膝关节后交叉韧带前外侧束和后内侧束止点的解剖学研究

目的 探讨国人后交叉韧带的分束情况,对前外侧束和后内侧束的止点进行观测,掌握更为详细的解剖学资料,为临床双束重建后交叉韧带提供解剖学基础。 方法 30例膝关节标本,将后交叉韧带分为前外侧束和后内侧束,对双束股骨及胫骨端止点进行标记和解剖学观测。 结果 后交叉韧带的双束股骨止点中点至股骨内髁关节软骨前缘的距离分别为(8.52±1.81)mm和(11.63±1.81)mm,至股骨髁间窝顶的垂直距离分别为(4.67±0.55)mm和(10.32±1.23)mm;胫骨止点中点至胫骨关节面的垂直距离分别为(8.43±1.21)mm和(14.52±2.31)mm,至胫骨内侧软骨边缘的距离分别为(47.44±6.23)mm和(45.95±6.32)mm。双束股骨附丽区面积分别为(107.12±15.25)mm²和(65.35±10.27)mm²;胫骨附丽区面积分别为(50.07±11.33)mm²和(51.08±10.22)mm²。 结论 揭示了后交叉韧带双束止点的解剖学特点,为临床应用提供解剖学基础。     

前交叉韧带胫骨止点撕脱骨折治疗研究进展

正随着运动损伤和交通创伤的不断增多,前交叉韧带胫骨止点撕脱骨折发生率呈不断升高趋势,在一般人群的发生率每年约为3/10万~([1])。前交叉韧带胫骨止点撕脱骨折属于关节内骨折,因其为前交叉韧带(anterior cruciate ligament,ACL)在胫骨的附着点,所以前交叉韧带胫骨止点撕脱骨折移位容易造成前交叉韧带功能丧失,常伴有外侧半月板前角损伤,严重影响膝关节功能,治疗不当会造成不同程度的残疾,给患者的     

膝关节前交叉韧带后外束股骨止点位置的解剖

目的 通过对膝关节前交叉韧带后外束股骨止点的解剖测量,找到确定前交叉韧带后外束股骨止点的简单可行的方法,为双束重建前交叉韧带手术中的骨道定位提供理论依据。方法 解剖20例新鲜膝关节标本（25~45岁）。在屈膝90°位,测量前交叉韧带后外束股骨止点中心点距股骨髁间窝外侧壁前方、后方和下方软骨缘的距离,再对测量数据进行评估和对比。结果前交叉韧带后外束股骨止点中心点距离股骨前方软骨缘(8.74±1.39)mm,距离后方软骨缘(8.69±1.57)mm（P =0.926）。后外束止点中心点距离股骨下方软骨缘(5.06±0.77)mm。结论膝关节屈膝90°位时,前交叉韧带后外束的股骨止点中心点位于股骨髁间窝外侧壁,距离下方软骨缘5mm,距离前方和后方软骨缘的距离相等。在前交叉韧带双束重建的手术中,应用本研究的结果能够简单、快捷地确定前交叉韧带后外束股骨骨道位置。     

MRI分析前交叉韧带胫骨止点撕脱骨折的解剖学危险因素

背景：前交叉韧带胫骨止点撕脱骨折是一种特殊类型的关节内骨折，多见于运动性损伤，目前关于该病的解剖学研究相对较少，而大量研究集中于前交叉韧带的损伤，普遍认为胫骨平台后倾角增大、内侧胫骨平台深度减小及股骨髁间窝缺口宽度指数减小是前交叉韧带损伤的危险因素，对于前交叉韧带胫骨止点撕脱骨折是否也与其相关尚不清楚。目的：探讨前交叉韧带胫骨止点撕脱骨折与胫骨平台后倾角、内侧胫骨平台深度、股骨髁间窝缺口宽度指数及胫骨平台冠状斜坡角度的相关性。方法：回顾性分析2019年1月至2022年12月因膝前疼痛就诊于徐州医科大学附属医院骨科的患者101例，其中接受关节镜治疗的51例前交叉韧带胫骨止点撕脱骨折患者为观察组，同期50例有膝前痛症状但查体及影像学检查确定无膝关节损伤的患者为对照组。通过术前MRI图像测定两组患者胫骨平台后倾角、内侧胫骨平台深度、股骨髁间窝缺口宽度指数等解剖学参数，统计分析导致前交叉韧带胫骨止点撕脱骨折的解剖学危险因素。结果与结论：(1)两组患者的外侧胫骨平台后倾角、外侧/内侧胫骨平台后倾角比值以及股骨髁间窝缺口宽度指数、胫骨平台冠状斜坡角度比较差异无显著性意义(P> 0.05)；观...     

膝关节内侧半月板前角异常腱束１例

正笔者在解剖一成年男性(约40岁)膝关节标本时,见其右膝关节内侧半月板前角有一腱性结构,于前交叉韧带的前内侧斜向外上止于股骨外侧髁的内侧。通过文献查询,该腱束较为少见,为积累国人资料和为临床提供参考,报道如下(图1)。该标本右膝关节内侧半月板前角未见与胫骨髁间隆起有附着,而是通过结缔组织与胫骨平台前缘连续。异常腱束起于内侧半月板的前角,在前交叉韧带的前方(偏左)向外上斜     

膝关节三维有限元模型建立和验证及模拟后交叉韧带重建术

目的建立健康成年人膝关节三维有限元模型并进行验证,在此基础上建立模拟后交叉韧带单束重建术的股骨、胫骨隧道和移植物模型,为进一步分析奠定基础。方法以MRI作为数据源,运用医学制图软件Mimics,逆向工程软件Geomagic studio、Solidworks及有限元分析软件Abaqus,参考大量有关实验的文献报道,建立所需三维有限元模型。验证模型:模拟膝关节在屈曲0°情况下,对股骨施加后向134 N集中力,得出胫骨股骨相对位移及主要韧带受力分布与已报道文献进行比较;模拟膝关节屈曲0°情况下,加载垂直方向395 N集中力(单腿站立时下肢受力),得出软骨及半月板von Mises应力并与已报道文献进行比较。结果建立的膝关节三维有限元模型包括股骨下段、胫腓骨上段、髌骨、股骨软骨、胫骨软骨、髌骨软骨、髌韧带、内外侧半月板、前后交叉韧带、内外侧副韧带,几何形状良好。模型验证:股骨相对胫骨前后、远近及内外方向上位移分别为4.52 mm、0.35 mm和1.12 mm,此时韧带应力主要分布在前交叉韧带股骨附着处和体部且股骨附着处最大,与类似实验报道结果一致,且与临床结论前交叉韧带主要限制胫骨前移、在股骨附着处易发生断裂一致;半月板承担主要应力且内侧大于外侧,主要分布在内缘,最大应力值为1.65 MPa,其次胫骨软骨最大应力为1.05 MPa,股骨软骨应力最小,主要受力部位在内侧,为0.78 MPa;与已报道文献及尸体解剖力学实验结果一致,验证了该模型的有效性,在此基础上模拟建立后交叉韧带单束解剖重建股骨、胫骨隧道和移植物模型,基本可以满足有限元分析的需要。结论采用MRI图像建立膝关节三维有限元模型切实可靠,能很好地模拟膝关节解剖结构及后交叉韧带重建术中的股骨、胫骨隧道并满足生物力学的研究。     

半月板的生物力学及其损伤修复的研究进展

临床工作中,在膝关节创伤时,经常会遇到半月板损伤。在现今,人们对半月板的生物力学功能进行许多研究（3-9）,越来越认识到半月板的生物力学功能重要性,认为不宜简单地将损伤半月板切除,而应修复它们,但半月板无血液供应区的损伤修复后不能愈合,这是骨科界的难题之一,为此人们亦进行了许多研究（10-16）。一. 半月板的大体形态、血液供应、显微镜下形态、生化等 半月板是介于股骨髁和胫骨平台之间的半月状软骨,其外侧缘较厚,内侧缘较薄,内侧半月板呈“c"形,外侧半月板近似呈“o"形。内侧半月板前角胫骨韧带止点附着于前交叉韧…     

前交叉韧带胫骨附着处临床解剖学研究

目的 研究前交叉韧带(ACL)胫骨附着处的解剖形态学特点,并探讨ACL胫骨附着处测量值埘选择ACL重建方式的意义.方法 对10例福尔马林处理的成人膝关节标本进行解剖.在屈伸膝关节时根据ACL纤维张力区分前内束和后外束,然后从胫骨附着处切断韧带,用Photoshop软件测量附着处的相关数据.结果 ACL存在着两个不同的功能束,即前内束和后外束;胫骨附着处的形状不规则,可分为倒三角形、椭1形及四边形三种;ACL胫骨附着处的前后径与横径分别为(17.89±2.44)mm、(13.85±1.79)mm;前内束和后外束胫骨附着处的面积分别为(101.18±32.28)m㎡、(77.61±19.86)m㎡;两束中心点连线的距离为(8.03±1.51)mm.结论 本研究改进的数字图像测量方法是一种既实用又廉价的测量方法;ACL胫骨附着处测量值可作为选择ACL重建方式的参考.     

关节镜下两种固定方式治疗Ⅱ、Ⅲ型前交叉韧带胫骨止点撕脱骨折的疗效比较

目的 对比关节镜下采用缝线固定与空心螺钉固定Ⅱ、Ⅲ型前交叉韧带胫骨止点撕脱骨折的临床疗效.方法 选取本院从2013年1月～2017年1月期间收治的Ⅱ、Ⅲ型前交叉韧带胫骨止点撕脱骨折60例患者,以随机数字表法分为关节下缝线固定组(A组)和关节下空心螺钉固定组(B组),每组各30例.比较两组患者手术时间、膝关节活动度(RO...     

Arthrex缝线联合免打结锚钉修复前交叉韧带胫骨止点撕脱骨折

背景:膝关节前交叉韧带胫骨止点撕脱骨折的治疗方法多样,各有优势。目的:探讨关节镜下应用两根Arthrex线双骨道联合pushlock免打结锚钉固定前交叉韧带胫骨止点撕脱骨折的手术方法及临床疗效。方法:纳入2014年12月至2015年11月在内蒙古医科大学第二附属医院住院治疗的23例前交叉韧带胫骨止点撕脱骨折患者,在关节镜下应用Arthrex线将骨折块十字交叉复位,在胫骨结节内侧拧入pushlock免打结锚钉以收紧Arthrex缝线,将骨折块牢固固定于胫骨髁间嵴附着点处。术后采用膝关节评分(Lysholm和Tegner评分)随访。应用前抽屉试验、Lachman试验评价膝关节稳定性,X射线片评价术后骨折端的复位及愈合。结果与结论:(1)23例患者随访时间为6个月-1年;(2)Lysholm关节评分术前为(47.31±6.16)分,术后为(94.69±1.28)分(P0.05),Tegner评分由术前的(3.14±1.58)分提高到术后的(7.74±1.69)分(P0.05);(3)查体:Lachman试验均为阴性,X射线片示骨折端愈合良好。未出现关节反复肿胀及交锁等机械症状,膝关节无屈伸活动受限,未出现感染、下肢深静脉血栓形成等其他并发症;(4)结果表明,关节镜下应用Arthrex线结合pushlock免打结锚钉固定前交叉韧带胫骨髁间嵴撕脱性骨折具有微创、操作简单、固定可靠、无金属内置物,效果满意等优点。     

Photoperiodicity and the function of the hypophysis and the adrenal cortex

Summary The ACTH content of the hypophysis of rats rises from a minimum in the morning to a maximum in the evening hours. These fluctuations are associated with the diurnal rhythm of light and darkness, and are abolished under conditions of continual light or darkness for 30 days. Rhythmic fluctuations of the ascorbic acid content of the adrenals are also found, with maximum values in the evening, and these are likewise abolished by maintenance under conditions of constant illumination.Presented by Active Member AMN SSSR V. V. Parin     

Anatomic considerations and the relationship between the piriformis muscle and the sciatic nerve

Stating background  The piriformis syndrome is one of the non-discogenics causes of sciatica. It results from the compression of the sciatic nerve (SN) by the piriformis muscle (PM) in the neutral and piriformis stretch test position. The evidence of the increase in pain in the test position requires a detailed anatomical study addressing the changes that occurred in the SN and PM anatomy during the test position. The aim of this study is to examine this relationship morphometrically. Materials and methods  A total of 20 right and left lower limbs of ten adult cadavers were examined. The SN and the PM were made visible. The location of the SN was evaluated with respect to the consistent bony landmarks, including the greater and the lesser trochanter of the femur, the ischial tuberosity, the ischial spine of the hip bone, the posterior inferior iliac spine of the hip bone and the posterior superior iliac spine of the hip bone. The study was done in both neutral and test positions (i.e., 30° adduction 60° flexion and approximately 10° medial rotation position of the hip joint). Results  The width of the greater sciatic notch was 63.09 ± 13.59 mm. The length of the lower edge of the PM was 95.49 ± 6.21 mm, and whereas the diameter of the SN where it emerged from the infrapiriforme was 17.00 ± 3.70 mm, the diameter decreased to 11.03 ± 2.52 mm at the level of the lesser trochanter of the femur. The SN intersected the PM most commonly in its medial second quarter anatomically. The vertical distance between the medial edge of the SN–PM intersection point and the ischial tuberosity was 85.62 ± 17.23 and 72.28 ± 7.56 mm (P < 0.05); the angle between the SN and the transverse plane was 66.36° ± 6.68° and 71.90 ± 8.48° (P < 0.05); and the vertical distance between the medial edge of the SN and the apex of the ischial spine of the hip bone was 17.33 ± 4.89 and 15.84 ± 4.63 mm (P > 0.05), before and after the test position, respectively. Conclusion  This study provides helpful information regarding the course and the location of the SN. The presented morphometric data also revealed that after stretch test position, the infrapiriforme foramen becomes narrower; the SN becomes closer to the ischial spine of the hip bone, and the angle between the SN and the transverse plane increases. This study confirmed that the SN is prone to be trapped in the test position, and diagnosis of this situation requires dynamic MR and MR neurography study.     

空肠和回肠直动脉及器官表面动脉的观测

目的　通过对空、回肠直动脉分支类型的观察、测量不同类型直动脉管径、间距以及器官表面动脉吻合网面密度 ,探讨空、回肠血供形态的异同 ,为临床空、回肠疾病手术、器官移植、介入治疗提供形态学依据。方法　选取 15具成人及 2～ 6岁小儿 10具进行股动脉插管、乳胶灌注后解剖剥离直动脉 ,将空回肠均分 5段观测相关指标。结果　成人空肠 (1、2段 )及回肠 (3～ 5段 )直动脉起始处外管径 (mm)分别为 0 6 8± 0 18、0 72± 0 0 1、0 6 1± 0 0 2、0 5 3± 0 0 3和 0 5 1± 0 0 1,相邻分支间距 (mm)分别为 2 89± 1 72、2 79± 2 0 6、2 2 1± 1 6 4、2 17± 1 17及 2 85± 0 4 6 ;空、回肠直动脉长、短干型分支供血能力不同 ;空肠器官表面动脉吻合网面密度大于回肠。结论　直动脉分支类型、管径、间距及器官表面动脉吻合网面密度对空、回肠血供影响较大。     

指背腱膜滑动与近侧指间关节屈曲关系及临床意义

目的:探讨指背腱膜滑动距离与近侧指间关节(PIP)屈曲关系,为临床修复提供解剖学基础。方法:男性成人新鲜尸体标本10侧30指(示、中、环指各10指),切除手指皮肤,不破坏腱鞘、屈肌支持带、伸肌支持带、内在肌及外在肌,使肌腱保持正常的生理状态,分别测量各指中央束(CS)、侧束(LB)在PIP屈曲45°和90°时的滑动距离。结果:当PIP屈曲45°时,CS滑动距离为(2.7±0.4)mm,LB滑动距离为(2.8±0.6)mm;当PIP屈曲90°时,CS滑动距离为(4.3±0.7)mm,LB滑动距离为(4.8±0.6)mm。结论:指背腱膜滑动距离减少,严重影响手指的屈曲功能。对于指背腱膜的新鲜性损伤应予以精确修复;对于陈旧性损伤的修复应确保指背腱膜的正常滑动范围。     

岛叶与锥体束空间关系的影像学和解剖学研究

目的研究岛叶与锥体束的空间位置关系,为岛叶病变手术中保护锥体束和减少术后运动功能障碍提供指导。方法2013年3—10月,选取10例健康志愿者采用MR弥散张量纤维束成像( DTT)重建锥体束影像,选取6例成人颅脑标本运用Klingler白质纤维解剖技术解剖岛叶区域显露内囊和放射冠,在标本上进行断层解剖观察并测量岛叶标志点与内囊和放射冠的间距,结合MRI与解剖观察结果,对岛叶与锥体束的空间位置关系进行前瞻性研究。结果岛叶标志点在颅脑标本和MRI中均容易辨认。 DTT重建影像显示锥体束经过了岛叶后上部的深部。在解剖标本利用上中央岛点( UCIP)和后下岛点( PIIP)间连线将岛叶划分成前下部和后上部两个区域。岛叶后上部皮层与锥体束之间为最外囊、屏状核和外囊,而无壳核和苍白球。 UCIP和后上岛点( PSIP)距其深部的放射冠分别为(5.0依0.3)mm和(4.7依0.3)mm,PIIP距其深部的内囊后肢(5.7依0.5)mm。结论利用UCIP和PIIP连线所划分出的岛叶后上部因毗邻锥体束是手术危险区域。岛叶危险区域的划分有助于术前评估手术风险和预后,术中保护锥体束,降低术后运动功能障碍的发生率。     

Organization and distribution of the upper and lower esophageal motoneurons in the medulla and the spinal cord of the rat

The upper cervical esophagus is exerted on swallowing and peristalsis by somatic and visceral motoneurons, whereas the lower esophagus is exerted on only peristalsis by visceral motoneurons. We examined the origin of the esophageal motoneurons and whether there were any differences between the distributions of the upper and the lower esophageal motoneurons in the medulla and the spinal cord using cholera toxin subunit b (CTb) as the retrograde tracer. Following injection of CTb into the cervical esophagus resulted in heavy labeling of the neurons in the nucleus ambiguus including the compact (AmC), semicompact (AmS) and loose (AmL) formations, and the medial column of lamina IX at the C1-C5 levels of the cervical spinal cord corresponding to the spinal accessory nucleus. A few labeled neurons were found in the inferior salivatory nucleus, the rostral division of the dorsal motor nucleus of the vagus (DMX), the accessory facial nucleus and the lateral column of lamina IX at the C2 and C3 levels. All these labeled neurons showed ChAT immunoreactivity. When CTb was injected into the cut end of the unilateral recurrent laryngeal nerve, many labeled neurons were found in the ipsilateral AmC, the AmL, and the bilateral medial column at the C1 and C2 levels. Following injection of CTb into the subdiaphragmatic esophagus resulted in heavy labeling of the neurons only in the AmC and the DMX. When CTb was injected into the sternomastoid muscle, many labeled neurons were found in the medullary reticular formation, the facial nucleus, the medial column at the C1-C3, C5 and C6 levels, and the lateral column at the C2, C3, C5 and C6 levels. Injections of a Fluoro-Gold into the cervical esophagus and a CTb into the sternomastoid muscle or the subdiaphragmatic esophagus in the same animal showed many double labeled neurons in the medial column of the accessory nucleus at the C1 and C2 levels, but no double labeled neurons in the AmC. These results indicated that the upper cervical esophagus is innervated by the visceral medullary vagal motoneurons as well as the somatic spinal accessory motoneurons. The lower esophagus is innervated only by the visceral medullary vagal motoneurons.     

Cutaneous calciphylactic reactions in the mouse and the rat and the effects of diphosphonates on the reaction in the rat

Calciphylaxis is a local tissue calcific reaction at the site of an injection of challenger substance given a critical time period after the oral administration of a sensitizer substance such as dihydrotachysterol (DHT), vitamin D or parathormone. Cutaneous calciphylaxis is readily induced in the rat but not in the mouse and this may be because, in the latter, the challenger substance is absorbed rapidly by macrophages. In the rat the administration of 500 micrograms/0.1 ml of DHT followed after 24 h by the subcutaneous (SC) injection of ferric chloride (FeCl3) (30 micrograms/0.1 ml) is followed rapidly by calcification of the SC site. There is an early transient acute inflammatory reaction with the incrustation of collagen fibres by the iron salt and an apparent exudation of calcium and phosphate ions from the bloodstream. These ions also become associated with collagen fibres. Two days after injection macrophages and multinucleated giant cells become the dominant cells. Calciphylaxis is a useful experimental model of ectopic calcification and is associated with an initial hypercalcaemia. The diphosphonates ethane-1-hydroxy-1, 1-diphosphonate (EHDP) and dichloromethylene diphosphonate (Cl2MDP) are effective inhibitors of the calciphylactic reaction when administered prior to the initiation of the experimental procedure.