家兔子宫血供及血管构筑

用血管铸型和透明方法观察了１５只雌性家兔子宫血供及血管构筑情况。子宫大部分血液来自子宫动脉，小部分来自生殖动脉。各弓状动脉进入宫壁后，即在宫壁内分支形成三个血管层：浆膜层、大血管层和粘肌层。研究发现家兔子宫内膜血管呈树杆状或有轻度弯曲，其形态与有月经的人子宫内膜螺旋动脉明显差异。据认为内膜血管是否呈螺旋状可能是子宫能产生月经的一个形态结构基础。     

脊髓血供及其监测研究

本文主要对脊髓的血供及目前的用于监测脊髓血供的方法和未来可能应用的新技术做一个综述,旨在协助临床脊柱外科医生能更好地对脊髓血供进行监测,预防脊髓缺血的发生,减少脊髓缺血所引起的损伤。     

脊髓供血的生物力学研究

传统观点认为脊髓各个节段供血量不等。T_4L_1位于两处不同来源的血流交界区,形成了脊髓供血薄弱区,亦是脊髓梗塞易发区,但临床实践证明脊髓梗塞易发区位于腰颈膨大区,与传统理论出现了不一致性。本文在大量形态学研究基础上,应用生物力学原理论证了脊髓任一平面内单位面积血流量相等,否定了脊髓供血薄弱区的存在。     

鼻唇沟任意型皮瓣血供的解剖学基础

目的 :为鼻唇沟皮瓣血供提供形态学基础。方法 :① 3 0例 (60侧 )经 10 %福尔马林固定的成人头部标本 ,动脉灌注红色乳胶 ,解剖观察鼻唇沟的动脉血供及静脉回流 ;②在 10侧头部铸型标本上 ,观测鼻唇沟皮肤和皮瓣蒂部的动脉血管分布及静脉回流 ;③ 1例新鲜成人尸体头颈部标本 ,从颈总动脉灌注明胶墨汁 ,切取鼻唇沟皮瓣并透明 ,观察血管分布及吻合。结果 :鼻唇沟部皮肤血供主要来源于面动脉、眶下动脉和面横动脉的分支 ,上述动脉发出小动脉入浅筋膜形成皮下动脉网 ,再由此发出分支至真皮下层形成真皮下动脉网。皮瓣蒂部血供来源于附近区域真皮下血管网。结论 :鼻唇沟皮肤血供极为丰富 ,任何一处均可为蒂形成真皮下血管网皮瓣 ,无需将主要血管包含在蒂内     

膝交叉韧带的血供及其临床意义

目的:探讨交叉韧带血管构筑特点、为韧带损伤的重建提供解剖学依据.方法:通过股动脉红色乳胶灌注并解剖观察、墨汁灌注组织透明、组织切片等方法,研究交叉韧带的动脉来源、分布特点并测量韧带内微血管密度.结果:前、后交叉切带的动脉分别来源于膝中动脉、髌下脂肪垫以及膝下外动脉的分支.多数韧带内血管沿长轴走行,同时也有横向交通的小血管,血管网呈梯状或半行的从状.近侧端和远侧端较密而中间部相对稀疏.结论:交叉韧带血供存在如下特点:①中心区为明显的乏血管区;②中间段边缘区也相对乏血管;③韧带两端血供最丰富,且近侧段好于远侧段.     

脊髓髓内动静脉畸形血管构筑学分析及其对治疗的启示

目的　探讨脊髓髓内动静脉畸形(SAVM)的血管构筑从而选择适宜的治疗方式。材料和方法　回顾性分析本中心治疗的120例SAVM病人的临床资料、血管造影影像资料及治疗方法和效果。结果　根据脊髓髓内动静脉畸形团的形状,将AVM分成两种类型：团块型和幼稚型。血管构筑学分析包括供血动脉、供血方式、伴随病变。其供血动脉为脊髓前动脉、脊髓后动脉和/或软膜动脉。经超选择脊髓血管造影可见畸型团有5种构筑方式：(1)终末供血形式,本组104例行栓塞治疗,其中85例单纯栓塞,70例神经功能恢复与改善;19例行术前栓塞、减少术中出血;(2)穿支供血形式本组16例,少量部分的用颗粒栓塞,栓塞后症状均改善;(3)动静脉直接交通1例;(4)AVM伴有动脉瘤13例,首先行动脉瘤栓塞;(5)AVM含有静脉动脉瘤样扩张2例。结论　脊髓髓内AVM的血管构筑学有助于选择治疗方案,终末型供血可行胶栓塞。穿支供血只能少量部分的用颗粒栓塞。AVM内的动脉瘤应首先栓塞,可明显减少再出血的危险。团块型AVM术前栓塞有利于手术切除。幼稚型AVM只能栓塞治疗。     

下颌骨血供及血管构筑的临床解剖学研究

目的：研究下颌骨血供及其血管构筑，为下颌骨截骨术提供形态学基础。方法：15例新鲜头颈部标本，其中8例经颈总动脉注入红色过氯乙烯填充剂，经腐蚀后制成头部血管铸型标本；2例去除部分内侧骨皮质，显示下牙槽动脉的分支分布情况；其余5例注入5％明胶墨汁，经脱钙、漂白、乙醇梯度脱水和二甲苯透明后，用水杨酸甲酯继续透明和保存，观察下颌骨膜和骨内的血管构筑。结果：下颌骨内部主要由下牙槽动脉供血；下颌骨表面及骨膜则由下颌骨骨膜动脉和肌动脉骨穿支营养；下颌骨骨膜动脉和肌动脉骨穿支经过下颌骨副孔穿入下颌骨内，与下牙槽动脉分支互相吻合，使下颌骨骨内与骨周围软组织间构成丰富的血管交通构筑。结论：下颌骨截骨手术后移动骨块和施行骨内固定时，要尽量少剥离下颌骨周围的软组织，以避免下颌骨发生坏死。     

桡神经臂部血供的显微解剖

目的为临床中修复桡神经长段缺损及利用该神经修复其他神经损伤提供形态学基础。方法对35侧经腋动脉灌注带色乳胶的成人上肢标本,解剖观察供给桡神经营养血管的来源、分布、微血管构筑、营养动脉的外径。结果桡神经接受的营养血管来源分为四种类型;营养血管分布在臂部中段较多;营养动脉起始处外径平均为(0.37±0.03)mm,入神经干处外径平均为(0.28±0.02)mm。结论35侧成人上肢的桡神经全段血供形式可分为3型。在臂部桡神经中,肱深动脉、桡侧返动脉为供给神经血液的主要血管,且大部分集中于中、下1/3段。     

面部真皮下血管网皮瓣血供的解剖学基础

目的 :为面部真皮下血管网皮瓣的血供提供形态学基础。方法 :① 2个新鲜成人尸体头颈部标本 ,分别灌注红色乳胶及明胶墨汁 ,后者制成透明标本 ;②在 10侧头面部铸型标本上 ,观测面部血管分布 ;③ 2例头面部血管铸型标本 ,扫描电镜观测血管的形态特点。结果 :面部皮肤血供主要来源于面动脉、颞浅动脉及眶下动脉的分支 ,亦有上颌动脉及眼动脉的终末支分支营养 ,并因区域的不同而具有一定的方向性。它们发出的分支入浅层构成皮下动脉网 ,再由皮下动脉网发出小动脉达真皮层形成真皮下动脉网 ,并相互吻合交通 ,形似“筛网”状。结论 :面部真皮下血管网皮瓣早期主要依赖于蒂部稠密的真皮下血管网供血。临床应用时应考虑其方向性。     

胸腰段脊柱手术与脊髓血供损伤的相关性研究

目的：为减少手术中对脊髓血供损伤和设计合理脊柱手术入路提供基础。方法：20俱尸体运用解剖、血管铸型及9例成年人常规进行超选择性脊柱脊髓血管造影等方法，对脊柱脊髓血管应用解剖较系统地研究，了解脊柱脊髓血供及代偿通路。结果：①节段动脉在肋横突关节内侧椎间孔部发出根髓动脉。②胸段毗邻的肋间动脉吻合主要是椎间孔周围和骶棘肌内两处；而腰段还有椎体侧面的髂腰肌和腰大肌中的吻合。③超选择性血管造影显示胸、腰段，毗邻的节段动脉之间及与对侧同名动脉之间有广泛吻合。胸段动脉多见以横向连接吻合，而腰段除此之外还可见明显的动脉上下2～3节段侧支吻合。结论：①脊柱前路矫形应在根髓动脉分支前，结扎多个节段血管，脊髓血供可以通过后方代偿，能避免累及脊髓根髓动脉产生脊髓损伤；②侧前入路应在根髓动脉分支后，经胸、腰段毗邻的动脉之间，椎间盘切除或椎间隙减压伤及根髓动脉出现脊髓损伤机率最小。③后入路截骨选择经过椎弓、椎体中部截骨损伤血管最少。     

Quantitative measurement of spinal cord blood volume in humans using vascular-space-occupancy MRI

Although perfusion is of major interest for many spinal cord disorders, there is no established, reproducible technique for evaluating blood flow or blood volume of the spinal cord in humans. Here the first report of in vivo measurement of human spinal cord blood volume (scBV) is presented. An FDA-approved contrast agent, Gd-DTPA, was used as an intravascular agent for the cord parenchyma, and pre-/post-contrast vascular-space-occupancy (VASO) MRI experiments were performed to obtain a quantitative estimation of scBV in mL blood/100 mL tissue. VASO MRI was used because it does not rely on knowledge of an arterial input function, it avoids the imaging artifacts of single-shot echo planar imaging approaches, and it requires only relatively simple and direct calculations for scBV quantification. Preliminary tests at 1.5 T and 3 T gave mean +/- SD scBV values of 4.3 +/- 0.7 ml/100 mL tissue (n = 6) and 4.4 +/- 0.7 ml/100 mL tissue (n = 4), respectively, consistent with the expectation that the scBV values would not be field-dependent.     

Nontumor lesions of spinal cord and spine

Nontumor lesions of the spinal cord and spine include developmental disorders, cystic tumor-like lesions, vascular disorders, infective diseases, demyelinating diseases, degenerative diseases, metabolic and toxic disorders, and spinal cord injury. In addition, diseases of the spine and extradural spaces secondarily cause spinal cord injury. Aside from tumors, these include developmental abnormalities, inflammatory diseases, nontumor space-occupying lesions, and tumor-like lesions such as lipomas, vascular malformations, and cysts. Awareness is required of hemostatic agents used during surgery and subsequently presenting as space-occupying lesions, which have to be differentiated from recurrent lesions. On the therapeutic front, stem cell transplantation into spinal cord for treatment of neurodegenerative disorders, spinal cord injury, and multiple sclerosis is a challenging prospect.     

Effect of cyclosporin A on functional recovery in the spinal cord following contusion injury

Considerable evidence has shown that the immunosuppressant drug cyclosporin A (CsA) may have neuroprotective properties which can be exploited in the treatment of spinal cord injury. The aim of this study was to investigate the cellular environment within the spinal cord following injury and determine whether CsA has an effect on altering cellular interactions to promote a growth-permissive environment. CsA was administered to a group of rats 4 days after they endured a moderate contusion injury. Functional recovery was assessed using the Basso Beattie Bresnahan (BBB) locomotor rating scale at 3, 5 and 7 weeks post-injury. The rats were sacrificed 3 and 7 weeks post-injury and the spinal cords were sectioned, stained using histological and immunohistochemical methods and analysed. Using stereology, the lesion size and cellular environment in the CsA-treated and control groups was examined. Little difference in lesion volume was observed between the two groups. An improvement in functional recovery was observed within CsA-treated animals at 3 weeks. Although we did not see significant reduction in tissue damage, there were some notable differences in the proportion of individual cells contributing to the lesion. CsA administration may be used as a technique to control the cell population of the lesion, making it more permissive to neuronal regeneration once the ideal environment for regeneration and the effects of CsA administration at different time points post-injury have been identified.     

Shh/Gli1信号参与小鼠脊髓损伤后血-脊髓屏障渗透性改变及运动功能恢复

目的:探讨sonic hedgehog/Gli1(Shh/Gli1)信号在小鼠脊髓损伤后病理变化及运动功能恢复中的作用。方法:成年雄性C57野生型、Gli1lz和Gli1lz/lz小鼠行T8节段脊髓夹伤及假手术。Gli1lz小鼠脊髓损伤及假手术后3 d行X-gal染色;7 d行Shh/PDGFr-α、Shh/GFAP、LacZ/GFAP染色,观察Shh/Gli1信号在小鼠脊髓损伤后的激活。C57野生型和Gli1lz/lz小鼠脊髓夹伤后7 d行GFAP染色和实时定量RT-PCR,观察星形胶质细胞反应;术后14 d尾静脉注射伊文氏兰观察血-脊髓屏障改变;术后1、3、5 d和7 d行BMS评分评价小鼠后肢运动功能。结果:脊髓损伤7 d后,损伤区Shh表达升高;Shh/Gli1信号报告基因LacZ表达升高,主要表达于反应性星形胶质细胞;免疫组织化学及实时定量RT-PCR结果显示Gli1基因敲除不影响脊髓损伤后GFAP表达;伊文氏兰染色及其定量分析显示Gli1lz/lz小鼠脊髓损伤后脊髓组织伊文氏兰外渗增加。BMS评分显示Gli1lz/lz小鼠运动功能恢复显著差于野生型小鼠。结论:Shh/Gli1信号在小鼠脊髓损伤后激活,可能参与脊髓损伤后血-脊髓屏障渗透性的改变,并影响脊髓损伤后的运动功能恢复。     

经椎弓根椎体截骨术治疗脊柱后凸畸形的临床疗效观察

目的：探讨经椎弓根椎体截骨脊柱缩短术治疗并发脊髓神经功能障碍的脊柱后凸畸形的临床疗效。方法将2013年5月至2014年6月期间我院收治的80例并发脊髓神经功能障碍的脊柱后凸畸形患者纳入研究对象,采用随机数字表法分为观察组和对照组各40例,观察组患者接受经椎弓根椎体截骨术治疗,对照组患者接受经椎板和小关节突截骨术,比较2组患者手术情况、椎体愈合和神经功能恢复、治疗效果。结果观察组患者手术时间[(76.52±9.1) min]、术后下床活动时间[(3.28±0.43) d]短于对照组[(113.46±13.44) min,(5.67±0.68) d],术中出血量[(36.14±4.28) mL]、术后引流量[(17.92±2.12) mL]少于对照组[(55.23±7.15) mL,(29.64±4.28) mL]。观察组患者的Cobb角、出现初始尿意和强烈尿意时的膀胱容量[(6.12±0.68) mL,(456.56±51.78) mL]、残余尿量[(241.45±28.56) mL,(63.78±7.24) mL]低于对照组[(9.78±1.21) mL,(335.54±36.86) mL,(586.35±63.12) mL,(96.32±10.22) mL],椎间隙高度[(12.62±2.81) mL]高于对照组[(8.41±1.32) mm]。观察组治疗优良率(97.50%)明显高于对照组(82.50%)。结论经椎弓根椎体截骨脊柱缩短术治疗有助于减小手术创伤,促进术后恢复,纠正后凸畸形,改善神经功能,提高治疗效果。     

MR-based measurement of spinal cord motion during flexion of the spine: implications for intradural spinal cord stimulator systems

This study develops a means of delivering electrical stimuli directly to the pial surface of the spinal cord for treatment of intractable pain. This intradural implant must remain in direct contact with the cord as it moves within the spinal canal. Therefore, magnetic resonance imaging was used to measure the movement of the spinal cord between neutral and flexed-back positions in a series of volunteers (n?=?16). Following flexion of the back, the mean change in the pedicle-to-spinal cord dorsal root entry zone distance at the T10-11 level was (8.5?±?6.0) mm, i.e. a 71% variation in the range of rostral-caudal movement of the spinal cord across all patients. There will be a large spectrum of spinal cord strains associated with this observed range of rostral-caudal motions, thus calling for suitable axial compliance within the electrode bearing portion of the intradural implant.     

Location of the spinal nucleus of the accessory nerve in the human spinal cord

The segmental extent and topography of the spinal nucleus of the accessory nerve (SNAN) was investigated in the adult human spinal cord. Transverse sections of segments between the lower medulla and C6 were stained with cresyl violet and the motor cell columns identified according to the numerical locations defined by Elliott (1942). The segmental extent and topography of the cervical part of column 2 resembled that previously described for the SNAN of primates.     

A rare case of extramedullary spinal cord germinoma

A rare case of spinal cord germinoma in a 20-year-old Japanese female is presented. The tumor was detected at the level of T11 and L3 by myelography. Histological findings of the resected tumor were identical to germinoma, which is characterized by polygonal tumor cells, lymphocytic infiltrate, and granuloma. Tumor cells and lymphocytes reacted with antibodies for placental alkaline phosphatase and CD45, respectively. A few multinucleated giant cells, negative immunohistochemically for human chorionic gonadotropin were also seen. The present case is the 10th case of spinal cord germinoma and is thought to be the first case of such a tumor located extramedullary. Diagnosis of such a rare tumor in an unusual location needs proper histological, ultrastructural and immunohistochemical evaluation.