颈内动脉岩内段形态位置与毗邻结构的相关分析

目的:探讨颈内动脉岩内段形态位置变化的规律及其与毗邻结构的关系.方法:对66侧正常成人颅底高分辨率CT连续图像进行分析,测量颞骨气房体积,建立定位颈内动脉岩内段及其毗邻结构的参照系,对其位置和形态进行测量,运用偏相关分析方法求出它们形态位置的变化规律及其影响因素.结果:在男性,颈内动脉垂直段更偏外侧,其水平段长度也大于女性.颞骨气化好,则颈内动脉垂直段更偏后移.颈内动脉垂直段与颈静脉球的位置变化表现为同步.垂直段的内外移位相应地使水平段与中线的夹角发生变化.颈内动脉水平段的方位与蜗轴方向相关,蜗轴偏离中线的角度越小,则颈内动脉水平段偏离中线的角度越大,反之亦然.结论:影响颈内动脉岩内段形态位置变化的因素是复杂和多重的,包括性别因素、颅底发育状态、颞骨气化程度以及毗邻结构发育状态均可能是影响因素.     

蝶窦的影像解剖学研究

目的 :为开展经鼻蝶窦鞍区手术及功能性鼻窦内窥镜手术提供蝶窦的影像解剖学基础。方法 :取 5 0具成人头颅标本 ,行冠状位、矢状位及水平位薄层CT扫描。观测蝶窦气化发育的情况 ,根据蝶窦向蝶骨体、蝶骨小翼及鞍背气化的程度进行分型分度。结果 :10 0侧蝶窦中属甲介型为 4% ,鞍前型为18% ,半鞍型为 18% ,全鞍型为 14 % ,鞍枕型为 46 % ;另外测得蝶窦的最大左右径的平均值 :左 18.5mm ,右17.6mm ;最大前后径的平均值 :左 2 2 .2mm ,右 2 0 .8mm ;最大上下径的平均值 :左 2 1.0mm ,右 2 0 .4mm。从正中线至蝶窦外侧壁的平均距离左 14 .8mm ,右 15 .2mm。结论 :冠状位以及水平位CT扫描能清晰显示两侧蝶窦腔气化发育的情况 ,气化程度不同的蝶窦在选择手术进路时有着极其重要的指导意义     

侧颅底手术中乙状窦应用解剖学研究

目的　探讨侧颅底手术中乙状窦相关解剖标志的位置，为进一步提高侧颅底手术安全性提供解剖学基础。 方法　选取成人头颅标本40个，采用耳后切口行标准乳突根治术。充分暴露颅中窝及颅后窝硬脑膜、外半规管、面神经膝部、乙状窦、颈静脉球、乳突、茎乳孔、二腹肌嵴、外耳道后壁等重要解剖结构。使用双脚规测径器或电子数显游标卡尺分别测量相关解剖结构之间的距离。 结果　乙状窦前缘至外耳道后壁的距离是(1.41±0.32)cm，乙状窦外侧壁至乳突外侧壁的距离是(1.02±0.38)cm，面神经乳突段的长度是(1.28±0.13)cm，面神经乳突段起点（即面神经膝部）到乙状窦的距离是(0.56±0.20)cm，面神经乳突段终点（即茎乳孔部）到乙状窦的距离是(0.62±0.22)cm，二腹肌嵴至乙状窦的距离是(0.52±0.18)　cm，茎乳孔至乙状窦的距离是(1.02±0.24)cm。 结论　面神经乳突段起点和终点至乙状窦的距离及乙状窦至二腹肌嵴和茎乳孔之间的距离均呈正相关；乙状沟的深浅、宽窄及骨壁的厚薄因乳突气化程度不同而各异。     

A quite rare condition: absence of sphenoidal sinuses

The absence of sphenoidal sinuses (SS) in an adult is an extremely rare condition. We investigated in agenesis of the sphenoid, maxillary, ethmoid, and frontal sinuses in 20 male adult cadavers. In a 50-year-old man, bilateral absence of the SS was observed. On the macroscopic examination, opening of the SS was not found on the lateral wall of the nasal cavity. There were multiple small mucosal grooves between the sphenoidal rostrum and the superior nasal turbinates. The bulging of the sphenoidal rostrum at the choanal level was flat. The body of the sphenoid bone was normal and consisted of a symmetrical bony structure with a total lack of pneumatization. Other paranasal sinuses agenesis was not observed. Surgeons should also consider the possibility of sphenoidal agenesis before transsphenoidal hypophysectomy. As a supplement to the traditional classification, agenesis of the SS can be described as the fourth type of pneumatization.     

Pneumatization of the sphenoid sinus in Chinese: the differences from Caucasian and its application in the extended transsphenoidal approach

In recent years, the transsphenoidal approach has been extensively used surgically to treat parasellar, suprasellar, clival, and even petrous lesions. Extended pneumatization of the sphenoid sinus (SS) is considered an indispensable element for the extended transsphenoidal (ETS) approach. Because most anatomical studies of the ETS approach use Caucasian subjects, the present study aims to clarify the pneumatic extension types in Chinese individuals as well as any differences from those in Caucasians and analyze these differences with respect to the application of the ETS approach. A total of 200 computed tomography (CT) images of SSs and 18 adult cadaveric heads were selected for observation and measurement. The conchal, presellar, and sellar types comprised 6, 28.5, and 65.5% of subjects, respectively; according to the extra extension, the prevalence of the lateral, clival, lesser wing, and combined extension sinus types was 11.4, 21.4, 0.8, and 48.1% of subjects, respectively. The percentages of pneumatization of the anterior and posterior clinoid processes, pterygoid process, and optic strut were 5.0, 1.0, 22.3, and 7.0%, respectively. Onodi cells were observed in 61.1% of the sides of the cadaveric heads, including 30.6% with good pneumatization with identifiable optical or ICA bulges. These features were related to poor lateral and clival gasification in Chinese compared with Caucasians, which might make extended surgery more dangerous. However, the anterior pneumatization, especially the higher presentation of Onodi cells, ensures that the anterior ETS approach can be performed safely in Chinese patients. In general, measurements showing smaller sinus volumes and thicker bones with identifiable bone landmarks that are hard to find compared with those in Caucasians suggest increased surgical risks in the Chinese population. In this situation, carefully analysis of presurgical CT and magnetic resonance imaging scans is important. Furthermore, in the ETS approach, the use of stricter intraoperative technological devices such as neuronavigation and ultrasound Doppler is advisable.     

乙状窦、颈静脉球及面神经位置变化的相关性分析

目的 :研究乙状窦、颈静脉球及面神经位置变化的相关性。方法 :对 2 2侧正常成人头颈标本进行显微解剖 ,建立乙状窦、颈静脉球及面神经乳突段位置的三维空间参照系 ,测量相关数据并进行相关分析。结果 :乳突板障型和气化型标本的乙状窦 外耳门距离均大于硬化型。乙状窦 外耳门距离与颈静脉球高度、鼓索起点高度负相关 ,与面神经 乙状窦距离正相关 ;棘孔 颈静脉球距离与颈静脉球顶 内耳门水平距离正相关 ;颈静脉球顶 外半规管垂直距离与颈静脉球顶 内耳门水平距离之间负相关 ,与面神经 颈静脉球距离正相关 ,而颈静脉球顶 内耳门水平距离与面神经 颈静脉球距离负相关。结论 :乙状窦前移则颈静脉球偏高 ,鼓索起点位置亦偏高 ;颈静脉球前移则伴随着内移 ;颈静脉球顶高则颈静脉球外移 ,并接近面神经     

Craniofacial morphology of the tricho-dento-osseous syndrome

Tricho-dento-osseous syndrome (TDO) is characterized by abnormal bone, hair, and tooth morphology. However, the reported craniofacial abnormalities are not well characterized. The purpose of this study was to compare the craniofacial parameters of 25 subjects affected with TDO (A) with those of 15 unaffected relatives (U). Standardized lateral cephalograms were traced and digitized. Each subject's data were compared by age and sex to cephalometric standards (Bolton, Behrents); severity was scored by standard deviations from the standard mean, and then grouped into A vs. U. All cephalograms were evaluated for frontal sinuses, mastoid pneumatization, diploe, and bone density, and cranial thickness was measured. Cranial base length (SN; NBa), cranial base angle (BaSN), and mandibular body length (GoPg) were greater in A than in U (p < 0.05). Both groups had longer total and lower facial heights (NMe; ANSMe) compared with normal standards. Frontal sinuses, mastoid pneumatization and diploe were visible less often in A than in U (p < 0.05). Parietal bone and bone at lambda was significantly thicker (p < 0.05) in A than in U. Variability was substantial in many measures in both A and U. The major TDO craniofacial features involve the cranial base, mandibular body length, absence of visible pneumatized mastoids, frontal sinuses and diploe, and thicker cranial bone.     

蝶窦的应用解剖学研究

目的　为经蝶手术安全切除鞍区肿瘤提供解剖学参数。方法　对 2 0例经 10 %福尔马林溶液固定成人尸头的蝶窦进行观察和测量。结果　 80 %蝶窦为全鞍型 ,其中 12 5 %为鞍枕型 ;仅 2例蝶窦中隔位置居中 ,占 10 % ;鞍底骨质厚度平均为 0 9mm ,其中≤ 1mm者占 5 5 %。颈内动脉在蝶窦内形成隆凸者占 4 5 %。结论　蝶窦中隔不能作为术中中线定位的惟一标准 ;鞍底向两侧扩大时要注意勿损伤颈内动脉海绵窦段     

Regional variations in human patellar trabecular architecture and the structure of the quadriceps enthesis: a cadaveric study

We investigated whether there were regional differences in the quadriceps enthesis and the patella bone structure that could suggest unequal force transmission to the patella. Quadriceps tendon enthesis was removed by cutting the patellae transversally in the middle and the quadriceps tendon approximately 1 cm from the bone. Tissues were post‐fixed, decalcified, dehydrated through and embedded in paraffin wax. Serial longitudinal sections were cut, mounted on glass slides at 1‐mm intervals and slides were stained. Trabecular architecture was analysed from digital images taken from the histological slides, and regional differences at the enthesis in the thickness of the uncalcified fibrocartilage and the cortical zone of calcified tissue (calcified cartilage and lamellar bone) were evaluated. At the quadriceps enthesis, the thickness of the cortical zone of calcified tissue was significantly greater in the central part of the enthesis than medially and laterally. The trabeculae were thicker in the central and lateral parts compared with the medial region. Similarly, the zone of uncalcified fibrocartilage was thicker laterally and centrally than medially. Bone structure and the thickness of uncalcified fibrocartilage presented a similarity between the centre and the lateral parts; however, the medial side was different. We suggest that the mechanical stress at the proximal quadriceps tendon enthesis is higher laterally and centrally compared with medially. This could induce a lateral patellar translation, which is potentially a risk factor for knee osteoarthritis.     

Cervical muscle response to trunk flexion in whiplash-type lateral impacts

The purpose of this study was to determine the response of the cervical muscles to increasing low-velocity, whiplash-type lateral impacts when the occupant is seated out of the recommended driving position (neutral posture). Twenty healthy volunteers were subjected to left lateral impacts of 4.1, 7.7, 10.5, and 13.7 m/s² acceleration, with their trunk flexed by 45° and laterally flexed to the right and left also by 45° at the time of impact. Bilateral electromyograms of the sternocleidomastoids, trapezii, and splenii capitis were recorded. Under these conditions of trunk-flexed postures, in a left lateral impact, muscle responses were of generally low magnitude with the trunk flexed to either the left or right. Even at the highest acceleration of 13.7 m/s², all muscles generated less than 37% of their known maximal voluntary contraction electromyogram. Also, in these left lateral impacts, the right splenius capitis showed a greater EMG response than the left splenius capitis regardless of whether the subject was flexed to the right or left at the time of impact. The right splenius capitis (the one contralateral to the left lateral impact direction) was more active than its counterpart. Compared to what is known for EMG responses with an occupant in the neutral posture, the right sternocleidomastoid (usually the most active muscle in a left lateral collision) was significantly less-active with trunk flexion than with neutral posture conditions (P<0.01). In the absence of bodily impact, the flexed trunk posture does not produce a biomechanical response that would increase the likelihood of cervical muscle injury in low velocity lateral impacts, and may lessen the risk of injury for some muscles.     

The relationship between presbycusis and mastoid pneumatization

Presbycusis is defined as the natural hearing loss accompanying aging, caused by degenerative changes in the inner ear. The etiology of presbycusis is uncertain. However, it would appear that a complex genetic cause is most likely. The determinants of mastoid size continue to be controversial. One of the pneumatization theories is the hereditary theory. In this study, the possible relationship between presbycusis and the extent of mastoid pneumatization was investigated. This study was carried out on 21 patients with presbycusis and 21 normal subjects of similar ages. The pneumatized volume was measured by computerized tomography. The temporal bone was scanned at 2 mm thickness intervals. Exposure (kV 130, mA105). The scan plane was parallel to the orbitomeatal line and the CT images covered the entire mastoid region. The average mastoid pneumatization in presbycusis group was 6.08 +/- 2.52 cm(3) in the right ear and 6.19 +/- 2.93 cm(3) in the left ear. However, in the control group it was 4.69 +/- 3.17 cm(3) in the right ear (p=0.12) and 5.10 +/- 3.49 cm(3) in the left ear (p=0.28). No significant difference was found between the presbycusis patients and normal subjects in terms of the volume of mastoid pneumatization.     

The relationship between the internal jugular vein and common carotid artery in the carotid sheath: the effects of age, gender and side

The internal jugular vein is often used for central venous catheter placement. The variations in the location of this vein along the major neck vessels (in the carotid sheath) may account for unsuccessful cannulations or iatrogenic arterial injuries. The aim of this study was to delineate the relation of the internal jugular vein and common carotid artery in the lower neck, and to assess the effects of age, gender and side on these anatomical structures. Two-dimensional ultrasonographic examinations of the right and left supraclavicular triangle were performed in 219 adult individuals who had no history of neck surgery or known pathology. The location of the internal jugular vein in relation to the common carotid artery was recorded. An anterolateral location of the internal jugular vein was the most common configuration observed on both sides (84% right side and 91.8% left side) followed by the lateral (14.2% right and 6.4% left) and anterior (1.4% right and 1.8% left) locations. A single case of a medial internal jugular vein was observed on the right side (0.23% of both sides). Subjects with a laterally located internal jugular vein were older than those with an anterolateral configuration (P<0.01). No gender differences were found with regard to these two configurations (P=0.867). The laterally located internal jugular vein was more frequent on right sides (P=0.007). Such information may be potentially useful for clinicians who are managing critically ill patients or patients undergoing hemodialysis.     

Development of the lateral plate mesoderm in medaka Oryzias latipes and Nile tilapia Oreochromis niloticus: insight into the diversification of pelvic fin position

The position of the pelvic fins among teleost fishes has tended to shift rostrally during evolution. This positional shift seems to have led to the diversification of feeding behavior and allowed adaptation to new environments. To understand the developmental basis of this shift in pelvic fin position among teleosts, we investigated the embryonic development of the lateral plate mesoderm, which gives rise to the pelvic fins, at histological levels in the medaka Oryzias latipes (abdominal pelvic fins) and Nile tilapia Oreochromis niloticus (thoracic pelvic fins). Our histological analyses revealed that the lateral plate mesodermal cells expand not only ventrally but also rostrally to cover the yolk during embryogenesis of both medaka and Nile tilapia. In medaka, we also found that the lateral plate mesoderm completely covered the yolk prior to the initiation of the pelvic fin buds, whereas in Nile tilapia the pelvic fin buds appeared in the body wall from the lateral plate mesoderm at the thoracic level when the lateral plate mesodermal cells only covered one-third of the yolk. We discuss the relevance of such differences in the rate of the lateral plate mesoderm expansion on the yolk surface and the position of the pelvic fins.     

Effects of body position on snoring in apneic and nonapneic snorers

STUDY OBJECTIVES: The positional dependency of obstructive sleep apnea (OSA) is well known, but objective evidence for the positional effect on snoring is lacking. The aim of this study is to elucidate the effect of body position on snoring, and that of sleep stage as well. DESIGN: Retrospective analysis of the effects of body position and sleep stage on snoring in nonapneic snorers (snorer group) and OSA patients (apneic group). SETTING: A sleep laboratory in a national hospital in Japan. PATIENTS: Seventy-two patients who complained of habitual snoring and underwent overnight polysomnography. INTERVENTIONS: N/A MEASUREMENTS AND RESULTS: In the lateral position, most subjects in the snorer group showed decreased snoring both in time (p = 0.0004) and intensity (p = 0.0003), but subjects in the apneic group showed variable changes. In the apneic group, the positional dependency of snoring (the ratio of lateral value to supine value) was correlated with supine apnea-hypopnea index (AHI), that is, OSA patients with higher supine AHI tended to show increased snoring in the lateral position. AS to the effect of sleep stage, snoring was increased in deeper non-rapid eye movement sleep and decreased in rapid eye movement sleep in a given position. CONCLUSIONS: This study demonstrated that the positional dependency is different between nonapneic snorers and OSA patients. Most of the nonapneic snorers snore less in the lateral position than in the supine position in contrast to OSA patients who often fail to decrease snoring even in the lateral position.     

Venous velocity of the right femoral vein decreases in the right lateral decubitus position compared to the supine position: a cause of postoperative pulmonary embolism?

The right lateral decubitus position is a risk factor for postoperative pulmonary embolism. We examined postural changes of femoral vein velocity in order to elucidate the mechanism. Thirty patients scheduled for general thoracic surgery were enrolled in this study. The common femoral veins on both sides were examined by color-duplex ultrasound for venous caliber and velocity when the patients were in the right lateral, left lateral, and supine positions. The maximum diameters of the right femoral vein in the right lateral decubitus position and the left femoral vein in the left decubitus position were significantly larger than those in the other positions. The venous velocity of the right femoral vein in the right lateral decubitus position was significantly smaller than that in the supine position, while the velocity of the left femoral vein in the left lateral decubitus position was not significantly decreased. We speculate that the decreased venous velocity of the right femoral vein in the right lateral decubitus position could result in a deep venous thromboembolism in the right leg, making this position a possible risk factor for postoperative pulmonary embolism.     

Developmental aspects of the sinus valves and the sinus venosus septum of the right atrium in human embryos

Summary In 32 human embryos from 5 to 27 mm of length, stages 13 to 23 (according to the Carnegie system of stages), the contributions of the sinus venosus septum and the right sinus valve of the right atrium to the formation of the Eustachian and Thebesian valve were examined by scanning electron microscopy. The sinus septum takes part in the subdivision of the right sinus valve into the Eustachian and the Thebesian valves. From its first origin the sinus septum forms a septal structure between the orifices of the right hepatic vein (hepatic portion of the inferior caval vein), the precursor of the inferior caval vein, and the left horn of the sinus venosus, the precursor of the coronary sinus. Before the incorporation of the sinus venosus into the right atrium, it has an intra-sinusal position, and extends between the bases of the left and the right sinus valve. During the incorporation of the sinus venosus into the right atrium the sinus septum receives an intra-atrial position, and its positional relationships to the sinus valves and the orifices of the corresponding veins remain unchanged in principle. Due to the connection between the sinus septum and the right sinus valve, after completion of the incorporation of the sinus, the superior portion of the right sinus valve branches y-like into a lateral limb, (i.e. its original inferior portion) and into a medial limb, (i.e. the sinus septum). Thus, the Eustachian valve is formed by the superior portion of the right sinus valve and the sinus septum; whereas the Thebesian valve is formed by the inferior portion of the right sinus valve. The normal variations in the configuration of the Eustachian and the Thebesian valves are supposed to be caused by differential growth of the constituents of the different portions of the valves. This work was supported by the Stiftung Volkswagenwerk (I/63 363). Gratefully dedicated to Professor Erich Blechschmidt on the occasion of his 85th birthday     

Variations of the bilateral testicular veins: embryological and clinical considerations

Variations of the bilateral testicular veins were observed during routine dissection of the posterior abdominal wall in a 77-year-old male Japanese cadaver. The right testicular vein consisted of the lateral and medial testicular veins. The right lateral testicular vein drained into the right renal vein. The right medial testicular vein accompanied the right testicular artery to ascend obliquely and drained into the left aspect of the inferior vena cava. The left testicular vein was composed of the lateral, middle and medial testicular veins. Three left testicular veins accompanied the left testicular artery to course cranially and then finally drained into the left renal vein.     

Frequency tagging of steady‐state evoked potentials to explore the crossmodal links in spatial attention between vision and touch

The sustained periodic modulation of a stimulus induces an entrainment of cortical neurons responding to the stimulus, appearing as a steady‐state evoked potential (SS‐EP) in the EEG frequency spectrum. Here, we used frequency tagging of SS‐EPs to study the crossmodal links in spatial attention between touch and vision. We hypothesized that a visual stimulus approaching the left or right hand orients spatial attention toward the approached hand, and thereby enhances the processing of vibrotactile input originating from that hand. Twenty‐five subjects took part in the experiment: 16‐s trains of vibrotactile stimuli (4.2 and 7.2 Hz) were applied simultaneously to the left and right hand, concomitantly with a punctate visual stimulus blinking at 9.8 Hz. The visual stimulus was approached toward the left or right hand. The hands were either uncrossed (left and right hands to the left and right of the participant) or crossed (left and right hands to the right and left of the participant). The vibrotactile stimuli elicited two distinct SS‐EPs with scalp topographies compatible with activity in the contralateral primary somatosensory cortex. The visual stimulus elicited a third SS‐EP with a topography compatible with activity in visual areas. When the visual stimulus was over one of the hands, the amplitude of the vibrotactile SS‐EP elicited by stimulation of that hand was enhanced, regardless of whether the hands were uncrossed or crossed. This demonstrates a crossmodal effect of spatial attention between vision and touch, integrating proprioceptive and/or visual information to map the position of the limbs in external space.     

骨盆后环骨折神经损伤的临床解剖学研究

目的：了解骨盆后环骨折易损神经的相对解剖位置及其与骨折的关系。方法：解剖20具骨盆标本，神经外膜下置管造影CT扫描5例，测量腰区各神经的走行特点、与骨盆壁和骶髂关节的距离。结果：腰4腰骶干支、腰5神经和腰骶干与骶骨翼的距离不超过1cm，距离骶髂关节不超过2．5cm。闭孔神经、股神经、股外侧皮神经与骨壁的距离依次渐远。CT测量结果和人工测量结果无显著性差异。结论：腰4腰骶干支、腰5神经和腰骶干是与骨盆壁和骶髂关节的关系最为紧密的神经，它们在骨盆后环骨折及其治疗时最易受损。