正中神经返支的观测及表面解剖定位

对100侧正中神经返支的形态进行观察、计测,82±3.84%源于正中神经主干分叉处。依其形态分为多支形(85±3.57%),双支型(10±3.60%),单支型(1±0.99%)、重复型(4±1.96%)。鱼际肌群(拇收肌除外)各肌神经分布呈多源性,拇对掌肌98%由正中神经返支支配。设计自舟骨结节中点与手掌第2指胰中点连线为纵轴线,通过第1掌骨小头顶端作纵轴线垂线为横轴线,以此座标测计正中神经返支的表面Ⅰ解剖定位。采用距纵轴线尺侧10～15mm设计适于临床应用的纵行切口,可避免损伤正中神经返支。     

拇短屈肌形态特点及其神经支配

目的：进一步弄清拇短屈肌的神经支配，为临床有关神经损伤的诊治提供应用解剖学形态基础。方法：对３０只成人手标本拇短屈肌形态和神经支配进行了观测。结果：拇短屈肌浅头受正中神经返支支配，拇短屈肌深头受尺神经深支支配。尺神经深支的拇短屈肌深头肌支出现率占８６．７％，肌内平均支数为２．０±０．７支，有１０％的拇短屈肌深头肌支既支配拇短屈肌深头，又支配拇短屈肌浅头，并有一交通支与正中神经相连。结论：１０％的拇短屈肌具有双重性神经支配。因此，当正中神经损伤，部分病例的鱼际肌中个别肌肉可不出现瘫痪。     

正中神经返支卡压及易损伤部位的解剖学基础

目的：探讨腕管综合征术后大鱼际功能恢复不良的原因与返支易损伤部位。方法：对20侧成人新鲜上肢标本进行显微解剖，观测正中神经返支走行中存在的卡压因素以及易损伤部位。结果：(1)拇短屈肌浅头尺侧存在腱弓及腱纤维束结构，对正中神经返支形成卡压；(2)住屈肌支持带远侧返支与掌腱膜关系密切，在此部位掌腱膜可对返支形成卡压或术中易误伤返支；(3)走行中返支与拇长屈肌腱和示指屈肌腱存在交叉走行关系。结论：(1)返支走行中存在易卡压因素，治疗腕管综合征时应常规探查松解返支；(2)涉及拇长屈肌腱，示指屈肌腱和掌腱膜手术时，应注意防止损伤返支。     

可吸收线治疗骨性锤状指远指间关节固定针位置的解剖研究

目的　通过测量末节手指的体表标记线与克氏针进针点的关系,为可吸收线捆扎固定撕脱骨块治疗骨性锤状指的远指间关节固定针进针点及角度、缝合线导引孔的位置提供解剖学依据。 方法　在16侧新鲜成人上肢标本的拇指、示指、中指、环指、小指各16根上模拟远侧指间关节的固定针（克氏针）固定,并测量进针点及进针角度。 结果　远侧指间关节伸0°位时,固定针宜从指体侧方进针,固定远侧指间关节的最佳进针点位于末节指骨基底部与指骨干交界处,进针角度与末节指骨中轴线成30°夹角,进针点到指远侧纹平面距离分别为：拇指13 mm、示指12 mm、中指13 mm、环指12 mm、小指11 mm。可吸收线导引孔最佳进针点在肌腱止点远端的指骨侧中线体表投影线上。 结论　固定针进针点以及导引孔位于上述各手指的位置时,既固定牢固、不损伤甲基质,也不影响撕脱骨片的复位。     

桡动脉掌浅支粗大合并分支异常一例

双侧掌浅支粗大合并行程异常及分支变异者比较少见。作者在解剖一例成年男尸时发现双侧桡动脉掌浅支粗大合并行程异常同时伴有分支变异。 左侧桡动脉的掌浅支自桡骨茎突上方0.85cm处发出(见附图)。发支后的桡动脉干外径为2.00mm。掌浅支起始部外径1.92mm,该支贴鱼际肌表面的筋膜下行达手掌与尺动脉终支吻合成掌浅弓。掌浅弓属桡尺动脉型,位置正常,弓之最细处外径为1.58mm。掌浅弓在拇短屈肌下缘发出一长为0.50cm,外径为1.54mm的短支,即拇主要动脉。该动脉随即分为两支:一支为拇指桡掌侧动脉,走行于拇指掌面的桡侧缘;另一支是拇指尺掌侧动脉和示指桡掌侧动脉的共干支,继行2.00cm后,于拇收肌下缘处即分为上述两支。分别至拇、示指掌面的相对缘。另外。桡侧两条指掌侧总动脉共干发自掌浅弓。     

1例拇指多指畸形报告

<正> 女尸,约35岁.右手拇指畸形,远节呈双拇指状,均有指甲,粗细大致相等,近节正常.右拇指的指间关节较健侧膨大.解剖中发现,末节指骨从指骨颈处起分开,形成大致相等的两干.在畸形拇指的背侧,拇长伸肌健在近节指骨头处终于指背腱膜,再由后者分成两股分别终止于末节指骨.在腹侧,拇长屈肌腱亦在近节指骨头处分成两股附着于末节指骨底的掌面;末节指骨底两侧均有膨大骨突.正中神经分支沿拇指两侧上行至末节指端及其相对缘,并有指掌侧固有动脉分支伴行.在臂中部,发现正中神经除由臂丛内、外侧束的外侧头和内侧头组成外,尚有部分肌皮神经纤维穿喙肱肌后发支加入,至臂下部时,纤维就难以分开.剖开腹部,发现内脏亦有肠管的变异(图1).回肠分两管,一管进入盲肠,另一管进人乙状结肠,而盲肠亦分两管,一管进入升结肠,另一管进入乙状结肠,阑尾缺如,升结肠、横结肠、降结肠相对较小但盲肠却很大,有许多粪便.胆囊异常变     

掌长肌缺如伴发自尺动脉的正中动脉吻合成掌浅弓1例

掌长肌缺如和掌浅弓组成的形式变异分别均早有记载 ,但右侧掌长肌缺如伴发自尺动脉的正中动脉吻合成掌浅弓的变异少见 ,作者在解剖一例 10岁男童标本时遇见 1例 ,现报道如下。右侧掌长肌缺如 ,掌腱膜近端附着于桡侧腕屈肌腱尺侧缘上 (图 1) ,其远端和左侧掌长肌未见异常。右侧正中动脉 ,在距肱骨内、外上髁连线中点下方 3.5ｃｍ处发自尺动脉桡侧 ,外径 2ｍｍ(图 2 ) ,穿经指浅、深屈肌间下行 2ｃｍ(距肱骨内、外上髁连线中点下方 5 .5ｃｍ)处与正中神经伴行于桡侧腕屈肌与指浅屈肌之间的深面 ,然后经腕管入手掌 ,达掌腱膜深面 ,正中神经的指…     

拇长屈肌的尺侧头

作者观测了45具(男29,女16)年成尸体90侧上肢的拇长屈肌,见65.56±5.01%有尺侧头。尺侧头多双侧性地出现或否,无性差及侧差。尺侧头上端附于指浅屈肌腱或肱骨内上髁者居多,肌腹斜向外下方,汇入拇长屈肌腱的上端。支配尺侧头的神经均发自骨间前神经,起始平面大多较支配拇长屈肌挠侧头的肌支稍高,行程短。供应动脉可以是尺侧下付动脉或骨间返动脉的细小分支。尺侧头与正中神经和尺动脉关系密切。本文就,拇长屈肌尺侧头的来源、功能以及命名等作了初步讨论。     

拇指伸肌腱宽度与拇短伸肌腱止点关系的研究

目的测量拇指伸肌腱的宽度,并分析该宽度与拇短伸肌腱远端止点之间的关系。方法 76例(左侧39例,右侧37例)经10%福尔马林溶液灌注固定的人体上肢标本,解剖第1骨纤维管、拇长展肌、拇短伸肌以及拇长伸肌,观察纤维管内肌腱中隔分布情况;采用游标卡尺,测量拇指近节指骨背面中点处伸肌腱宽度,利用ROC曲线,分析该宽度与拇短伸肌腱远端止点之间的关系。结果①52例第1骨纤维管内出现肌腱中隔(68.4%);30例拇短伸肌腱止点发生延长,即越过拇指掌指关节;②拇短伸肌腱未延长组,伸肌腱宽度(6.04±0.92)mm;而延长组拇指伸肌腱的宽度(7.52±1.38)mm,显著高于未延长组(t=4.050,P=0.000);③通过测量拇指近节指背中点处伸肌腱宽度,判断拇短伸肌腱止点延长的情况:ROC曲线下面积0.823,临界值7.21 mm,灵敏度和特异度分别是0.843和0.927,正确率为90%。结论当拇短伸肌腱止点延长时,拇指近节指骨背面肌腱的宽度增加;此宽度不仅能够用来识别变异,对于拇指腱鞘炎的外科治疗,具有一定的指导意义。     

成人前臂前群肌的神经入肌点定位及意义

目的 准确定位成人前臂前群肌神经入肌点（NEP）的体表位置和深度。 方法 成人尸体12具,仰卧。紧贴皮肤连接肱骨外上髁和内上髁间的曲线为横向参考线(H),肱骨外上髁和桡骨茎突间的曲线为纵向参考线(L)。解剖暴露NEP,硫酸钡标记,螺旋CT扫描与三维重建。将NEP在体表上的投影点记为P点,P点通过NEP后投射至前臂后体表上的点为P'点。P点投射到H线与L线上的位置分别记为PH和PL。Syngo系统下确定PH和PL在H和L线上的位置及NEP的深度。 结果 旋前圆肌、桡侧腕屈肌、掌长肌、尺侧腕屈肌、指浅屈肌、拇长屈肌、指深屈肌（正中神经支）、指深屈肌（尺神经支）、旋前方肌NEP的PH分别位于H线上的58.08%、64.17%、75.14%、61.14%、62.26%、52.07%、50.81%、63.38%和51.37%处;PL分别位于L线上的9.79%、3.97%、16.37%、4.42%、17.88%、34.17%、30.27%、11.48%和75.32%处;穿刺深度分别位于PP'线的26.80%、25.06%、27.68%、28.13%、37.30%、39.85%、49.26%、70.86%和44.25% 处。以上数据均为平均值。 结论 这些NEP的体表穿刺位置与深度的界定可为提高前臂前群肌痉挛肌外神经溶解术靶点阻滞的效率、手术切断神经肌支治疗肌痉挛的微创切口设计、作为供肌的功能评估、以及肌移植术中对神经的保护等提供形态学指导。     

The interrelation of the "local" and the "general" in inflammation

The relationships between the local and the general in inflammation are analysed basing on the literature and original data. Local chemoattraction is postulated to be an underlying factor initiating primary local cooperation of cells relevant to inflammation. Being essential in this cooperation, macrophage seems to warrant both the local developments and triggering of general mechanisms of regulation which are relevant to control over subsequent secondary cell cooperation. The latter is biologically aimed at localization of the inflammation focus and separation of its pathogenic factors from intact internal medium. General mechanisms of inflammation control are provided by neuroendocrine, immune, vascular, coagulative, fibrinolytic and other systems, and operate through the products of the acute phase, by immune defence factors and rearrangement of nervous regulation of homeostasis in intact organs and tissues. The result of the regulation manifests with sequential presentation of the inflammation stages in time, correlation of local and general responses intensity. Eventually, local inflammation and lesion involve stress and intoxication which are not considered direct attributes of inflammation, nevertheless can influence general regulatory systems concerned with the course of local inflammation. It is concluded that inflammation implies dialectic unity of local and systemic responses of the body outlined to resolve inflammation and restore homeostasis.     

Comparison of the "mammal machine" and the "reptile machine": energy production

Standard metabolism and body composition were measured in Amphibolurus nuchalis and Mus musculus (a reptile and mammal with the same weight and body temperature). The metabolic capacity for energy production was assessed in liver, heart, brain, and kidney in the lizard and mouse by two methods: measurement of mitochondrial enzyme activity (cytochrome oxidase) and measurement of both mitochondrial volume density and membrane surface area. Both methods gave a three- to sixfold greater capacity for energy production in the mammal compared to the lizard which is less than the eightfold difference in their standard metabolisms. The difference in energy production capacity was not due to any single parameter but was a summation of several smaller differences. The mammal had relatively larger internal organs than the reptile, their organs had a greater proportion of mitochondria, and their mitochondria had a greater relative membrane surface area. These differences, it is suggested, may be due in part to different thyroid function in reptiles and mammals.     

Autoimmunity and the immunotherapy of cancer: targeting the "self" to destroy the "other"

It is increasingly clear that immunity to "self"-antigens may result in tumor destruction in mouse and man. But which antigens should be targeted with therapeutic cancer vaccines? In the case of melanoma, recognition of melanocyte differentiation antigens (MDA) can be associated with autoimmune depigmentation (vitiligo). We propose that intersection of protein transport to melanosomes and endosomes allows for the loading of MDA-derived peptides on MHC class II molecules, resulting in the activation of MDA-specific CD4+ "helper" T cells that aid the induction of melanoma-specific CD8+ T cells. Thus, the immunogenicity of MDA may be a consequence of their unique cell biology. Studies of MDA-based vaccines can provide new insight into the development of more effective cancer vaccines.     

Interactions between the "cognitive" and "metabolic" brain in the control of food intake

If the new environment and modern lifestyle cause obesity in individuals with thrifty genes by increasing energy intake, it is important to know by what mechanisms hyperphagia occurs and why energy balance is not kept in check by the homeostatic regulator. The argument is developed that procuring and ingesting food is an evolutionarily conserved survival mechanism that occupies large parts of the brain's computing capacity including not only the hypothalamus but also a number of cortico-limbic structures. These forebrain systems evolved to engage powerful emotions for guaranteed supply and ingestion of beneficial foods from a sparse and often hostile environment. They are now simply overwhelmed with an abundance of food and food cues that is no longer interrupted by frequent famines. After briefly reviewing structure and functions of the relevant cortico-limbic structures and the better-known hypothalamic homeostatic regulator, the review focuses mainly on interactions between the two systems. Although several cortico-limbic processes are sensitive to metabolic depletion and repletion signals, it appears that they are underlying the same reversible leptin resistance that renders hypothalamic circuits insensible to continuously high leptin levels during periods of feast. It is hypothesized that this naturally occurring leptin resistance allowed temporary neutralization of satiety mechanisms and evolved as a response to survive subsequent periods of famine. With today's continuous and abundant food availability for a segment of the population, the powerful cognitive processes to eat and the resulting overweight can partially escape negative feedback control in prone individuals most strongly expressing such thrifty genes.