上肢深筋膜形态解剖学观察

目的 观察上肢深筋膜形态结构。方法 20例福尔马林固定尸体经乳胶灌注后作上肢逐层解剖、观察。结果 肩部、臂、和前壁后深筋膜,厚约0．4－0.7mm,浅深面连结紧密。臂、前臂前区深筋膜,厚约0．3－0．5nm,连结疏松,前臂深筋膜形成4个肌间隔。手掌内、外侧部和背部的深筋膜较薄,掌心部深筋膜较厚。结论 上肢各部深筋膜厚度、连结不同,前臂有4个肌间隔。     

一种简单的上肢关节坐标系定义方法

人体运动的运动学或者动力学分析通常需要对各关节建立局部坐标系,目前大部分人体关节坐标系定义方法基于临床应用,要求专业的解剖学知识,可操作性差.本文定义了上肢的主要解剖学特征点,通过这些特征点构建了肩关节、肘关节及腕关节坐标系,并详细阐述了直接采用肩锁关节点（AC）构建肩关节坐标系的方法和必要性.利用运动捕捉系统对自愿者步态过程中的上肢运动轨迹进行采集,通过分析坐标系特征点在运动过程中空间相对位置的不变性,说明了文章提出的上肢局部坐标系定义方法在一定范围内是合理的.     

骶髂关节的放射解剖学观测

目的:为临床准确观测骶髂关节提供正确的放射解剖学依据.方法:2具成人男性(其中1具带有副骶髂关节)及1具女性干燥骨盆标本,在标记出(副)耳状面的边界和耳状面的范围后,以骶髂关节正位和斜位X线片进行投照,观测骶髂关节(副)耳状面的边界和范围以及骶髂关节的前间隙和后间隙.结果:骶髂关节位于骶髂间隙的下2/3,耳状面的前边界和后边界分别构成骶髂关节前间隙和后间隙的下2/3.骶髂关节正位和斜位均可显示骶髂关节间隙及耳状面,但斜位片可更清晰地显示同侧上半部分的骶髂关节间隙和对侧的(副)耳状面.结论:耳状面走行、骨性凹凸以及副耳状面等因素的存在使得骶髂关节X线观测较为复杂.骶髂关节正位基本可以满足骶髂关节的检查的需要,而骶髂关节斜位更易观察(副)耳状面和部分骶髂关节.     

新生儿心脏的解剖学观测

1 材料和方法选取长春地区、经防腐固定的50例足月新生儿,男30女20.开胸,至心包处断离各血管.(主动脉、肺动脉自瓣膜平面切除)取心,用游标卡尺、铅丝、双角规测心外径.沿血流方向剖开心脏,流水下冲洗内部杂质,称重.在大口径量杯内(排水法)量全心实质体积.以室间隔中点前室间沟两侧为准,测左右室壁厚度.乳头肌按群取最大、最小值,并计出均值.腱索起、止端分别计数,长度从乳头肌尖端至瓣膜附着处的直线距离计算.所有数据,均经统计学处理(X±S,最小值.最大值).2 结果2.1 心脏重量,体积和室壁厚度,结果如下表1.     

上肢皮瓣淋巴回流的显微外科解剖学研究

从28例上肢注射亚甲蓝或普蓝氯仿溶液及碳素墨水注射的材料,选10例已做淋巴系统注射的成人上肢,每一上肢做5组皮瓣,设5组移植皮瓣供区,分成13种大小规格,测量了供区内集合淋巴管数量和外径,讨论了临床意义,指出皮瓣中淋巴管存在数的规律,保护血管蒂中的淋巴管和防止或减轻逆向旋转皮瓣严重水肿,使其转危为安的做法,以提高皮瓣的成活率。     

成年人正常骶髂关节间隙的CT影像解剖学观测及其临床意义

目的　观测成年人正常骶髂关节间隙的CT影像解剖学特征,为骶髂关节半脱位的影像学诊断提供影像解剖学数据。 方法　对56例无骶髂关节病变的受检者的骶髂关节CT影像进行观测：（1）不同性别同一位置骶髂关节间隙的差异;（2）不同水平面上骶髂关节间隙的差异;（3）同一水平面上同侧前、中、后骶髂关节间隙的差异;（4）同一水平面上左右两侧骶髂关节间隙的差异。 结果　（1）骶2第1水平面（S2-1）和骶2第2水平面（S2-2）左后区骶髂关节间隙不同性别之间存在统计学差异（P<0.05）;（2）骶1第1水平面至骶3第2水平面（S1-1~S3-2）6个水平面上,同侧骶髂关节前、中、后关节间隙存在统计学差异（P<0.05）;（3）右前区中,S1-1水平骶髂关节间隙分别大于S1-2、S2-1、S2-2和S3-2（P<0.05）;（4）左中区中,S2-1水平骶髂关节间隙分别大于S1-1、S1-2、S2-2和S3-2（P<0.05）;（5）右中区中,S2-1水平骶髂关节间隙分别大于S3-1和S3-2（P<0.05）, 且S2-2水平骶髂关节间隙大于S3-2（P<0.05）;（6）左后区中,S2-1水平骶髂关节间隙大于S3-2（P<0.05）;（7）右后区中,S2-2水平骶髂关节间隙大于S3-2（P<0.05）。 结论　本研究为成年人正常骶髂关节间隙的宽度提供了影像解剖学参考标准。成年人正常骶髂关节间隙在水平面和冠状面上存在一定的影像解剖学差异。     

肾蒂的解剖学观测

目的观测肾蒂的解剖结构,为肾手术的临床应用提供形态学依据,丰富体质与形态学数据。方法解剖甲醛固定的成人尸体标本66例,分离解剖肾蒂内结构,对相关结构进行观测,对数据进行统计分析。结果肾蒂长度左侧（4.70±1.31）cm,右侧（3.15±1.17）cm;肾动脉长度左侧（4.70±1.31）cm,右侧（6.22±1.44）cm;肾动脉管径左侧（0.77±0.48）cm,右侧（0.74±0.18）cm;肾静脉长度左侧（6.88±1.34）cm,右侧（3.15±1.17）cm;47侧出现副肾动脉,占35.6%;肾静脉管径左侧（1.76±0.38）cm,右侧（1.34±0.31）cm;肾静脉汇入下腔静脉角度左侧（77.9°±16.3°）,右侧（66.8°±22.9°）;肾蒂内结构的位置关系,由前向后为静脉、动脉、肾盂者占59.8%,肾动脉位于最前面占40.2%。结论肾蒂内动脉分支、静脉属支、各结构位置关系类型复杂,变异多样,临床手术中应予以充分注意。     

Ultrastructure of developing muscle in the upper limbs of the human embryo and fetus

Background: The ultrastructure of the myogenesis, which proceeds along with the appearance of muscle-specific proteins and isozymes, has not been fully described in the upper limb of staged human embryos. Methods: Eight human embryos (Carnegie stage 14–22) and two fetuses (11 and 12 weeks of gestation) were fixed with 5% glutaraldehyde, 4% paraformaldehyde, and 0.2% picric acid in 0.1 M phosphate buffer, pH 7.2. The upper limbs were dissected out and processed for transmission electron microscopy, and sections of the biceps brachii muscle were cut and examined. Results: At stage 14, the myoblasts were loosely scattered in the ventral proximal region of the upper limb bud and had a small amount of cytoplasm with a few intracellular organelles. At stage 16, the myoblasts were spindle shaped and oriented parallel to the axis of the upper limb bud. These cells had irregularly shaped nuclei with prominent nucleoli, rough endoplasmic reticulum (ER), and mitochondria, but no myofilaments were observed. At stages 17–19, rough ER, free ribosomes, and mitochondria increased in number and thick and thin filaments with faint Z-lines appeared in the peripheral cytoplasm of the myotube. The plasma membranes of some neighboring myotubes were continuous, suggesting that these cells were in the initial stages of the fusion process. At stage 22, the striated pattern of the myofilaments became evident and tubular structures appeared around them and near the plasma membrane. In the fetus at the 11th week, the basal lamina began to surround the myotubes, and T-tubules with sarcoplasmic reticulum were observed. Dyads and triads were observed in the myotube of the 12th week fetus. Conclusion: These findings suggest that rapid myogenesis occurs during the late embryonic period in human upper limbs and that the ultrastructural characteristics of mature myotubes are established during the early fetal period. © 1995 Wiley-Liss, Inc.     

上肢皮神经及其营养血管皮瓣的应用解剖

目的：为上肢皮神经及其营养血管为蒂的岛状皮瓣提供解剖学依据。方法：在34侧经动脉灌注红色乳胶的成人上肢标本上,解剖观察了上肢皮神经及其营养血管的来源、走行、分布、吻合及外径;2侧成人新鲜上肢标本墨汁灌注,观测营养血管的墨染范围。结果：上肢所有皮神经都有来源于知名血管的营养血管伴行,在神经旁形成纵向血管链,除营养神经外,发出众多皮支深筋膜血管网、皮下血管网广泛吻合营养皮肤。结论：以上肢皮神经及其营养血管为蒂可设计顺利或逆行岛状皮瓣。     

Arterial, neural and muscular variations in the upper limbs of a single cadaver

Arterial, neural and muscular variations were observed in both upper limbs of a female adult cadaver during routine student dissection. Two superficial radial arteries were observed, which originated from the brachial and axillary arteries in the left and right upper limbs respectively. In the right upper limb, an ulnar nerve with a lateral root from the lateral cord of the brachial plexus in the axilla and, in the left forearm, an accessory muscle belly inserting into the muscle belly of the flexor digitorum superficialis were also observed. Formation of these variations is discussed on the basis of the embryological development of the upper limb structures. The clinical importance of the variations is emphasized.     

The development of a core syllabus for teaching musculoskeletal anatomy of the vertebral column and limbs to medical students

The study of human anatomy is fundamental to medical education globally. Knowledge of musculoskeletal anatomy is essential for safe and effective clinical practice, yet this topic often receives insufficient medical program time and perceptions differ regarding which knowledge is core. Given the lack of syllabuses specific to musculoskeletal anatomy, this article aims to provide a detailed syllabus for the vertebral column and limbs relevant to medical students. A Delphi panel comprising anatomists and clinicians rated 2,260 anatomical structures and concepts as “essential,” “important,” “acceptable,” or “not required,” with evaluations based around the core knowledge deemed acceptable for a competent medical student. Based on the percentage of panelist agreement for an item to be considered “essential,” each item was then classified as core (≥60%), recommended (30%–59%), not recommended (20%–29%), or not core (<20%). Items not classified as core or recommended but rated important by greater than 50% of the panel were highlighted for future consideration. A total of 252/389 musculoskeletal concept items were categorized as core or recommended. The number of core or recommended items for the vertebral column, upper limb, and lower limb were 220/438, 322/663, and 318/770, respectively. Ninety‐six items were recommended for future consideration. The results of this Delphi panel will be published on the International Federation of Associations of Anatomists website for continuing international consideration and deliberation by relevant stakeholders. The aim is to set an internationally recognized syllabus, that covers the minimum musculoskeletal content that is academically and clinically relevant. Clin. Anat. 32:974–1007, 2019. © 2019 Wiley Periodicals, Inc.     

动力髁螺钉治疗股骨远端骨折的应用解剖

目的为临床应用动力髁螺钉治疗股骨远端骨折提供解剖学数据。方法 (1)男女性股骨标本各30根,测量股骨髁宽、内侧髁宽、外侧髁宽、内侧髁前后径、外侧髁前后径、股骨内侧髁倾角、股骨外侧髁倾角等数值。(2)X线摄片30位正常成年志愿者股骨,进行冠状面上角度测量。结果股骨髁宽、内侧髁髁宽、外侧髁髁宽、内侧髁前后径、外侧髁前后径等值均有显著的性别差异(P<0.01),同性别内侧髁倾角明显大于外侧髁倾角(P<0.01)。股骨干与股骨远侧段之间的夹角、股骨干与股骨近侧段之间的夹角、股骨干与膝关节面之间的夹角存在性别差异(P<0.01～P<0.05)。股骨远侧段与股骨近侧段的夹角不存在显著的性别差异(P>0.05)。结论动力髁螺钉手术中应注意股骨髁形态的性别差别和股骨远侧段存在的弯曲,以提高动力髁螺钉治疗股骨远端骨折的手术效果。     

基于有限元模型的下肢长骨动态试验的仿真研究

目的研究在动态载荷下下肢长骨的损伤极限。方法基于中国人体下肢有限元模型,分别对股骨、胫骨、大腿和小腿进行动态三点弯曲仿真,并借助尸体试验验证该模型的有效性。结果仿真所得撞锤的撞击力-位移曲线走势与尸体试验结的基本吻合。裸股骨、裸胫骨、大腿和小腿失效时的撞击力分别为4.29、3.94、4.81和4.086 kN,位移分别为17.78、34.00、52.10和47.06 mm,与尸体试验结果也较为相符。结论本研究验证了模型的有效性,为后续对膝关节以及对整个下肢模型的验证奠定基础,为碰撞事故中对行人进行保护提供了科学的理论依据。     

上胸段交感干切断术的微创外科解剖学

目的:探索胸交感干及其周围的显微解剖,为交感干切断术提供解剖学依据。方法:28例成人胸腔标本,在放大5×25倍手术显微镜下,对交感干及其周围组织进行逐层显微解剖、观察及测量。结果:星状神经节(颈胸神经节)及T2￣T5神经节的长径依次是(21.5±3.2)、(10.6±2.8)、(8.5±3.1)、(8.2±2.7)和(7.1±1.8)mm。T2￣T5神经节出现在相应肋间水平的发生率依次是92.7%、85.5%、40.0%、36.4%。旁路纤维只在T1或T2及T2或T3之间发现,出现率分别是69.1%、49.1%。结论:针对手汗症、头面多汗症治疗以及复合性局部疼痛综合症的交感干切断手术,只需切断节间束纤维及其旁路上传纤维即可,其余交感干的相关结构应尽量保护。     

Ambulatory measurement of upper limb usage and mobility-related activities during normal daily life with an upper limb-activity monitor: a feasibility study

The aim of this research was to assess the ability of an upper limb-activity monitor (ULAM) to discriminate between upper limb usage and non-usage in healthy and disabled subjects during normal daily life. The ULAM was based on ambulatory accelerometry and consisted of several acceleration sensors connected to a small recorder worn around the waist. While wearing this ULAM, four healthy and four disabled subjects performed an activity protocol representing normal daily life upper limb usage or non-usage. The motility feature (derived from the raw acceleration signals) was used as a measure of the extent of upper limb usage. Agreement scores between ULAM output and videotape recordings (reference method) were calculated. ULAM data that were of special interest for rehabilitation were detected satisfactorily (overall agreement 83.9%). There were no systematic differences in the agreement percentages between healthy and disabled subjects for mobility-related activities (p=0.345) and the different forms of upper limb usage or non-usage (p=0.715). The ULAM can be used in future studies in subjects with upper limb disorders to discriminate between upper limb usage and non-usage during performance of mobility-related activities to determine activity limitations.     

Effect of local leg cooling on upper limb trajectories and muscle function and whole body dynamic balance

This study was designed to find out if local leg cooling affects muscle function and trajectories of the upper limb during repetitive light work as well as capability to maintain dynamic balance. Nine healthy female subjects performed repetitive lifting task with right hand for 60 min while standing in front of a table with six target angles (30°–220°) and with the legs inside a container with 15°C cold water (Cold condition, C) or without water (Normal condition, N). Muscle temperature of the medial aspect of the gastrocnemius, rectal, and skin temperatures were measured continuously. The trajectories of the right upper limb were recorded with a 3D motion analysis system. Muscular strain (averaged EMG, a-EMG) and EMG gaps in eight muscles of the right upper limb were measured. End point excursion depicting the ability to maintain dynamic balance was measured before and after each experiment. Leg cooling decreased significantly (P < 0.05) the muscle and the mean skin temperature in C compared with N (6.7 and 2.2°C, respectively). No marked changes in the trajectories or EMG activity were observed between the different environmental conditions. The end point excursion was significantly (P < 0.05) reduced in C compared with N and a positive correlation between excursion and muscle temperature was found at the end of the working period in C. In conclusion, local leg cooling did not affect upper limb muscle function or trajectories, but ability to maintain dynamic balance was reduced.