利用信息技术融入临床知识在《正常人体解剖学》教学中的探索

<正>人体解剖学是医学的基础课,因此大学一年级即开设该课程。在理论课上,不管老师如何强调解剖学的重要性以及与临床关系的密切性,学生还是感到很茫然,几年后,他们在见习、实习时才切身感受到关于解剖学的知识是必须掌握的~([1])。可是3年时间已经过去,失去了最佳的学习机会。可是,19世纪末20世纪初,世界各国高等医学教育的课程改革趋势之一就是早期接触临床~([2])。国内同样认为有必要寻找一个将解剖学基础知识与临床     

The developmental anatomy of the human superior hypogastric plexus: A morphometrical investigation with clinical and surgical correlations

The superior hypogastric plexus (SHP) is the part of the autonomic nervous system, which is responsible for the sympathetic innervation of pelvic organs and extrapelvic genitals in humans of both sexes. The SHP also functions as the anatomic pathway for the major part of visceral sensitive fibers originating from pelvic viscera. In this study, the morphology of the SHP was analyzed through anatomical dissections performed both in human adult and fetal cadavers. A computerized morphometrical investigation of the SHP was also performed and the resulting quantitative data statistically assessed. The comparison between fetal and adult SHP revealed that in the male group there was a developmental increase of six times (in height) and of about five times (in width); while in the female group, there was a developmental increase of 3.5 times both in height and width values. In addition, the distance from the superior border of the SHP to the bifurcation of the common iliac arteries presented a developmental increase of about six times in the male group, and about four times in the female group. We propose an original morphological classification with six types, based upon the anatomical arrangement of the nervous fibers in this autonomic plexus.     

The surgical anatomy of the superior gluteal nerve and anatomical radiologic bases of the direct lateral approach to the hip

Summary In view of the increasing popularity of the direct lateral approach to the hip joint for hemi- or total hip arthroplasty, the location of the superior gluteal nerve (SGN) was studied. This nerve is in danger when using a transgluteal incision. In 20 embalmed specimens the relation of the SGN to the tip of the greater trochanter (TT) was studied as well as the relation to the iliac crest. For this purpose macroscopy, microscopy and CT were used. In 13 hips a so-called most inferior branch was found at an average of 1 cm distal to the inferior branch, the main trunk of the nerve. There was substantial variation in the course of both the inferior and the most inferior branch of the SGN. In order to prevent nerve damage, proximal extension of the transgluteal incision should be limited to 3 cm cranial to TT. Furthermore the incision has to be confined to the distal one third of the distance TT-iliac crest. In tall people extra care should be taken.

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Anatomie chirurgicale du nerf glutéal supérieur et bases anatomo-radiologiques de l'abord latéral direct de la hanche

Résumé Les recours de plus en plus fréquent à la voie latérale directe de la hanche pour les prothèses totales ou cervico céphaliques nous a conduit à étudier la localisation du nerf glutéal supérieur (SGN) qui est exposé lors de l'incision transglutéale. Les rapports du SGN avec le sommet du grand trochanter (TT) et avec la crête iliaque ont été étudiés sur 20 cadavres embaumés. Nous avons eu recours à l'étude macroscopique, microscopique ainsi qu'au scanner. Dans 13 cas nous avons mis en évidence une branche très inférieure, donc plus distale, située 1 cm en moyenne en dessous de la branche inférieure habituelle de bifurcation du tronc principal. Il existait des variations importantes dans les trajets de ces deux branches inférieures. Afin de prévenir une lésion chirurgicale du nerf, l'incision transglutéale ne doit pas aller au delà de 3 cm du sommet du grand trochanter, de plus l'incision doit être confinée en dessous du tiers distal de la ligne joignant le grand trochanter à la crête iliaque.

     

The anatomy of the infrarenal lumbar splanchnic nerves in human cadavers: implications for retroperitoneal nerve‐sparing surgery

Injury to the nerves of the aortic‐ and superior hypogastric plexuses during retroperitoneal surgery often results in significant post‐operative complications, including retrograde ejaculation and/or loss of seminal emission in males. Although previous characterizations of these plexuses have done well to provide a basis for understanding the typical anatomy, additional research into the common variations of these plexuses could further optimize nerve‐sparing techniques for retroperitoneal surgery. To achieve this, the present study aimed to document the prevalence and positional variability of the infrarenal lumbar splanchnic nerves (LSNs) through gross dissection of 26 human cadavers. In almost all cases, two LSNs were observed joining each side of the aortic plexus, with 48% (left) and 33% (right) of specimens also exhibiting a third joining inferior to the left renal vein. As expected, the position of the LSNs varied greatly between specimens. That said, the vast majority (98%) of LSNs joining the aortic plexus were found to originate from the lumbar sympathetic trunk above the level of the inferior mesenteric artery. It was also found that, within specimens, adjacent LSNs often coursed in parallel. In addition to these nerves, 85% of specimens also demonstrated retroaortic LSN(s) that were angled more inferior compared with the other LSNs (P < 0.05), and exhibited a unique course between the aorta/common iliac arteries and the left common iliac vein before joining the superior hypogastric plexus below the aortic bifurcation. These findings may have significant implications for surgeons attempting nerve‐sparing procedures of the sympathetic nerves in the infrarenal retroperitoneum such as retroperitoneal lymphadenectomies. We anticipate that the collective findings of the current study will help improve such retroperitoneal nerve‐sparing surgical procedures, which may assist in preserving male ejaculatory function post‐operatively.     

下颈椎的侧方外科入路解剖及其临床意义

目的：探讨下颈椎侧方外科入路。方法和结果：通过解剖研究和临床实际应用，对下颈椎入路的解剖层次及各种结构的外科处理要点作了描述。结论：本文所描绘的下颈椎侧方外科入路能兼顾半侧椎体及附件，在临床上尤合适作半侧脊椎切除术以治疗某些脊柱肿瘤     

The masks of Lorenzo Tenchini: their anatomy and surgical/bioengineering clues

An academic, anatomist, and Lombrosian psychiatrist active at the University of Parma in Italy at the end of the 19th century, Lorenzo Tenchini produced ceroplastic‐like masks that are unique in the anatomical Western context. These were prepared from 1885 to 1893 with the aim of ‘cataloguing’ the behaviour of prison inmates and psychiatric patients based on their facial surface anatomy. Due to the lack of any reference to the procedure used to prepare the masks, studies were undertaken by our group using X‐ray scans, infrared spectroscopy, bioptic sampling, and microscopy analysis of the mask constituents. Results showed that the masks were stratified structures including plaster, cotton gauze/human epidermis, and wax, leading to a fabrication procedure reminiscent of ‘additive layer manufacturing’. Differences in the depths of these layers were observed in relation to the facial contours, suggesting an attempt to reproduce, at least partially, the three‐dimensional features of the facial soft tissues. We conclude the Tenchini masks are the first historical antecedent of the experimental method for face reconstruction used in the early 2000s to test the feasibility of transferring a complete strip of face and scalp from a deceased donor to a living recipient, in preparation for a complete face transplant. In addition, the layering procedure adopted conceptually mimics that developed only in the late 20th century for computer‐aided rapid prototyping, and recently applied to bioengineering with biomaterials for a number of human structures including parts of the skull and face. Finally, the masks are a relevant example of mixed ceroplastic‐cutaneous preparations in the history of anatomical research for clinical purposes.     

The effect of anterior abdominal wall scars on the vascular anatomy of the abdominal wall: A cadaveric and clinical study with clinical implications

The anterior abdominal wall integument is frequently used in a range of reconstructive flaps. These tissues are supplied by the deep and superficial inferior epigastric arteries (DIEA and SIEAs) and the deep and superficial superior epigastric arteries (DSEA and SSEAs). Previous abdominal wall surgery alters this vascular anatomy and may influence flap design. One hundred and sixty‐eight patients underwent abdominal wall computed tomographic angiography (CTA) for preoperative imaging. Fifty‐eight of these patients had undergone previous abdominal surgery, and were assessed for scar pattern and relationship to the course and distribution of all major axial vessels and perforators. Two cadaveric abdominal wall specimens with midline abdominal scars underwent contrast injection of the DIEAs and DSEAs, with subsequent CTA. The course and distribution of all cutaneous vessels were assessed. In all clinical and cadaveric cases, the vasculature of the abdominal wall had been altered by previous surgery. In the clinical cases, vascular architecture was universally altered in the region of the scar, often modifying the filling patterns of the abdominal wall and occasionally precluding the use of an abdominal wall flap. In both cadaveric specimens, regions of non‐filling were evident upon contrast injection, highlighting the angiosomes not supplied by the DIEA or DSEA. Previous abdominal wall surgery necessarily alters the vascular architecture of the abdominal wall, and may alter the source vessels supplying cutaneous tissues. CTA was useful in identifying and delineating these changes, and may be used as a preoperative tool in this role. Clin. Anat. 22:815–822, 2009. © 2009 Wiley‐Liss, Inc.     

Viewpoint: exploring the human interior: the roles of cadaver dissection and radiologic imaging in teaching anatomy.

For a variety of reasons, new radiological imaging techniques are supplanting traditional cadaver dissection in the teaching of human anatomy. The authors briefly review the historical forces behind this transition, and then explore the advantages and drawbacks of each approach. Cadaver dissection offers an active, hands-on exploration of human structure, provides deep insights into the meaning of human embodiment and mortality, and represents a profound rite of passage into the medical profession. Radiological imaging permits in vivo visualization, offers physiologic as well as anatomic insights, and represents the context in which contemporary practicing physicians most frequently encounter their patients' otherwise hidden internal anatomy. Despite its important strengths, radiology cannot simply substitute for cadaver dissection, and the best models for teaching gross anatomy will incorporate both cadaver dissection and radiological imaging.     

The vascular basis of the hemi-hamate osteochondral free flap. Part 2: surgical anatomy and clinical application

Purpose

The free vascularised hemi-hamate flap combines the utility of providing a small osteochondral portion of hamate for reconstruction, while providing a means of vascularisation to preserve articular cartilage after transfer. In Part 1 of this series, we highlighted the vascular approaches to such a technique. The current study investigates the bony architecture of the hamate, with particular emphasis on its utility for a range of osteochondral defects in the hand.

Methods

A morphometric assessment of the hamate as a potential osteochondral flap donor site for resurfacing digital phalangeal heads (either total or unicondylar) and/or bases was thus undertaken. This anatomic study was undertaken using in vivo imaging performed for a range of clinical indications, with computed tomographic angiography (CTA) and digital subtraction angiography (DSA) of the upper limb included. Bony and vascular measurements and relationships were recorded and assessed both quantitatively and qualitatively. A clinical case is presented, highlighting the application of these measurements.

Results

The mean digital artery diameter was 0.7 mm with a mean distance between digital artery and interphalangeal joint surface (i.e. pedicle length) of 1.18 mm. Mean hamate dimensions comprised a transverse width 16.62 mm, lateral width of 14.29 mm and ridge height of 1.43 mm. Measurements of the phalangeal bases, condyles and total phalangeal heads were recorded, and the optimal hamate harvest approaches demonstrated. Despite perceived differences, in all cases there was statistical similarity demonstrated between the fragments.

Conclusion

The hemi-hamate osteochondral flap can be applied to a range of osteochondral defects in the hand and may offer new options to the hand surgeon.     

HuGE Watch: tracking trends and patterns of published studies of genetic association and human genome epidemiology in near-real time

HuGE Watch is a web-based application for tracking the evolution of published studies on genetic association and human genome epidemiology in near-real time. The application allows users to display temporal trends and spatial distributions as line charts and google maps, providing a quick overview of progress in the field. http://www.hugenavigator.net/HuGENavigator/startPageWatch.do     

The importance of teaching clinical anatomy in surgical skills education: Spare the patient,use a sim!

Anatomical knowledge is a key tenet in graduate medical and surgical education. Classically, these principles are taught in the operating room during live surgical experience. This puts both the learner and the patient at a disadvantage due to environment, time, and safety constraints. Educational adjuncts such as cadaveric courses and surgical skills didactics have been shown to improve resident confidence and proficiency in both anatomical knowledge and surgical techniques. However, the cost-effectiveness of these courses is a limiting factor and in many cases prevents implementation within institutional training programs. Anatomical simulation in the form of “desktop” three-dimensional (3D) printing provides a cost-effective adjunct while maintaining educational value. This article describes the anatomical and patient-centered approach that led to the establishment of our institution's 3D printing laboratory for anatomical and procedural education. Clin. Anat. 32:124–127, 2019. © 2019 Wiley Periodicals, Inc.     

外科应用解剖与手术学在医学教育中的重要性

外科应用解剖与手术学（Applied Surgical Anatomy and Operative Surgery）是一门实用性很强的学科,是由外科应用解剖学与外科手术学组成,两者之间有着密切联系,是基础医学与临床医学之间的桥梁课,外科应用解剖学与手术学紧密结合,为学生学习好外科学奠定基础,是医学教育中必不可少的课程。本文将本学科的现状及展望作一阐述,为医学教育改革提供参考。     

植入人体耗材的信息化追踪管理

随着医用昂贵耗材数量、种类的发展和医院管理的不断完善,对植入人体耗材的管理也赋予了新的特征和意义.为此,基于PACS系统开发了植入人体耗材管理系统,不仅实现了耗材基本信息的录入和统计,同时融入了图像信息,最终实现了对植入耗材使用的追踪.     

人体解剖学与组织学胚胎学教学能力大赛的参赛体会

为贯彻《国家职业教育改革实施方案》,推动课程改革与教学创新,提升教师的教学能力,全国职业院校教学能力比赛成为广大教育工作者交流、竞技的大舞台.基于学情和岗位需求,大赛重点考察教师通过创新教学模式,改进教学方法,科学运用教学资源和信息化手段,有效解决教学重、难点,积极融入德育教育,提升教学效率,提高教学质量.解剖学传统教学模式向信息化教学转变是一种趋势[2],笔者根据以高职护理专业人体解剖学与组织学胚胎学之椎骨及其连接参加教学能力大赛的经历,谈谈心得体会,以供交流.     

Escaping from Flatland: clinical and biological aspects of human mammary duct anatomy in three dimensions

Accurate knowledge of breast duct anatomy in three dimensions is needed to understand normal breast development, how intraepithelial neoplasia may spread through a breast, and the potential for diagnostic and therapeutic access to breast parenchyma via the nipple. This paper reports three related exploratory studies. In study 1, the median number of milk-collecting ducts in the nipple was determined in 72 breasts excised for cancer; in study 2, the volumes of all 20 complete duct systems ("lobes") in an autopsy breast were measured from 2 mm serial "subgross" sections; and in study 3, a 3D digital model of all collecting ducts in a mastectomy nipple was made from 68 100 micro m serial sections. The mastectomy nipples contained 11-48 central ducts (median 27, inter-quartile range 21-30). In the autopsy breast, the largest "lobe" drained 23% of breast volume; half of the breast was drained by three ducts and 75% by the largest six. Conversely, eight small duct systems together accounted for only 1.6% of breast volume. The 3D model of the nipple revealed three distinct nipple duct populations. Seven ducts maintained a wide lumen up to the skin surface (population A); 20 ducts tapered to a minute lumen at their origin in the vicinity of skin appendages (population B) on the apex of the nipple; and a minor duct population (C) arose around the base of the papilla. Major variations in duct morphology and extent define highly variable territories in which intraepithelial neoplasia could grow. While population A ducts appear accessible to duct endoscopy or lavage, population B and population C ducts may be less accessible.