拉力螺钉内固定骶髂关节的影像学与三维重建研究

目的为经髂后下棘与髂结节连线置入拉力螺钉内固定骶髂关节术式提供解剖学基础。方法用60例正常成人骨盆CT数据(男、女各30例)导入mimcs15.01进行三维重建,从骶骨耳状面长轴与S1、S2、S3椎弓根中轴的交点置入螺钉。测量各螺钉与冠状面夹角α及水平面的夹角β。结果 (1)3根螺钉在髂骨翼外侧的穿出点在髂后下棘与髂结节的连线上(2)α、β角分别为男:α1(13.6±3.7)°、α2(4.3±1.8)°、α3(10.0±4.4)°;β1(19.1±5.3)°、β2(9.5±4.1)°、β3(4.0±1.5)°。女:α1(12.4±3.4)°、α2(4.5±2.1)°、α3(10.7±4.0)°;β1(17.5±4.6)°、β2(10.0±4.1)°、β3(3.7±1.5)°。结论经髂后下棘与髂结节连线上确定的进针点置入拉力螺钉内固定骶髂关节安全简便。     

髋臼前柱拉力螺钉内固定的定量解剖学研究

目的 :为髋臼前柱拉力螺钉内固定提供解剖学基础。方法 :取半骨盆标本 3 0个 ,自髋臼切迹至髋臼上缘作系列截骨面 ,用一斯氏针由最小截面的圆心逆行打入 ,在髂骨后外侧穿出点为P。将该截面下方的系列截面解剖复位 ,再将斯氏针顺行打出 ,测量其在髋臼前柱骨皮质内的长度。作一参考线AB ,其中A为髂前上、下棘间的切迹 ,B为坐骨大切迹 ,并作AB的中垂线CD。结果 :P位于AB的中垂线上 ,P点距AB的距离为 (15 .3± 4.7)mm ,斯氏针与AB的夹角为 (90 .1± 4.7)° ,与CD的夹角为 (2 5 .3± 3 .9)° ,髋臼前柱骨皮质内斯氏针长度为 (82 .0± 7.9)mm。最小截面位于髋臼切迹上方 15 .0mm处 ,该截面平均直径为 :(5 .2± 1.9)mm。结论 :髋臼前柱拉力螺钉的入钉点在髂前上下棘之间切迹与坐骨大切迹连线中点上方 (15 .3± 4.7)mm处 ,其进针方向与该线呈 (90 .1± 4.7)° ,与该线中垂线呈 (2 5 .3± 3 .9)° ,该拉力螺钉直径为 (5 .2± 1.9)mm ,长度为 (82 .0± 7.9)mm。     

CT辅助导航经皮骶髂螺钉内固定路径

目的:探讨CT辅助导航经皮骶髂螺钉内同定术的定位和路径.方法:60个成年健康志愿者行S1～3多层螺旋CT扫描,由计算机重构图像后测量通过椎弓根狭窄处中心点与正中推辞矢状面之间的角度、椎弓根高度和宽度等参数,根据这些数据确定体表进钉点、进钉角度和螺钉长度,结果:S1进针点距离后正中线(91.03±10.62)mm,同侧髂嵴后部(41.16±8.80)mm,位于通过髂后上棘连线的骶骨层面头侧(11.29±5.87)mm,进钉方向与水平而夹角(30.76±5.34)°,欠状而(48.76±9.43)°,最佳长度(84.59q±5.29)mm.S2体表进针点距离后正中线(127.82±15.63)mm,同侧髂嵴后部(59.34±9.03)mm,位于通过髂后上棘连线的骶骨层而尾侧(15.35±5.50)mm,进钉方向与水平面夹角(30.76±5.34)°,矢状面(61.15±8.38)°,最佳长度(64.04±6.65)mm.仰卧位和俯卧位骶骨倾斜度差别无统计学意义(P＞0.05),结论:(1)经多层螺旋CT扫描图像分析确、上的体表进钉点、进钉角度和螺钉长度可直接引导经皮骶髂螺钉内固定术;(2)分析确立的由CT扫描导航经皮骶髂螺钉内固定手术定位和路径为临床骶髂关节修复手术提供了一种快速、准确、安全的方法.     

应用3D打印技术改良髂骨螺钉技术的解剖测量与设计

目的 运用CT三维重建及3D打印技术进行改良髂骨螺钉技术的相关解剖学观测及钉道设计,探讨改良髂骨螺钉技术的可行性。方法 回顾性纳入2015年4月—2017年3月佛山市中医院60例患者骨盆CT检查数据,其中男女各30例,年龄21~65岁,骨骼发育均成熟且排除骨盆疾病。首先采用患者CT DICOM数据,使用Mimics Research 21.0软件进行骨盆CT三维重建,利用3D打印技术制作骨盆3D打印模型。在60例骨盆CT三维重建模型上,分别按照传统髂骨螺钉(对照组)和改良髂骨螺钉(改良组)两种不同方法模拟植钉,测量最大进钉深度、尾向倾角、外向倾角、入钉点与髂后最高点垂直距离、与中线距离、钉道最窄髂骨厚径,测量数据分别纳入对照组和改良组,并进行组间、组内比较。在骨盆3D打印模型上采用改良髂骨螺钉技术分别植入直径7.5 mm长80 mm的髂骨螺钉,观察植钉成功率以及有无螺钉穿出或钉道受阻情况。结果 改良组以髂后上棘向尾侧1 cm处、髂骨缘内半中心点为进钉点,以髂前下棘与髋臼上缘中点为进钉方向,尾向倾角为28.6°±4.2°、外向倾角为32.8°±4.9°,为改良组的髂骨螺钉钉道。对照组的最大进钉深度(123.6±5.0)mm、钉道最窄髂骨厚径(14.5±3.6)mm、尾向倾角29.5°±2.1°、外向倾角31.4°±5.1°,与改良组的最大进钉深度(122.1±5.8)mm、钉道最窄髂骨厚径(15.4±2.7)mm、尾向倾角28.6°±4.2°、外向倾角32.8°±4.9°比较,差异均无统计学意义(P值均＞0.05)。对照组的入钉点与髂后最高点垂直距离(0.0±0.0)mm、与中线距离(44.3±4.9)mm,与改良组的入钉点与髂后最高点垂直距离(16.5±2.9)mm、与中线距离(32.1±4.3)mm比较,差异均有统计学意义(t=44.072、14.496, P值均＜0.05)。改良组中男性最大进钉深度(124.9±6.1)mm、外向倾角33.4°±5.6°、入钉点与髂后上棘垂直距离(17.3±1.9)mm、与中线距离(33.2±3.8)mm、钉道最窄髂骨厚径(15.5±2.9)mm,与女性最大进钉深度(122.3±5.5)mm、外向倾角32.2°±5.6°、入钉点与髂后上棘垂直距离(16.1±2.9)mm、与中线距离(31.0±4.8)mm、钉道最窄髂骨厚径(14.9±2.9)mm比较,差异均无统计学意义(P值均＞0.05),改良组中男性尾向倾角30.3°±3.6°与女性尾向倾角26.9°±4.5°比较,差异有统计学意义(t=3.232, P＜0.05)。60例3D打印模型均顺利植入髂骨螺钉,植钉成功率100%,未见螺钉穿出或钉道空间受限情况。结论 改良螺钉钉道的最大进钉深度、钉道最窄厚径、尾向倾角、外向倾角恒定,均能满足长度为8 cm、直径7.5 mm的髂骨螺钉,符合临床髂骨螺钉的植入安全性;改良后的进钉点与髂后最高点垂直距离、与中线距离,较传统进钉点更接近L₅、S₁椎弓根螺钉进钉点所在的直线,方便安装,并可降低进钉点切迹,减少并发症。改良髂骨螺钉是髂腰固定手术中一种较佳的髂骨植钉方式。     

经皮骶髂螺钉内固定术的应用解剖学研究

目的:为骶髂关节骨折脱位经皮螺丝钉固定提供解剖学依据。方法:50块干燥成人骶骨及30个骨盆防腐标本,测量S1、S2侧突、侧块厚度等指标,观察骶髂关节周围神经血管分布,定位进针点;通过标本断层及正常骨盆CT片测量螺钉进针方向及深度。结果:S1侧突高度为(22.1±4.6)mm,厚度为(27.8±3.1)mm,S2侧突高度为(13.4±3.6)mm,厚度为(20.9±2.2)mm。S1进针点位于髂前上棘-髂后上棘连线中后1/3交点附近,S2进针点位于髂结节-髂后上棘连线前4/5与后1/5交点附近。S1侧突中轴与矢状面夹角约为55°,S2则约为80°,S1侧突中轴与冠状面的夹角约为36°,S2则约为15°。结论:(1)S1侧突能容纳直径为6.5～7.0mm的螺丝钉2枚,S2侧突可容纳1枚。(2)S1侧突螺丝钉进针方向与矢状面夹角约为55°,与冠状面夹角约为36°;对S2则分别约为80°和15°。S1进针深度为68mm,S1为55mm。(3)经皮骶髂螺丝钉固定手术应严格限制在骨折精确复位的病例。     

脊柱骨盆固定中髂骨钉的应用解剖学

目的 探讨脊柱骨盆固定术中髂骨钉入钉点、钉长及直径、植钉方向,为其正确植入提供解剖学依据. 方法 选用35侧成人尸体髋骨标本(左16侧,右19侧,男30侧,女5侧),经髂后上、下棘间切迹上缘至坐骨大切迹顶弧做一直线并延续至髋臼缘,定为基线(a),通过坐骨棘和髂前上棘做一直线(b),该线与a线相交于C点上.经过a线和C点在髂骨后部向上做5°、10°、15°、20°、15°、30°、35°的扇形线,之后经过10°～30° 5个角度做髂骨斜截面.观察各斜截面形态,并从截面上面进行相关数据测量.同时观察髂骨后部内外侧唇、中间线的形态和可辨性.确定髂骨钉入钉点、直径、长度及进钉方向后,以2具尸体标本进行验证. 结果 35°扇形线已到达髂窝,髂骨臀盆面间距明显变窄,5°扇形线紧邻坐骨大切迹弧顶,坐骨大切迹弧顶A点到各截面垂直距离变短明显. f线在各截面最为狭窄. 髂骨后部中间线明显可辨,呈一规则弧形,为后部髂嵴最凸出部,在所选实验标本中均可观察到.进钉点至髋臼顶软骨距离(k)测得值最小为109.38mm. 结论 通过基线(a)、C点及10°～30°之间髂骨外侧板能准确、安全植入髂骨钉;钉长以不超过100mm、直径不超过9mm为宜.     

腰椎-髂骨固定的临床解剖学研究

目的:通过对成人尸体髂骨固定的相关数据进行测量,提出髂骨后柱的概念,为腰椎-髂骨固定提供临床解剖学依据。方法:选用保存完好的尸体骨及干燥骨。设定髂前下棘下缘向后经过臀后线与髂嵴后部交叉点的连线截面为A线截面,此线与Chiotic线平行(Chiotic线与髂嵴后部交叉点称为CLIC点)。沿A线和Chiotic线截断髂骨,测量以下数据:髂骨后柱的长度、宽度和高度,观察坐骨大切迹及髂粗隆的解剖学形态;用该技术治疗骶骨骨折5例,骶骨肿瘤6例。结果:髂骨后柱的平均长度为110.57mm,宽度24.24mm;高度有两个,标准高度是坐骨大切迹顶弧到弓状线的垂直高度14.54mm,安全高度是坐骨大切迹顶弧到A线截面的距离31.46mm。CLIC点距坐骨大切迹前支85.43mm。结论:髂骨后柱是髂骨后部的承重骨骼,可容纳7mm直径的髂骨棒植入。     

术前应用螺旋CT个体化测量在骶髂关节置钉中的意义

目的　探讨切开复位骶髂螺钉内固定术前应用螺旋CT个体化测量健侧螺钉钉道参数,指导术中置钉的可行性。 方法　⑴对10例冰冻正常成人骨盆标本进行螺旋CT扫描与多平面重组,在不同重组图像中依次测量左右侧S1螺钉的进针方向、进针点与髂后上、下棘的距离、钉道的长度与安全角度等参数;⑵将10例骨盆标本左右侧骶髂关节制成垂直不稳定贩折模型,然后左右侧骶髂关节分别根据对侧的CT测量结果进行个体化置钉验证。 结果　⑴进针方向与冠状面、水平面的夹角分别为（25.95±　1.39）°与（19.61±2.97）°,进针点与髂后上、下棘的距离分别为(37.17±2.90)mm与(38.23±1.69)mm,冠、轴状面上的安全角度分别为(19.87±1.61)°与(23.84±2.08) °;⑵左侧骶髂关节所置10枚螺钉均安全、准确地到达S1椎体预定位置;右侧骶髂关节所置螺钉除1枚偏离突出骨质外,其余9枚均安全到达S1椎体预定位置。 结论　切开复位骶髂螺钉内固定术前应用螺旋CT个体化测量健侧螺钉钉道参数,指导术中置钉的方法是可靠的。     

合并腰骶移行椎时应用骶髂螺钉的临床解剖测量

目的　探讨合并腰骶移行椎时骶1、2椎弓根的形态学特点,为应用骶髂螺钉固定提供形态学基础。 方法　选取生前资料完整的标本共79例。对骶1、骶2椎体前后径、椎体高度、椎体横径、椎弓根前高、椎弓根后高、椎弓根宽度、进针深度、进针角度进行测量。 结果　正常骶1椎弓根前高(18.1± 　3.8)mm,后高(20.6±3.6)mm,宽度(27.7±3.1)mm;Ⅱ型骶1椎弓根前高(19.9±2.0)mm,后高(19.2±2.6)mm,宽度(29.9±2.2)mm;Ⅲ型骶1椎弓根前高(18.5±3.0)mm,后高(16.9±3.1)mm,宽度(27.8±2.2)mm。正常骶2椎弓根前高(12.4±2.3)mm,后高(14.34±2.9)mm,宽度(22.2±3.1)mm,Ⅱ型骶2椎弓根前高(10.4±1.5)mm,后高　(14.4±2.4)mm,宽度(19.5±2.7)mm;Ⅲ型骶2椎弓根前高(9.5±2.0)mm,后高(14.0±3.0)mm,宽度(18.6±3.4)　mm。Ⅱ型骶1椎弓根大于正常,Ⅲ型与正常接近。正常骶2椎弓根大于Ⅱ型和Ⅲ型。 结论　合并腰骶移行椎时可应用骶髂螺钉固定,骶1椎弓根可容纳1~2枚螺钉,骶2椎弓根可容纳1枚螺钉。     

CT数字重建技术测量经骶椎后方骶髂关节螺钉固定应用解剖参数

目的 测量经骶椎后方骶髂关节螺钉（sacroiliac screw passing the back of sacrum,SISPTBOS）固定的相关解剖参数,为临床应用提供依据。 方法 分析32例骨盆正常的成人三维CT重建图像,观察SISPTBOS钉道范围,采用CT数字重建技术模拟植入SISPTBOS,测量钉道有关解剖参数,包括钉道长度（L）、进针点与S1上关节中央的距离（M1）、出针点与髋臼后上缘的距离（M2）、前倾角（e）、外倾角（f）、矢状面安全角（a）、冠状面安全角（b）、矢状面钉道最小直径（d1）和冠状面钉道最小直径（d2）。 结果 钉道内侧壁为弓状线,外侧壁为椎管后外侧壁和髂骨外层,下壁为S1骶孔与坐骨切迹的连线,上壁为骶骨翼斜坡、骶髂关节表面和大骨盆底部。L为（11.90±1.62） cm,M1为（2.07±1.40） mm,M2为（4.78±2.57） mm,e为（57.97±4.28）°,f为（54.89±5.13）°,a为（11.45±2.73）°,b为（7.46±1.34）°,d1为（8.57 ± 0.99）mm,d2为（6.75±0.84） mm。男女比较,仅e和f存在显著性差异（P<0.05）。 结论 可选择直径5.0~6.0 mm、长度9~10 cm螺钉作为SISPTBOS固定。该通道植入螺钉可行,较为安全。     

Asymmetry of the internal connections of the striate cortex of the cat in the projection zone of the center of the field of vision

Studies were carried out on the organization of the internal connections of the striate cortex in cats in the projection zone of the center (0–5°) of the field of vision by microintophoretic application of horseradish peroxidase to electrophysiologically identified orientational columns. The area containing neurons showing retrograde labeling in most cases extended in the mediolateral direction. Labeled cells were located in the upper (II, III) and lower (V, VI) layers of the cortex, and the shapes and orientations of the areas containing labeled neurons in these layers coincided. Spatial asymmetry was detected in the distribution of labeled neurons relative to the orientational column studied. Labeled cells were located predominantly medial to the columns, regardless of the distance from the projection of the area centralis. Considering the visuotopical map of field 17, the asymmetry detected here provides evidence that neurons in orientational columns have more extensive connections with neurons of the peripheral part of the cortex. An asymmetrical distribution of “silent” zones around the receptive fields of neurons in orientational columns is suggested, and that these appear to receive influences from the periphery of the visual field. Laboratory of Visual Physiology and Laboratory of Central Nervous System Morphology, I. P. Pavlov Institute of Physiology, Russian Academy of Sciences, 6 Makarov Bank, 199034 St. Petersburg, Russia. Translated from Fiziologicheskii Zhurnal imeni I. M. Sechenova, Vol. 82, No. 12, pp. 23–29, December, 1996.     

Effects of the lesion of the postcommissural part of the septum on the behavior of the rat.

The effects of the lesion of the postcommissural part of the septum on behavior of the rat has been studied. Results may be summarized as follows. An increase in the exploratory behavior in the open field which decreases rapidly; a decrease in the number of defecations in this test and a decrease in time leaving a dark environment for exploration. In the shuttle box test, no facilitation of the acquisition, but a permanent and quite significant increase in the intertrial activity has been found. We conclude that the lesions tend to decrease the emotivity of the subjects. An interpretation on the basis of the species -- specific defensive reactions explains the transitory and permanent effects of the lesions on the spontaneous activity.     

Counterpointing the functional role of the forebrain and of the brainstem in the control of the sleep-waking system

This paper reviews the lifetime contributions of the author to the field of sleep-wakefulness (S-W), reinterprets results of the early studies, and suggests new conclusions and perspectives. Long-term cats with mesencephalic transection show behavioral/polygraphic rapid eye movement sleep (REMS), including the typical oculo-pupillary behavior, even when the section is performed in kittens prior to S-W maturation. REMS can be induced as a reflex. Typical non-rapid eye movement S (NREMS) is absent and full W/arousal is present only after a precollicular section. The isolated forebrain (IF) rostral to the transection exhibits all features of W/arousal and NREMS [with electroencephalographic (EEG) spindles and delta waves], arousal to olfactory stimuli, and including the appropriate oculo-pupillary behaviors. These features also mature normally after neonatal transection. REMS is absent from the IF. After deprivation there is NREMS pressure and rebound in the IF, but the decerebrate cat only shows pressure for REMS. Most IF reactions to pharmacologic agents are within expectations, except for the tolerance/withdrawal effects of long-term morphine use which are absent. In contrast, these effects are supported by the brainstem (i.e. seen in the decerebrate cat). In cats with ablation of the telencephalon, or diencephalic cats, delta waves are absent in the thalamus. EEG thalamic spindle waves are seen triggering S for only 4-5 days after ablation. Therefore, true NREMS is absent in chronic diencephalic cats although pre- and postsomniac behaviors persist. These animals are hyperactive and show a pronounced, permanent insomnia; however, a low dose of barbiturate triggers a dramatic REMS/atypical NREMS rebound. Cats without the thalamus (athalamic cats), initially show a dissociation between behavioral hyperactivity/insomnia and the neocortical EEG, which for 15-20 days exhibits only delta and slower oscillations. Fast, low-voltage W rhythms appear later on, first during REMS, but spindle waves and S postures are absent from the start, such that these cats also display only atypical NREMS. Athalamic cats also show barbiturate-sensitive insomnia. Cats with ablation of the frontal cortices or the caudate nuclei remain permanently hyperactive. They also show a mild, but significant hyposomnia, which is permanent in afrontal cats, but lasts for about a month in acaudates. The polygraphic/behavioral features of their S-W states remain normal. We conclude and propose that: (a) the control of the S-W system is highly complex and distributed, but is organized hierarchically in a well-defined rostro-caudal manner; the rostral-most or highest level (telencephalon), is the most functionally complex/adaptative and regulates the lower levels; the diencephalic/basal forebrain, or middle level, has a pivotal role in inducing switching between S and W and in coordinating the lowest (brainstem) and highest levels; (b) W can occur independently in both the forebrain and brainstem, but true NREMS- and REMS-generating mechanisms exist exclusively in the forebrain and brainstem, respectively; (c) forebrain and brainstem S-W processes can operate independently from each other and are preprogrammed at birth; this helps understanding normal and abnormal polygraphic/behavioral dissociations in humans and normal dissociations/splitting in aquatic mammals; (d) NREMS homeostasis is present in the IF, but only REMS pressure after deprivation persists in the decerebrate cat; (e) the thalamus engages in both NREMS and W; (f) insomnia in diencephalic cats is the result of an imbalance between antagonistic W- and S-promoting cellular groups in the ventral brain (normally modulated by the telencephalon); (g) the EEG waves, which are signature for each S-W state, appear to truly drive the concomitant behaviors, e.g. a hypothetical human IF could alternate between behavioral NREMS and W/arousal/awareness; (h) a role for REMS is to keep the individual sleeping at the end of the self-limiting NREMS periods. The need for accelerating research on telencephaling NREMS periods. The need for accelerating research on telencephalic S-W processes and downstream control of the lower S-W system levels is emphasized.     

The development of the ligament of the head of the femur

The hip joints of 30 human male and female fetuses and stillborns between 20 mm and 350 mm crown-rump length were studied by light microscopy. The ligament of the head of the femur developed in situ as a condensation of mesenchyme at the end of the second month of intra-uterine life (IUL), and was vascularized by branches of acetabular vessels early in the fourth month. In the majority of fetuses older than 5.5 months IUL, vessels in the ligament passed a short way into the femoral head within cartilage canals, to supply a small region around the fovea capitis. The remainder of the head was supplied by vessels in canals from around the upper part of the neck. The ligament changed from predominantly cellular to fibrous during the last 4 months of IUL. This increase in strength suggested significant mechanical functions in utero: limitation of adduction-flexion and opposition to postero-superior dislocation were the most likely.     

Topical organization of the projections of neurons of the substantia nigra and the ventral field of the tegmentum of the midbrain to the head of the caudate nucleus of the cat

Neuroscience and Behavioral Physiology -     

Involvement of the striatum in the central regulation of the hormonal functions of the gonads

Studies reported here show that intrastriatal administration of corticoliberin to rats decreases the blood testosterone level. However, in conditions of chemical deficiency of dopaminergic transmission in the dorsal striatum induced by injection of 6-hydroxydopamine, the effect of this neurohormone did not appear. It is concluded that extrahypothalamic corticoliberin is involved in regulating the hormonal reproductive system acting via dopaminergic mechanisms. Translated from Rossiiskii Fiziologicheskii Zhurnal imeni I. M. Sechenova, Vol. 85, No. 4, pp. 594–597, April, 1999.     

Ultrastructure of the endothelium of the drainage system of the eye

The endothelium of the ocular drainage system (Schlemm’s canal, collector tubules, and aqueous veins) in primary juvenile glaucoma undergoes degenerative dystrophic changes with compensatory hypertrophy and proliferation at the initial stages of the glaucomatous process and atrophy and desquamation at advanced and terminal stages. Progressive decrease in the pinocytous function of endotheliocytes, reduction of the protein-synthesizing and mitochondrial compartments of the cytoplasm, and formation of autophagosomes reflect the process of endotheliocyte degeneration in general. __________ Translated from Byulleten’ Eksperimental’noi Biologii i Meditsiny, Vol. 145, No. 5, pp. 574–577, May, 2008