扬子鳄附肢关节的初步研究

观察了６例扬子鳄附肢骨骼的连结情况，并对前、后肢各主要关节的结构和功能进行了比较，发现肩带仅以上喙软骨与胸廓相连，腰带形成完整的骨环；肩臼鞍状，髋臼大而浅；肩关节和髋关节结构相似，囊的前下方无有滑膜襞，但后者关节囊较厚，且囊内有韧带；肘关节和膝关节结构亦相似，膝关节内尚有半月板和交叉韧带；足关节较复杂；掌指、跖趾和指、趾间关节均为屈戌关节；指、趾短伸、屈肌肌健分别止于爪的基部背、腹侧。     

腰椎间关节滑膜嵌顿的解剖

在20具成人腰部脊柱标本上观察了腰椎间关节的结构。椎间关节囊的前、后壁紧张,上、下壁松弛.关节腔的上、下两极被滑膜皱襞填充.关节滑膜内有神经纤维,可能与痛觉有关.当关节运动和多裂肌收缩不协调时,滑膜皱襞可能被嵌于椎间关节面之间而导致腰背痛.     

椎间关节滑膜嵌顿综合征的解剖学基础

目的：为椎间关节滑膜嵌顿综合征的诊治提供解剖学基础。方法：解剖观察成人脊柱标本７条（共１７５对３５０个椎间关节）。观察椎间关节滑膜层及纤维层的结构特点。结果：椎间关节囊外为纤维层，内为较薄的滑膜层。关节囊包绕相邻上下关节突，关节腔狭小。滑膜层在相对关节面周缘，并形成双层突向关节腔内的滑膜皱襞，９０．６％有滑膜皱襞，依其根部连接滑膜层的部位分Ⅰ、Ⅱ、Ⅲ和Ⅳ型，依滑膜皱襞伸入关节腔内长度分Ⅰ、Ⅱ度。结论：滑膜皱襞的嵌顿是引起椎间关节滑膜嵌顿综合征的形态学基础。     

颈椎间关节关节面的形态、面积及其力学分析

在45套(男25,女20)通辽地区出土的干燥成人骨骼标本上,观测了颈椎间关节关节面的形态和面积。颈椎间关节关节面的形态可分为圆型、椭圆型和不规则型,各节段均以椭圆型占优势。各节段下关节突关节面的面积均大于上关节突关节面的面积,但仅颈4～5和颈5～6节段有显著性差异。     

膝关节半月板的形态学研究进展

膝关节由股骨下端、胫骨上端和髌骨组成,是全身关节中负重多而运动量大的关节。在构造上,膝关节除具有关节软骨面积最大和滑膜最多的特点外,在关节内尚有前、后交叉韧带及内、外侧半月板;在功能上,膝关节不仅是一个屈戍关节,又因半月板的形状和活动功能,使之具有某些球窝关节特征。因此,膝关节不仅能屈伸。还具有一定范围的旋转运动。上述复杂的构造及多轴化的运动,致膝关节损伤和疾患的发病率较高,其中半月板撕裂达2/3以上,其病损亦日趋复杂,相应地要求临床诊断更为精细、准确。因此,掌握半月板的解剖,对其病损的诊治大有裨益。本文对膝关节半月板的形态、功能及临床影像解剖学的有关报道,综述如下。     

生长因子在关节软骨损伤修复中的应用进展

关节是人体重要的运动器官,其组织结构特殊,成熟关节软骨组织没有血供,一旦损伤难以自愈.临床上常用的关节软骨损伤修复手段有微骨裂术、关节软骨移植、关节置换术、软骨组织工程等,但这些方法的修复效果都不理想.生长因子是体内组织分泌的一种具有生物活性的物质,可促进细胞生长、增殖、迁移和分化.软骨发育过程中有许多生长因子参与,如成纤维细胞生长因子(FGF)、骨形态发生蛋白(BMP)、胰岛素样生长因子(IGF)等.研究显示,在关节软骨修复过程中加入外源性生长因子可有效促进关节软骨损伤的修复.对目前应用于关节软骨损伤修复研究中的生长因子进行综述,讨论这些生长因子在关节软骨发育及其在关节软骨修复中的作用,分析生长因子在关节软骨修复应用中存在的问题.     

腰椎椎间关节滑膜皱襞的解剖学研究及成人儿童的比较

目的：研究腰椎椎间关节滑膜皱襞的解剖学组织结构，探讨其临床价值。方法：对24具成人腰椎脊柱标本和40具儿童腰椎脊柱标本的解剖，观测腰椎间关节内滑膜皱襞的结构。结果：无论成人还是儿童，各腰椎间关节均可出现滑膜皱襞。两者比较，成人滑膜皱襞的出现率为85．9％高于儿童（35．9％），且成人以大中型滑膜皱襞为主，而儿童以小型为主。成人滑膜皱襞主要出现在外上（14．6％）、外下（16．6％）及外侧（17％），而儿童主要出现在上（20_3％）、下缘（27．1％），成人与儿童的滑膜皱襞的形态均以片状为主。结论：成人腰椎椎间关节滑膜皱襞的出现率高，以大中型滑膜皱襞为主，这很可能是腰椎椎间关节滑膜皱襞嵌顿多见于成人，而儿童少见的解剖学基础，也可能是成人较儿童腰背痛多见的原因之一。     

半月板切除对急性关节软骨损伤愈合影响的实验研究

目的　探讨半月板切除对急性关节软骨损伤 (缺损 )愈合的影响。方法　分离收集 5月龄新西兰兔 35只。,将新西兰兔的股骨内髁行钻孔术造成深达软骨下骨的全层关节软骨缺损模型 ,右膝为实验组 ,切除半月板 ;左膝为对照组 ,保留半月板 ,于 10周取材行大体、组织学、透射电镜观察。结果　大体观察 :10周时对照组关节软骨缺损已由泛白色的类似于正常关节软骨的组织修复 ,而实验组修复组织表面有裂隙、剥脱等迹象。组织学观察 :10周时对照组的关节软骨缺损已基本由软骨下骨的软骨细胞层修复 ,而实验组修复组织表层软骨结构存在裂隙 (纤维性变 )、剥脱等不良改变。透射电镜观察显示 :10周时实验组修复组织表层软骨细胞很多发生凋亡 ,而对照组软骨细胞结构基本正常。结论　表明半月板切除诱发了全层关节软骨缺损修复组织表层软骨结构中的软骨细胞发生凋亡 ,导致裂隙、剥脱等不良改变。半月板是不可缺的生理结构 ,它有极其重要生物学功能 ,即通过维持正常的生物力学环境 ,保证急性关节软骨损伤修复     

85例半月板损伤与关节软骨损伤相关性研究

目的探讨关节软骨损伤与半月板破裂的关系.方法85例共96膝半月板损伤患者,按受伤到手术时间参考Keene时间划分标准分为三组①急性期组;②亚急性期组;③慢性期组.观察半月板损伤的部位、形态及病程与关节软骨破坏程度范围之间的关系.结果整个病例组均有不同程度的软骨病损.其中急性损伤的软骨病损多为Ⅰ-Ⅱ度,亚急性损伤软骨病损为Ⅱ-Ⅲ度,慢性损伤以Ⅲ度为主,开始出现Ⅳ度病损.9例交叉韧带损伤及14例盘状半月板损伤的患者软骨损伤明显较同期患者严重.软骨损伤程度与半月板破裂时间成正相关(P＜0.01).结论半月板破裂能导致软骨损伤,同时软骨损伤能加重半月板损伤.应早期诊断和治疗半月板破裂,减少伤残的发生.     

强直性脊椎炎骶髂关节早期改变的MRI诊断

目的:探讨强直性脊柱炎(AS)骶髂关节(SIJ)早期改变的MRI表现及诊断。方法:回顾性分析经病理证实的50个AS骶髂关节早期改变的MRI表现。结果:MRI显示47个SIJ滑膜软骨异常,在这些关节中骨髓水肿、骨髓内脂肪沉积分别有45、28个,骨质侵蚀及骨质硬化各有15、6个。MRI动态增强发现在这47个滑膜软骨异常的关节中,30个轻度强化,17个明显强化。3个关节MRI未见异常,动态增强示这3个关节无异常强化。结论:关节滑膜软骨异常、骨髓水肿、脂肪沉积等是AS骶髂关节早期改变的MRI重要征象,可作为MRI诊断早期AS的依据。     

颈椎横突孔及其附近骨性结构的观察

作者观察356个颈椎(51具成人干燥骨骼)的横突孔。观察有关横突孔指向、圆度、变异及其附近骨性结构的骨赘和横突孔内骨棘诸项内容,对变异、骨赘和骨棘的好发部位及临床意义进行讨论。     

Macroscopic and histological observations on the human sternoclavicular joint disc

To know the detailed morphology of the human sternoclavicular joint and its articular disc is essential to understanding the movement of this joint and the functional role of the disc. In the present study, 51 articular discs of the sternoclavicular joint of 29 Japanese cadavers were macroscopically examined and then embedded in paraffin to make a complete series of coronal sections for light microscopic observation. We classified the articular discs into three types, discoid, ring, and meniscoid. The discoid-type disc was flattened and round in shape, whereas the other two types had partial defects in the centers (ring type) or in the periphery (meniscoid type). We found the bony process that protruded from the sternal end of the clavicle and fitted into the defect part of the ring- or meniscoid-type discs. The mean values of this bony process of the clavicle adjacent to the articular disc were 2.1, 4.7, and 6.0 mm, respectively, in the three types of articular disc. The movement between the articular disc and the clavicle may be limited, because the articular disc was directly attached to the clavicle on its medial region. The present histological observation demonstrated that the sternal side of the disc was composed of fibrocartilage and dense connective tissue. The clavicular side of the disc was composed of only fibrocartilage. The clavicular side of the articular disc of the sternoclavicular joint has the function of resisting the compressive load to the clavicular surface.     

Synovial recesses and bursae of the lumbosacral joint]

There are four types of cavities of the lumbosacral joints. Type A: The synovial membrane is all around attached to the margin of the articular facet of the superior articular process of the sacrum. Type B: The synovial membrane extends to the posterior surface of the sacrum forming a recess at the root of the superior articular process; this recess communicates widely with the cavity of the joint. Type C: The synovial membrane also forms a recess similar to that of type B, but the gap of communication is narrowed by a fibro-adipose meniscoid. Type D: The synovial membrane is attached in the same way as described in type A; besides a synovial bursa non communicating with the cavity is found at the root of the superior articular process. We have found 43% showing type A, 33% type B, 16% type C and 8% type D. The recesses and bursae described above enable the inferior articular process of the fifth lumbar vertebra to slide at the posterior surface of the sacrum, thus avoiding a painful rubbing during dorsiflexion of the lumbar spine. The existence of these sliding facilities does not depend on the range of the lumbosacral angle nor on the quality of the lumbosacral intervertebral disc.     

Experimental haemarthrosis in rhesus monkeys: morphometric, biochemical and metabolic analyses

The effects of a single episode of massive haemarthrosis in rhesus monkeys were studied. Autologous whole blood was injected into a femorotibial joint of 16 anaesthetized monkeys, equally divided into four groups and killed 7 days, 2, 3 and 6 months post-injection (PI). Synovial membrane and femoral articular cartilage were analysed morphometrically and articular cartilage was further analysed biochemically and metabolically. At 7 days PI, morphometric evaluation revealed a significant increase (P less than 0.05) in synovial membrane cellularity and synovial intimal thickness of injected joints versus control joints. This change was no longer evident 2 months PI. There was also an overall (n = 16) significant increase (P less than 0.05) in femoral articular cartilage cellularity in injected joints. The average chondrocyte lacuna area of injected joints was not statistically different from the control joints. Biochemical analyses of femoral articular cartilage revealed a significant decrease in hexosamine concentration (P less than 0.05) of injected joints. There was no significant difference between the injected and control joints in hydroxyproline or total protein concentration. Metabolic analyses revealed a significant increase (P less than 0.05) in cartilage collagenous protein production by injected joints compared with control joints. There were no significant differences in cartilage or secreted total protein production between injected and control joints. There were also no significant differences in cartilage or secreted proteoglycan production between joints. Morphometric evaluation of articular tissues following massive haemarthrosis has quantified a temporary hyperplastic reaction. A significant decrease in cartilage hexosamine concentration in haemarthrotic joints suggests this is a crucial biochemical event in the pathogenesis of blood-induced cartilage destruction.     

肋骨肋头关节面的解剖学观测及其临床意义

目的观测成人肋头关节形态特征,填补国人人类学数据,并为临床诊治脊柱胸段疾患提供解剖学依据。方法观测成套肋骨标本,描述肋头关节形态学特征。结果肋头关节面48．7％为双关节面,按面积大小分型,上小下大型占41．7％,上下相等型占6．5％,上大下小型仅占0．5％;按凸凹形态分型,上平下凹型占32．1％,上下双凹型占13．9％,上凹下平型仅为2．7％。构成单关节面的肋头关节占51．3％,可分为平面型和凹面型两种,分别为平面型24．1％、凹面型27．2％。结论肋头关节面多分为单、双两种形态,其中第3～10肋双关节面出现率更高,且形态变异较大,可能是双关节面更易出现肋头关节劳损与错位的重要原因。     

Application of three-dimensional rendering in joint-related ganglion cysts

The origin of para-articular cysts is poorly understood and controversial. The relatively common, simple (extraneural) cysts are presumed to be derived from joints, although joint connections are not always established. Rarer complex cysts are thought by many to form de novo within nerves (intraneural ganglion cysts) or within vessels (adventitial cysts) (degenerative theory). We believe that these simple and complex ganglion cysts are joint-related (articular theory). Joint connections are often not readily appreciated with routine imaging or at surgery. Not identifying and/or treating joint connections frequently leads to cyst recurrence. More sophisticated imaging may enhance visualization of these joint connections. We created a 3D rendering technique to assess potential joint connections of simple and complex cysts localized to the knee and superior tibiofibular joints in patients with fibular (peroneal) neuropathy. Two- and three-dimensional data sets from MRI examinations were segmented semiautomatically by signal intensity with further refinement based on interaction with the user to identify specific anatomic structures, such as small nerves and vessels on serial images. The bone, cysts, nerves, and vessels were each assigned different color representations, and 3D renderings were created in ANALYZE using the data sets closest to isotropic (voxel with equal length in all dimensions) resolution as the primary background rendering. We selected four cases to illustrate the spectrum of pathology. In all of these cases, we demonstrated joint connections and correlated imaging and operative findings. Surgery addressing the cyst and the joint connection resulted in excellent outcomes; postoperative MRIs done more than 6 months later confirmed that there was no recurrence. In addition to highlighting the important relationship of these cysts to neighboring anatomic structures, this 3D technique allows visualization of "occult" connections not readily appreciated with standard MR imaging. We believe that these joint-related cysts have a common pathogenesis; they dissect through a capsular rent and follow the path of least resistance; they may form simple cysts by dissecting out into the soft tissue, or more complex cysts by dissecting within the epineurium of nerves or adventitia of vessels (along an articular branch), or various combinations of all of these types of cysts. Understanding the pathogenesis for cyst formation will improve surgical management and outcomes. We have adapted this 3D technique to enhance the visualization of cysts occurring at other joints.     

Composition of the extracellular matrix in human cricoarytenoid joint articular cartilage.

The extracellular matrix of the human cricoarytenoid joint articular cartilage is involved in different pathological changes. Interestingly, in contrast to the limb joints, the extracellular matrix composition of the healthy cricoarytenoid joint articular cartilage has not yet been elucidated except by some light microscopical investigations. The present study investigates the extracellular matrix components of the cricoarytenoid joint articular cartilage by means of light microscopy, immunohistochemistry, transmission electron microscopy and scanning electron microscopy and compares them with the limb joints for a better understanding of their involvement in joint disease. Chondrocytes near the joint surface of the cricoid and arytenoid cartilage differ from chondrocytes of deeper cartilage layers. The extracellular matrix of the articular cartilage contains chondroitin-4-sulfate, chondroitin-6-sulfate and keratansulfate as well as collagen types II, III, VI, IX and XI. Type-III-collagen shows a special distribution throughout the joint cartilage. In deeper cartilage layers, type-III-collagen occurs only pericellularly; in higher cartilage layers type-III-collagen is also located territorially and interterritorialy in small amounts. Scanning and transmission electron microscopy have revealed the articular surface of the cricoid and arytenoid cartilage to consist of a network of irregularly organized collagen fibrils, which are lined by a layer of electron dense material. The network coats subjacent collagen bundles which descend obliquely downward and intermingle at right angles in the middle part of the articular cartilage with collagen bundles of the deeper cartilage zones. The articular cartilage surface shows structural characteristics which differ from the underlying cartilage. The superficial electron dense layer possibly plays a role in the lubrication of the articular cartilage surface. The alignment of the fibrillar structures in the articular cartilage of the cricoarytenoid joint varies from those of the limb joints based on the different strain occurring during arytenoid movement. Nevertheless, the human cricoarytenoid joint articular cartilage can be compared with the joints of the limbs despite its extracellular matrix composition and its involvement in joint pathology. Evidence of type III collagen in the outermost layer of the articular cartilage of the cricoarytenoid joint presents a peculiarity, which has yet not be demonstrated in the articular cartilage of limb joints.