首先开始与基准状态有显著性差异（P=0.003）。 结论 激光扫描三维重建原貌再现骨性表面,是获得精确测量数据的前提;动态测量的方法较为客观准确,是测量椎间孔的理想方法;测量发现在下颈椎骨性椎间孔随着椎间高度在下降而缩小,其中间面积首先发生显著缩小,提示此处容易发生狭窄而引起临床症状。