我国新生儿尸眼各径长度的测量

用解剖学方法对１０８只新生儿鲜尸眼（５４具尸体）进行了解剖学测量。其结果表明，新生儿眼球前后径１７．８４±０．３８ｍｍ，横径１７．３２±０．４２ｍｍ，垂直径１６．７４±０．３４ｍｍ，各径间比例与成人一致，呈近似球形，并非短眼。本文还对新生儿角膜、视神经形态和各径长度以及视神经位置进行了研究。     

A reappraisal of pediatric thoracic surface anatomy

Accurate knowledge of surface anatomy is fundamental to safe clinical practice. A paucity of evidence in the literature regarding thoracic surface anatomy in children was identified. The associations between surface landmarks and internal structures were meticulously analyzed by reviewing high quality computed tomography (CT) images of 77 children aged from four days to 12 years. The results confirmed that the sternal angle is an accurate surface landmark for the azygos‐superior vena cava junction in a plane through to the level of upper T4 from birth to age four, and to lower T4 in older children. The concavity of the aortic arch was slightly below this plane and the tracheal and pulmonary artery bifurcations were even lower. The cardiac apex was typically at the 5^th intercostal space (ICS) from birth to age four, at the 4^th ICS and 5^th rib in 4–12 year olds, and close to the midclavicular line at all ages. The lower border of the diaphragm was at the level of the 6^th or 7^th rib at the midclavicular line, the 7^th ICS and 8^th rib at the midaxillary line, and the 11^th thoracic vertebra posteriorly. The domes of the diaphragm were generally flatter and lower in children, typically only one rib level higher than its anterior level at the midclavicular line. Diaphragm apertures were most commonly around the level of T9, T10, and T11 for the IVC, esophagus and aorta, respectively. This is the first study to provide an evidence‐base for thoracic surface anatomy in children. Clin. Anat. 30:788–794, 2017. © 2017Wiley Periodicals, Inc.     

窒息新生儿凝血功能变化

目的:检测分析窒息新生儿凝血功能部分指标的变化及其临床意义。方法:回顾性分析554例新生儿凝血四项指标:凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原含量(FIB)的检查资料,分为正常新生儿组(n=32)、轻度窒息足月新生儿组(n=143)、重度窒息足月新生儿组(n=85)、早产儿组(n=215)及窒息早产儿组(n=79),分析各组PT、APTT、TT、FIB结果并作统计学比较。结果:以上各组四项指标数据经方差分析,差异有统计学意义(F值分别为8.41、13.18、7.30、3.19,P均0.05)。两两比较结果显示,与正常新生儿组比较,轻度窒息足月新生儿组PT、APTT、TT、FIB差异均无统计学意义(P0.05),早产儿组PT、TT、FIB亦无统计学差异(P0.05),只有APTT延长(P0.05);窒息早产儿组、重度窒息足月新生儿组PT、APTT、TT明显延长而FIB浓度明显降低(P均0.05)。窒息早产儿组PT、APTT、TT较早产儿组显著延长而FIB浓度降低(P均0.05)。重度窒息足月新生儿组PT、APTT较轻度窒息足月新生儿组延长,FIB水平较轻度窒息新生儿组降低,差异有统计学意义(P0.05)。结论:窒息早产儿和重度窒息足月新生儿凝血功能变化明显。     

新生儿皮褶厚度与体成分

新生儿皮褶厚度及体成分均是评估新生儿营养状况的重要指标.本文重点介绍了皮褶厚度的测量工具、方法、相关因素及由皮褶厚度估算体成分的方法,简述了研究皮褶厚度与体成分的意义.     

A reappraisal of pediatric abdominal surface anatomy

Surface anatomy is fundamental to clinical and surgical practices. As the surface anatomy varies with age, the purpose of this study is to provide age-standardized surface markings for the abdomen in children. A total of 155 abdominal computed tomography scans of healthy children aged 0–18 years were categorized into six groups, and the surface anatomy of the major vascular structures, solid viscera, and anatomical planes in the abdomen was analyzed. The vertebral levels of the celiac trunk, superior mesenteric artery, and hepatic portal vein formation were higher in the youngest age group, whereas the levels of the inferior mesenteric artery, formation of the inferior vena cava, and renal arteries did not differ with age. The right kidney lay between T12 and L3 and the left at T11-L3; however, both kidneys were in lower positions in younger children. The spleen was most commonly located between the 8th and 11th ribs except in toddlers. In all age groups, the hepatic portal vein formation was within the transpyloric plane and the aortic bifurcation was above the supracristal plane. In vivo reassessment of the surface anatomy enables the substantial variability of surface landmarks to be highlighted. This study demonstrates that taking account of age-related variations will increase the accuracy and therefore the clinical relevance of surface anatomy.     

幼儿人工耳蜗植入面神经隐窝的应用解剖学

目的:对幼儿面神经隐窝等相关结构进行观测,为幼儿人工耳蜗植入及其它耳科手术提供形态学依据。方法:取1～5岁儿童尸头14个(28侧),模仿经乳突后鼓室径路,进入后鼓室;在手术显微镜下观察测量与面神经隐窝相关的解剖学数据。结果:经面神经隐窝入路从不同的角度可清楚地看到锥隆起、面神经管凸(面神经水平段)、砧镫关节、镫骨底板、匙突、圆窗龛及鼓岬等主要结构。面神经垂直段长度为(10.58±1.20)mm,面神经圆窗龛平面到乳突表面、面神经锥曲段到鼓索神经、水平半规管到面神经水平段以及鼓索神经起点到茎乳孔的距离分别为:(11.90±1.80)mm,(3.79±0.45)mm,(1.94±0.43)mm,(5.14±0.80)mm。结论:幼儿面神经隐窝与成人的不同点以及幼儿面神经隐窝的相关测量数据,可为幼儿手术中避免面神经损伤提供形态学依据。     

400名九江地区新生儿头面部的活体测量

本文对九江地区400名(男女各200名)出生24小时内的新生儿进行头最大长、头最大宽等十九项头面部径线测量,计算头指数、头长高指数等十四项指数,结果表明:男女在新生儿时期,其头最大长、头最大宽、容貌面高、面宽、额最小宽、左及右侧眼裂宽、外毗距、鼻高、鼻宽、鼻深、口裂宽、容貌耳长和头耳高的大小已有明显著性差异。同时,根据男女头指数、头长高指数、头宽高指数,形态面指数和鼻指数数值的大小分型,确定新生儿头面部的形态为:圆头型、高头型、狭头型、超阔面型、超阔鼻型。     

Chromosomes and clinical anatomy

Chromosome abnormalities may cast light on the nature of mechanisms whereby normal anatomy evolves, and abnormal anatomy arises. Correlating genotype to phenotype is an exercise in which the geneticist and the anatomist can collaborate. The increasing power of the new genetic methodologies is enabling an increasing precision in the delineation of chromosome imbalances, even to the nucleotide level; but the classical skills of careful observation and recording remain as crucial as they always have been. Clin. Anat. 29:540–546, 2016. © 2016 Wiley Periodicals, Inc.     

Premedical anatomy experience and student performance in medical gross anatomy

Gross anatomy is considered one of the most important basic science courses in medical education, yet few medical schools require its completion prior to matriculation. The effect of taking anatomy courses before entering medical school on performance in medical gross anatomy has been previously studied with inconsistent results. The effect of premedical anatomy coursework on performance in medical gross anatomy, overall medical school grade point average (GPA), and Comprehensive Osteopathic Medical Licensing Examination Level 1 (COMLEX 1) score was evaluated in 456 first‐year osteopathic medical students along with a survey on its perceived benefits on success in medical gross anatomy course. No significant differences were found in gross anatomy grade, GPA, or COMLEX 1 score between students with premedical anatomy coursework and those without. However, significant differences and higher scores were observed in students who had taken three or more undergraduate anatomy courses including at least one with cadaveric laboratory. There was significantly lower perceived benefit for academic success in the medical gross anatomy course (P<.001) from those students who had taken premedical anatomy courses (5.9 of 10) compared with those who had not (8.2 of 10). Results suggest that requiring any anatomy course as a prerequisite for medical school would not have significant effect on student performance in the medical gross anatomy course. However, requiring more specific anatomy coursework including taking three or more undergraduate anatomy courses, one with cadaveric laboratory component, may result in higher medical gross anatomy grades, medical school GPA, and COMLEX 1 scores. Clin. Anat. 30:303–311, 2017. © 2017 Wiley Periodicals, Inc.     

临床应用解剖学带教体会

为了加强基础医学与临床的对接,培养研究生的动手能力,参加了北京协和医学院研究生院临床应用解剖学课程的带教课程。经过几年的教学实践,对所获得的经验及存在的问题进行总结,以期为未来的教学提供借鉴。     

翼腭窝手术入路的断层与应用解剖学研究

目的:用改进火棉胶包埋技术,为翼腭窝新型手术入路提供应用解剖学依据.方法:固定成人尸头标本30例,取其前颅底.标本经脱钙、脱水等系列处理,分别行三维连续薄切片,厚度0.25 mm.同时对80侧干燥骨进行测量.结果:翼腭窝形态多样,除有三角形外,还有弧形、横置"S"形、楔形、"L"形、哑铃形、短棒状或斜向外上的窄长条形.翼腭窝在中鼻道处内侧壁厚度为(1.95±0.66)mmm(左),(1.97±0.74)mm(右).在中鼻道处上颌窦口后缘至翼腭窝距离(11.25±1.95)mm(左),(11.22±1.96)mm(右).结论:新型手术入路不经过上颌窦,运用器械从中鼻道深入至翼腭窝的内侧壁深度,打开薄骨板,直接进入翼腭窝,由此处入路手术创伤小、出血少、安全、术后并发症少.     

视神经管手术入路断层与应用解剖学研究

目的为开展视神经管新型手术提供精细的解剖学基础。方法在大体解剖学研究基础上,应用改进的火棉胶包埋技术对前颅底区域进行连续的三维薄切片,通过两者的有机结合,深入研究视神经管区域精细的解剖结构与复杂的毗邻关系。结果对视神经管区域解剖结构与毗邻关系显示良好精确。中鼻甲根部上缘至视神经管距离左侧为(28.0±5.0)mm,右侧为(29.0±6.0)mm。蝶窦下壁厚度左侧为(3.0±0.9)mm,右侧为(2.7±0.9)mm,视神经管与蝶窦或(和)筛窦间壁厚度左侧为(1.0±0.3)mm,右侧为(1.0±0.4)mm。结论经鼻、蝶窦或(和)筛窦入路行视神经管手术安全可行。     

儿童气管镜应用解剖学

目的：研究气管镜操作术的成功率和安全性。方法：观测儿童尸体气管的解剖长度、临床长度和气管的横径、矢状径，并与儿童身高和上部量进行相关分析，另外分析临床资料85例，其中58例在使用支气管镜前做了气管横径、矢状和长度的预测。结果：两性儿童的身高和上部量与气管的解剖长度、临床长度、气管内径之间密切相关。结论：测量儿童的身高和上部量就可根据他们之间的回归方程计算出气管的长度和内径大小，为临床准确选用气管镜型号和插管的深度提供可靠的依据。以保证一次性成功率和安全性。     

足的矢状断层解剖学

目的 为足部疾患的矢状断层影像学诊断提供解剖学依据。方法 用常规固定的成年男尸右足标本4例,先画线再冰冻后,切制成矢状断层解剖标本。结果 观察了每断层内各足骨、关节、肌肉及血管的形态特征和毗邻关系,讨论了其在影像诊断中的临床意义。结论 利用5个矢状断量层,即可显示出足的各骨及关节。     

窦口鼻道复合体的应用解剖

目的：确定窦口鼻道复合体的境界，为临床在内窥镜下施行上颌窦手术提供解剖学依据。方法：在６０例成人鼻腔外侧壁的标本上，测量半月裂、钩突、筛泡、额鼻管和筛漏斗的有关数据。并观察了它们相互间的关系以及上颌窦的自然开口。结果：半月裂、钩突、筛泡、额鼻管的长度分别为１５．０ｍｍ，１８．３ｍｍ，１６．２ｍｍ和５．９ｍｍ；钩突与筛泡的高度分别为６．９ｍｍ和５．８ｍｍ；筛漏斗宽３．９ｍｍ、深３．７ｍｍ。上颌窦自然开口９８％在半月裂内，其中６０％位于半月裂后部、３３％位于中部、５％位于前部、１例变异。结论：窦口鼻道复合体的形态和病变与鼻窦炎的发病有直接联系     

足的横断层解剖学研究

目的 为给足部疾患的横断层影像学诊断提供解剖学依据。方法 用成年男尸新鲜右足标本6例,冰冻后切制横断层解剖标本。结果 观察了各断层的形态、结构、毗邻关系及血管神经等的特征及其变化规律。结论 其解剖形态、结构对影像诊断有很重要的临床意义。     

睾丸神经切除术的应用解剖

目的：为睾丸神经切除术提供解剖学基础。方法：在３０侧成年男性尸体标本上对精索腹股沟管腹环至皮下环段进行了解部学观测。结果：输精管位于精索后内方,睾丸动脉位于中央,被蔓状静脉丛包绕,输精管动脉位于精索内生殖股神经生殖支与输精管静脉之间稍后方,髂腹股沟神经位于精索的外侧、生殖股神经生殖支位于精索的内侧,与精索伴行。结论：在显微外科睾丸神经切除术中应注意寻找保护睾丸动脉和输精管动脉,切断睾丸神经,根除交感神经的支配,即可阻断睾丸神经的痛觉传导。     

筛窦的影像解剖学研究

目的 :为临床开展筛窦外科手术提供影像解剖资料。方法 :对 5 0具成人头部标本采用高分辨CT进行冠状位、矢状位以及水平位薄层扫描 ,观测了筛窦的各主要径线。结果 :筛窦的左右径 :前端 :左 9.4± 1.5mm ;右 9.7± 2 .1mm ;后端 :左 15 .5± 4.2mm ;右 15 .1± 4.1mm ;上下径 :外侧前端 :左 2 9.1± 6 .8mm ;右 2 7.3± 6 .9mm ;外侧后端 :左 2 1.2± 8.2mm ;右 2 1.6± 6 .8mm ;内侧前端 :左 18.6± 7.5mm ;右 17.8± 6 .9mm ;内侧后端 :左 15 .9± 4.3mm ;右 16 .1± 5 .1mm。前后径 :上部 3 3 .0± 5 .2mm ;下部 3 2 .3± 5 .4mm。结论 :三种不同层面的薄层扫描可给筛窦影像解剖研究者提供更多更详细的解剖数据 ,为筛窦的三维立体成像提供了方便。     

掌浅弓的应用解剖

ObjectiveTo provide anatomical basis for repair of the superficial palmar arch with transplanted superficial vein when the operations of vessel repair and replantation of severed palm are performed.MethodsThe origin and branches of ulnar of superficial palmar arch were observed and measured on 30 cases of hand specimens.ResultsThere were 4 types of branches arising from the ulnar side of superficial palmar arch.If the center of pisiform bone was regarded as point O,the origin of the proper palmar digital artery of little finger as point A,the origin of common palmar digital arteries of the 3rd、2nd、1st fingers were regarded as point B,C,D respectively;then the distance was as followO-A 30.1±5.6 mm;A-B 8.1±4.7 mm;B-C 9.2±6.0 mm;C-D 6.2±3.9 mm.The diameters of the origins of branches followedA1.24±0.34 mm;B1.50±0.34 mm;C1.78±0.42 mm;D1.54±0.38 mm.ConclusionsThe branches of superficial palmar arch on ulnar side are constant.The anatomical data will benefit the repair the repair of superficial palmar arch.