小针刀治疗肩胛上神经嵌压症的应用解剖

目的为小针刀减压治疗肩胛上神经嵌压症提供形态学基础.方法在34侧常规固定的成人尸体标本上解剖出冈上孔、冈下孔和肩胛上神经及血管,观察冈上孔、冈下孔及其与肩胛上神经、血管的走行位置关系,测量有关数据.结果冈上孔位于锁骨锥状结节的后端深面,由肩胛切迹和横架于其上方的肩胛上横韧带围成,距体表(4.75±0.79)cm.冈下孔位于肩胛冈中外1/3交界处下方2cm处的深面,由冈盂切迹和连于肩峰根部及肩胛骨背面的肩胛下横韧带围成,距体表(3.93±0.95)cm.肩胛上神经起自臂丛上干,行向后外下,穿冈上孔人冈下窝,再向后穿冈下孔入冈下窝,沿途发支至冈上肌、冈下肌和肩关节.肩胛上血管经肩胛上横韧带的外上方入冈上窝与神经伴行.结论本文提出同时扩大或开放两孔进行治疗的新思路,提供的有关数据和定位方法,可提高小针刀治疗肩胛上神经嵌压症的准确性和安全性.     

儿童先天性主动脉缩窄的解剖特点及外科治疗策略

目的 探讨儿童先天性主动脉缩窄(CoA)的解剖变异特点及相应外科治疗策略。方法 回顾性分析2012年5月—2014年6月南京医科大学附属儿童医院心胸外科手术治疗的30 例先天性CoA患儿的临床资料,其中男22例,女8例;年龄12 d～6岁。依据国际小儿心脏外科命名和数据库的分类标准:单纯型CoA 12例,合并室间隔缺损型8例,合并复杂先天性心脏病型 5例,合并主动脉弓发育不良型5例。30例患者中,体外循环下手术矫治20例,同期矫治心内畸形,其中8例在选择性脑灌注下行手术矫治;非体外循环手术10例,2例采用正中切口,其中1例采取镶嵌手术封堵肌部室间隔缺损,其余8例采用左后外侧切口。 结果 30例患者均顺利完成手术,手术时间95～675 min,平均165.68 min。术后死亡2例;1例术后出现气道压力增高,左上肺不张,不能脱离呼吸机,再次行手术悬吊松解,顺利脱离呼吸机并出院;余27例患儿均顺利康复并出院。28例患儿获随访,随访时间6个月～2年,其中1例于术后2年出现再次狭窄,上下肢血压压差在50 mmHg(1 mmHg=0.133 kPa)左右,目前仍在随访中;余患儿生长发育正常,术后上下肢血压压差＜10 mmHg。结论 对先天性CoA患儿,根据CoA不同的解剖分型选择相应的外科治疗及体外循环方案,可取得良好的治疗效果。     

新生儿先天性甲状腺功能低下症和苯丙酮尿症筛查治疗分析

目的先天性甲状腺功能低下症(CH)和苯丙酮尿症(PKU)是严重危害儿童健康的内分泌疾病和先天性遗传病,为了筛查此类患儿的发生率,做到早诊早治。方法我们采用时间分辨免疫分析法(DELFA)和细菌抑制法(BIA)进行检测。结果 2007年1月—2009年11月检出CH患儿3例,PKU患儿1例。结论早期诊断早期治疗及做好宣教是防止此类患儿发生的关键。     

先天性甲状腺功能减低症筛查结果及治疗随访分析

目的了解佛山市先天性甲状腺功能减低症的发病率、分布特点及治疗随访情况,以促进佛山市新生儿疾病筛查工作更好开展。方法分析佛山市2007年1月至2009年6月期间新生儿先天性甲状腺功能减低症（CH）的筛查结果及治疗随访情况,筛查阳性病例采用化学发光法检测血清中游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）及促甲状腺激素（TSH）水平,确诊病例按疾病诊疗常规进行治疗和随访。结果共筛查169 530例新生儿,确诊先天性甲状腺功能减低症73例,发病率1/2322,确诊年龄为10～30天,平均14.5天,发病患儿以暂住人口所生子女居多,以禅城及南海两区居多,确诊者立即开始治疗,并定期至筛查中心进行随访。结论通过新生儿筛查可早期诊断先天性甲状腺功能减低症,并早期进行治疗随访,减少患儿智力低下的发生,提高人口素质。     

罕见膝反屈型先天性多发性关节挛缩症的手术治疗

目的：探讨罕见膝反屈型先天性多发性关节挛缩症(Arthrogryposis面上multiplex congenita，AMC)的手术治疗方法及疗效。方法：3例膝反屈型AMC中，2例接受了手术治疗，每例均分两期施行16个手术。第1期下肢手术包括腱切断、腱延长、关节凹侧关节囊切开和切除术，股骨下端旋转性截骨及畸形足的三关节融合术；第2期上肢手术为肱骨下端切骨术及手部肌力平衡术。结果：2例均获十分满意的结果，无畸形复发。结论：选择恰当的术式治疗膝反屈型AMC是很有效的。     

跟痛症的病因及相关应用解剖研究进展

跟痛症（Painful heel syndrome，PHS）是足跟周围疼痛性疾病的总称，是指多种慢性疾患所引起的跟部包括跟后、跟跖、跟内和跟外侧急、慢性疼痛。多发生于40-70岁的中老年人，男性多于女性，男女比约2：1，特别是男性肥胖者及运动员，可一侧或两侧同时发病。     

先天性甲状腺功能减低症27例误诊及预后分析

本文对治疗并随访３年以上的２７例误诊的先天性甲低的治疗效果及远期预后进行评价。本文病例误诊时间从３月－７年，通过治疗随访，显示误诊时间越短、诊治年龄越小，身高恢复正常的比率越高；误诊时间越长，对智能影响越大，超过１年的既使治疗也多半有不同程度的智能落后。本文分析了误诊原因，提出儿科医生应加强对本病的认识，注意鉴别诊断以减少误诊；应尽早普遍地开展新生儿甲低筛查并给予正确长期治疗，以减少甲低所致的智力低下等后遗症     

先天性甲状腺功能低下症二例的检出与治疗

先天性甲状腺功能低下 (ｃｏｎｇｅｎｉｔａｌｈｙｐｏｔｈｙｒｏｉｄｉｓｍ ,ＣＨ) ,是最常见的新生儿内分泌代谢性疾病 ,主要由甲状腺萎缩、异位或发育不全引起 ,也可由缺碘、妊娠、哺乳期接受放射性碘治疗及酶缺陷等造成。我们通过对 2例ＣＨ患儿定期随访 ,监测血清ＴＳＨ、     

新生儿先天性甲状腺功能低下症筛查治疗分析

目的先天性甲状腺功能低下症（CH）是严重危害儿童健康的内分泌疾病,及时筛查此类患儿,做到早诊早治,以降低出生缺陷儿发生。方法我们采用时间分辨免疫分析法（DELFA）进行检测。结果 2007年1月-2011年11月对12 077例新生儿进行筛查,检出CH患儿5例,检出率为1/2415。结论早期诊断早期治疗及做好宣教是防止此类患儿发生的关键。     

The pillars of the scapula

Total shoulder replacement has been shown to provide predictable pain relief and functional improvement in patients with glenohumeral arthritis. Loosening of the glenoid component remains the most frequent indication for revision surgery at long-term follow-up. The component most widely used is an all-polyethylene keeled or pegged design cemented to the glenoid cavity of the scapula. The glenoid is small and its cup-shaped morphology allows only a restricted site for limited fixation devices. This is particularly so in revision surgery where there are often large bony defects of the glenoid. In an anatomical study, we investigated the scapula in order to identify substantial bony pillars for better component fixation. Forty cadaveric shoulders (mean age 86, range 67-101) were dissected, the glenoids were denuded from cartilage, and the subchondral and cancellous bone was removed. Two bony pillars approaching the glenoid were consistently identified in all scapulae investigated. These pillars were outlined by three cortices and orientated to the circle formed by the rim of the inferior quadrants of the glenoid. One pillar is directed inferiorly near the margo lateralis and the other pillar is directed superiorly into the spine of the scapula. We defined these pillars in length and direction, and three-dimensionally located them in relation to the joint surface. This study demonstrated two bony pillars as important anatomical landmarks in the scapula. They were constant in presence, surgically accessible, and have not been described before. These results can be used as a guideline in the development of prosthetic designs to improve the fixation of glenoid components.     

Congenital undescended scapula (Sprengel deformity): a case study

This study describes a congenital deformity of the shoulder joint in a 5-year-old female, associated with an undescended scapula and the presence of an omovertebral bone. Dissections on 16 cadavers were done to identify structures in danger of injure before operating on the patient. Surgeons need to take specific note of the dorsal scapular nerve.     

肩胛骨骨折内固定的应用解剖

目的:为肩胛骨骨折的手术内固定提供解剖学依据。方法:对30侧成人肩胛骨标本进行测量,分别用千分尺及螺旋测微仪测量长度和厚度,用角度仪测量角度。所得数据进行统计学处理。结果:肩胛骨的平均长度为(146.3±12.0)mm,离边缘1cm处内侧缘厚度为(4.1±2.5)mm。肩胛骨外侧缘距关节面1cm、2 cm处的前后厚度分别为(17.8±3.5)mm(13.4±3.1)mm,距关节面1/4、2/4、3/4距离处的厚度分别为(13.5±5.8)mm、(11.5±4.0)mm、(8.6±5.0)mm。肩盂关节面有一向后的倾角平均为(5.6±3.1)°。结论:①肩胛骨的内侧缘和外侧缘有足够的骨量支持内固定物的植入,尤以肩胛骨的外侧缘骨量丰富,是放置内固定物的重要部位;②肩胛颈部较大的骨量及关节面的倾角对于内固定植入和置钉位置有重要意义。     

肩胛骨上角区的解剖及临床意义

目的:研究肩胛骨上角的解剖学特点及其临床意义。方法:在16具32侧成人尸标本上对肩胛骨上角区的肌肉附着、神经走行及其相互关系进行详细观测。结果:斜方肌位于肩胛骨上角处深面筋膜增厚变白,增厚筋膜平均面积为4cm×2cm。其中有滑囊出现率12.5%(4/32),副神经位于增厚筋膜内的出现率78.12%(25/32)。副神经距肩胛骨上角最近距离为(2.0±0.6)cm。肩胛背神经主干与肩胛提肌交点距肩胛骨上角距离为(1.25±0.32)cm。结论:肩胛骨上角复杂肌肉附着及神经走行于肩胛骨上角附近时易造成卡压是肩背痛的解剖学基础。     

改良先天性肌性斜颈手术方法的解剖学研究

【摘要】目的：根据颈筋膜解剖特点,改进传统的先天性肌性斜颈的手术方法。方法：选取经福尔马林固定,颈部无肉眼病变的成人尸体标本12具。沿锁骨切开皮肤、颈阔肌,向上在颈筋膜浅层浅面（封套筋膜）进行仔细分离,观察封套筋膜和颈阔肌的相互关系,粘连程度。以锁骨上方1.5 cm水平为中心,在胸锁乳突肌内缘内侧0.5 cm纵行剪开封套筋膜约3 cm,在胸锁乳突肌后鞘深面进行分离达胸锁乳突肌外侧,感觉分离的难易程度,观察封套筋膜和颈动脉鞘的完整性。结果：封套筋膜在颈前完整、致密,将胸锁乳突肌完整套封,颈阔肌与封套筋膜可以轻易地完整分离;在颈中下部胸锁乳突肌后鞘与颈动脉鞘也无粘连,各自独立,很容易完整分离。结论：依据胸锁乳突肌前后筋膜鞘的结构特点,可以将先天性肌性斜颈传统手术加以改进,提高疗效。     

Somitic origin of the medial border of the mammalian scapula and its homology to the avian scapula blade

The scapula is the main skeletal element of the pectoral girdle allowing muscular fixation of the forelimb to the axial skeleton. The vertebrate limb skeleton has traditionally been considered to develop from the lateral plate mesoderm, whereas the musculature originates from the axial somites. However, in birds, the scapular blade has been shown to develop from the somites. We investigated whether a somitic contribution was also present in the mammalian scapula. Using genetic lineage‐tracing techniques, we show that the medial border of the mammalian scapula develops from somitic cells. The medial scapula border serves as the attachment site of girdle muscles (serratus anterior, rhomboidei and levator scapulae). We show that the development of these muscles is independent of the mechanism that controls the formation of all other limb muscles. We suggest that these muscles be specifically referred to as medial girdle muscles. Our results establish the avian scapular blade and medial border of the mammalian scapula as homologous structures as they share the same developmental origin.     

肩胛骨外侧缘入路与标准Judet入路手术治疗肩胛骨骨折的疗效

目的探讨肩胛骨外侧缘入路与标准Judet入路方式治疗肩胛骨骨折的疗效。方法回顾性分析2006年1月至2013年2月48例肩胛骨骨折患者的病例资料,根据手术入路方式分为观察组和对照组,观察组27例采用肩胛骨外侧缘入路手术治疗,对照组21例采用标准Judet入路手术治疗,比较2组临床疗效和并发症发生情况。结果观察组手术时间和术中出血量均少于对照组(P0.05),骨折愈合时间也短于对照组(P0.05);术后6个月,观察组优良率高于对照组(P0.05)。术后观察组患肢日常活动和肌力评分高于对照组,差异均有统计学意义(P0.05),疼痛评分、关节活动评分组间比较差异无统计学意义(P0.05)。结论肩胛骨外侧缘入路手术治疗肩胛骨骨折操作简便、并发症少,可作为肩胛骨骨折手术治疗的优选方案。     

肩胛下角的解剖形态学分型及临床意义

目的　研究肩胛下角的解剖形态学特点,从而探讨其解剖学意义。 方法　选取275例人体干燥肩胛骨标本,设肩胛下角为a点,盂下结节为b点,肩胛冈与肩胛骨内侧缘交点为c点,肩胛上角为e点,冈盂切迹为f点,经a点做cf连线的垂线,与cf交于d点;用游标卡尺、量角器分别测量a点厚度（以肩胛下角最厚处为准）,ab、ac、ad长度,∠bac、∠ace（肩胛骨解剖学意义上矢状面投影）、∠ace′（肩胛骨解剖学意义上冠状面投影）角度。 结果　根据形态学特点发现肩胛下角分为3型：副角型（145,52.73%）、U型（87,31.64%）、V型（43,15.64%）。其中,副角型与V型在a点厚度、ab上有统计学差异（P<0.05）;副角型与U型,副角型与V型在ac上有统计学差异（P<0.05）;副角型与V型,U型与V型在ad上有统计学差异（P<0.05）;副角型与U型在∠ace′上有统计学差异（P<0.05）。此外,左右两侧肩胛下角在∠bac上有统计学差异（P<0.05）。 结论　在本次实验中,发现肩胛下角存在三种形态学变异,以副角型为主,其解剖形态学分型具有一定的临床指导意义。     

Comparison of clinical characteristics between congenital fiber type disproportion myopathy and congenital myopathy with type 1 fiber predominance

Congenital myopathies are clinical and genetic heterogeneous disorders characterized by skeletal muscle weakness and specific structural changes in muscle fiber. Congenital myopathy with fiber type disproportion (CFTD) is an established disorder of congenital myopathy. CFTD is characterized by non-progressive childhood neuromuscular disorders with a relatively good prognosis and type 1 fiber predominance and smallness. Congenital myopathy with type 1 fiber predominance (CMT1P) is also a distinct entity of congenital myopathy characterized by non-progressive childhood neuromuscular disorders and type 1 fiber predominance without smallness. Little is known about CMT1P. Clinical characteristics, including dysmorphic features such as hip dislocation, kyphoscoliosis, contracture, and high arch palate, were analyzed along with laboratory and muscle pathologies in six patients with CMT1P and three patients with CFTD. The clinical manifestations of CFTD and CMT1P were similar. However, the frequency of dysmorphic features is less in CMT1P than in CFTD. Long term observational studies of CMT1P are needed to determine if it will change to another form of congenital myopathy or if CMT1P is a distinct clinical entity.