颞骨茎突的测量及其临床意义

目的 :研究颞骨茎突及其周围结构毗邻关系 ,为临床诊断和治疗茎突综合征提供解剖学数据。方法 :用局解的方法直接观察、测量、研究 45 8侧茎突的长度、方位及其周围结构的毗邻关系。结果 :长度 :2 4 68± 5 .72mm ,左侧 :2 4 3 7± 5 .5 1mm ,右侧 :2 4 96± 6.1 8mm ;方位 :前倾角 1 8 96± 5 .1 2°,内倾角 2 3 67± 6 84° ;测量了与周围重要结构之间的距离和有关结构的孔径。结论 :茎突综合征的发病与茎突过长和方位不正有着密切的联系。     

双轴点掌背皮动脉轴行皮瓣的应用解剖

目的 :报道手背一种新型皮动脉岛状皮瓣设计的解剖学基础。方法 :对 2 0侧新鲜成人标本 ,在 5倍显微镜下观测掌背血管、肌腱、神经的解剖特点和皮肤的血供。结果 :手掌背皮下组织内存在掌背动脉相平行的皮动脉。第 1掌背动脉出现率为 95 % ,起点外径 ( 0 .8± 0 .1)mm ,长度 ( 7.8± 1.1)cm ,末端外径 ( 0 .4± 0 .2 )mm。第 2掌背动脉出现率为 10 0 % ,起点外径 ( 0 .6± 0 .1)mm ,长度 ( 6.5± 0 .8)cm ,末端外径 ( 0 .4± 0 .1)mm。第 3掌背动脉出现率为 10 0 % ,起点外径 ( 0 .5± 0 .1)mm ,长度 ( 6.5± 0 .7)cm ,末端外径 ( 0 .3± 0 .1)mm。第 4掌背动脉出现率为 90 % ,起点外径 ( 0 .4± 0 .1)mm ,长度 ( 5 .5± 0 .9)cm ,末端外径 ( 0 .3± 0 .1)mm。结论 :掌背皮动脉走行、分支较为恒定 ,可以其为蒂 ,设计双轴点的顺行或逆行岛状皮瓣 ,用于腕、手及手指的软组织缺损的修复。     

内窥镜辅助颞下锁孔入路的应用解剖

目的 :为颞下锁孔入路提供解剖学基础。方法 :2 1例福尔马林固定尸体头部标本上进行入路相关解剖结构观察和测量 ,在 9例新鲜标本上模拟内窥镜辅助颞下锁孔入路手术 ,记录入路的显露范围及可利用的操作空间 ,尝试增加显露和操作空间的方法。结果 :圆孔、卵圆孔、棘孔、三叉神经压迹、弓状隆起、岩大神经裂孔到颞下颌关节处颧弓上缘和中线的距离分别为 :(4 5 .2± 3 .3 )mm和 (2 0 .1± 2 .3 )mm、(3 2 .6± 2 .1)mm和 (2 3 .7± 1.2 )mm、(2 8.9± 1.1)mm和 (3 1.2± 3 .1)mm、(4 0 .1± 1.2 )mm和 (15 .6±2 .7)mm、(2 5 .0± 2 .7)mm和 (3 3 .8± 0 .9)mm、(2 6.7± 2 .3 )mm和 (2 9.6± 0 .8)mm ,Kawase三角各边长度 :耳蜗至岩大神经与下颌神经交点 (18.6± 1.6)mm、耳蜗至三叉神经孔 (19.6± 1.5 )mm、三叉神经孔至岩大神经与下颌神经交点 (16.2± 0 .8)mm ;Day菱形区各边长度 :三叉神经孔至岩大神经与下颌神经交点(16.2± 0 .8)mm、弓状隆起至三叉神经孔 (2 1.7± 2 .5 )mm、岩大神经与下颌神经交点至膝状神经结 (7.2± 1.3 )mm、膝状神经结至弓状隆起 (12 .5± 2 .1)mm ;颞下锁孔入路最大控制范围前至视交叉 ,后到脑干腹外侧乳头体至中下斜坡的区域。结论 :颞下锁孔入路是治疗鞍上区和岩斜区病变     

小儿门静脉及其主要属支的形态观察

用从初生至身长150cm的童尸180具(分为6组),观察了小儿门静脉的汇合状况.测量了小儿门静脉及其主要属支的长度和外径等,并藉此探讨了小儿门静脉形态结构的年龄特征.主要结果为:(1)门静脉合成有三种类型,“π”型占56.1%、“F”型占 28.g%“K”型占15.0%,门脾角变动于76～128°之间,平均为103.618.7°(2)门静脉长度分别为16.0±3.2 22.5±6.0、29.6±6.9、35.1±10.7、39.1±8.2和412±7.7mm,直线回归方程为y((mm)=3.4056X(cm)～11.2466:门静脉外径分别为4.6±1、0、6.1±1.5、6.8±1.0、7.8±2.2、9.0±1.7和10.5±2.2mm,直线回归方程为y(mm)=15.967IX(cm)～27.2044.( 3)脾静脉和肠系膜上、下静脉的长度和外径的测量值与成人资料相衔接.     

肝左静脉的解剖学类型及其临床意义

目的 :为肝移植和肝部分切除术提供解剖学资料。方法 :在 40例成人尸体肝膈面沿肝左肝静脉切除肝实质 ,显露肝左静脉 ;对肝左静脉及其属支进行了观测。结果 :肝左静脉长度 ( 3 0 .3± 1 .1 )mm ;主干直径 ( 1 1 .3±0 .2 6)mm ;主要属支直径为 ( 6.0± 0 .5 2 )mm ;肝左静脉主干在膈面距离下腔静脉汇入口 1 0、2 0、3 0mm处的深度分别是 ( 1 1 .5± 0 .49)、( 1 6± 0 .5 9)和 ( 1 9.1± 0 .64)mm ;肝左静脉在膈面与肝镰状韧带呈 ( 3 0 .2 9± 1 2 .3 3 )°角 ;肝左、中静脉共干的出现率仅为 3 0 % ;肝左静脉按其属支多少分为 6型。结论 :肝左静脉在肝实质内的位置和属支数目不恒定 ,以 3～ 4支最多。所观测的资料 ,对肝外科手术具有重要意义。     

寰椎横韧带的形态特点及其生物力学特性研究

目的 :研究寰椎横韧带的形态特点及其抗拉伸性能。方法 :成人寰枢椎固定标本 2 4例及新鲜寰椎横韧带标本 9例。测量横韧带中点处的厚度、宽度以及左右两端的宽度。取 2例新鲜横韧带标本行组织学片观察。 7例新鲜横韧带标本 ,通过MTS -85 8材料试验机测试其抗拉伸性能。结果 :寰椎横韧带的长度为 ( 2 0 .0± 2 .4)mm ;中点处的厚度为 ( 2 .1± 0 .5 )mm ;中点处的宽度为 ( 10 .7± 1.6)mm ;左右两端的宽度分别为 ( 6.6± 1.1)、( 6.7± 1.0 )mm ;左右两端的厚度分别为 ( 3 .8± 1.1)、( 3 .7± 1.1)mm。横韧带与枢椎齿突的关系可分为三种类型 :①横韧带将齿状突后面完全包裹 ,占 3 0 .3 % ( 10例 ) ;②横韧带包裹齿状突后面的大部 ,超过 1/ 2 ,占 5 4.5 % ( 18例 ) ;③部分覆盖齿状突的后部 ,不超过其 1/ 2 ,占 14 .5 % ( 5例 )。寰椎横韧带的齿状突面的中部可见有纵行的纤维 ,组织切片显示为较疏松的结缔组织。横韧带的最大载荷为( 60 5 .5± 89.6)N ,最大变形量为 ( 4 .3± 0 .5 )mm。结论 :( 1)本文结果与国外的相关报道比较 ,在长度上较白种人稍短 ,而与黄种人相近 ,这与人种的高矮有关。 ( 2 )寰椎横韧带与齿突接触面的中部可有条索状的疏松结缔组织存在。 ( 3 )寰椎横韧带与枢椎齿突的关系不恒定 ,     

中国小儿无名动脉与颈总动脉及其分支的研究

本文调查了76例(♂44,♀32)1、2和3岁中国小儿无名动脉和颈总动脉的位置、长度、周径、分支部位和分支型。1.76例小儿无名动脉与气管的位置关系,共分三型:第1型2例(2.63±1.84%);第2型33例(43.42±5.72%),第3型41例(53.95±5.71%)。2.76例小儿无名动脉分支部位,在胸锁关节上缘上方者57例(75.0±4.96%),在胸锁关节后方者19例(25.0±4.96%),小儿较成年人高。 3.76例1、2和3岁小儿无名动脉平均长度分别为20.7±0.42毫米、19.2±0.56毫米和21.8±0.94毫米。平均周径分别为19.8±0.64毫米、20.3±0.21毫米和21.0±0.51毫米。4.76例小儿无名动脉有63例(82.9±4.32%)单独由主动脉弓发出;另外13例(17.1±4.32%)与左颈总动脉先形成共同干而后发出。在76例无名动脉中,有71例(93.42±2.84%)在走行中并不发支,但有4例(5.26±2.56%)直接由无名动脉发出甲状腺最下动脉,有1例(1.32±1.31%)由共同干发出甲状腺最下动脉。5.小儿颈总动脉的分支部位平均位于第3、4颈椎椎间盘上缘高度,小儿较成年人高。6.颈总动脉分支所形成的夹角,共分三型,在152侧中锐角型60侧(39.5±3.96%);弓状型40侧(26.3±3.57%);中间型52侧(34.2±3.84%),小儿锐角型较多于弓状型。7.1、2和3岁中国小儿颈总动脉平均长度:右侧分别为42.9±1.55毫米、45.7±0.57毫米和47.8±1.50毫米;左侧分别为59.0±1.10毫米、56.7±2.99毫米和64.9±1.62毫米。平均周径:右侧分别为14.8±0.77毫米、16.3±0.14毫米和16.6±0.19毫米。左侧分别为15.6±0.61毫米、16.6±0.13毫米和17.3±0.40毫米。     

β—淀粉样蛋白31—35和载脂蛋白E4对大鼠海马神经元存活和生长的影响

目的 :研究 β 淀粉样蛋白 (Betaamyloidpritein ,Aβ)与载脂蛋白E4(ApolipoproteinE ,ApoE4)对神经元的共同作用 ,探讨老年性痴呆发病的细胞分子机制。材料与方法 :体外培养神经细胞 ,采用MTT比色法和免疫组化标记 ,结合图像分析技术 ,研究Aβ3 1 3 5和ApoE4对海马神经元存活和生长的作用。结果 :(1 )Aβ3 1 3 5(1 0 0 μmol/L) +ApoE4(1 0 μg/ml)和Aβ3 1 3 5(2 0 μmol/L) +ApoE4(1 0 μg/ml)的OD值 ,分别为 0 .1 97± 0 .0 2 1和 0 .1 91± 0 .0 2 4,明显低于对照组 0 .2 2 9± 0 .0 0 3 μm(P <0 .0 5 )。 (2 )这两组神经元胞体的最长径分别为 1 0 .0 7± 1 .98μm和 1 0 .0 1± 1 .68μm ;最短径分别为 6.40± 0 .77μm ,6.2 8± 0 .89μm ,明显低于对照组 1 2 .73± 3 .0 0 μm、7.0 5± 1 .0 4μm ,Aβ3 1 3 5组 1 2 .0 9± 2 .45 μm、7.0 1± 1 .0 2 μm ,最长径和最短径 (P <0 .0 5 ) ;(3 )两组神经元突起平均长度分别为 2 6.3 6± 7.73 μm和2 3 .86± 7.2 9μm ,明显低于对照组 3 0 .88± 9.79μm、2 8.3 4± 4.40 μm ,P <0 .0 5。 (4 )Aβ3 1 3 5(2 0 μmol/L)组的平均突起长度 (2 6.81± 5 .42 μm) ,明显低于对照组和ApoE4组 3 0 .60± 7.3 0 μm(P <0 .0 5 )。ApoE4对海马神经元的存     

正常髌骨厚度和高度测量及其临床意义

目的:测量髌骨厚度与长度,为微创张力带固定法治疗髌骨骨折提供解剖学依据。方法:360份无髌骨损伤的X线片,在X线片上髌骨关节面中点做其垂线(L0),取垂线中点做髌骨关节面的平行线(H0);成人髌骨标本60个,在髌骨关节面中央嵴(L1)两侧各0.5mm处做其平行线L1、L2,以中央嵴的中点(H1)做水平线,与前两条平行线相交H2、H3。测量髌骨的长度(L)及厚度(H)。结果:X线片髌骨测量厚度为(21.32±0.12)mm,髌骨长度为(42.36±0.18)mm。髌骨标本测量厚度,H1为(22.42±0.14)mm,H2(19.42±0.88)mm,H3(18.42±0.96)mm;最小为14.12mm。髌骨长度,L1为(44.58±0.28)mm,L2为(40.28±0.94)mm;L3为(38.36±0.88)mm;最小为26.32mm。左右两侧比较无显著性差异(P>0.05)。结论:髌骨厚度及长度的测量可为髌骨骨折治疗及手术器械研制提供解剖学参数。     

大鼠面神经颅外段的解剖及其应用

目的 :为大鼠面神经损伤模型的制备提供解剖学依据。方法 :解剖和观测大鼠面神经颅外段。结果 :大鼠面神经出茎乳孔后可分为两段。第 1段长度为 (5 .2 1± 0 .4 8)mm ,中点外径为 (1.31± 0 .13)mm ,第 2段分三个终末支 ,其中耳睑神经较短为(8.97± 0 .95 )mm ,颊肌神经和下颌缘神经平均长度分别为 (2 5 .2 3± 1.4 1)mm、(2 6 .6 1± 1.2 2 )mm ,中点外径为 (1.0 5± 0 .2 0 )mm、(0 .95± 0 .2 0 )mm。二者在口角外侧汇合成神经节样体。结论 :大鼠面神经的第 1段宜作钳夹、结扎损伤模型 ;第 2段的颊肌神经和下颌缘神经宜作神经断离自体静脉套接、神经断端外膜缝合及电生理检测等。     

The anatomical basis for ultrasonography of the lateral pterygoid muscle and the infratemporal fossa

Summary The infratemporal fossa and its contents (particularly the pterygoid muscles) is a region difficult to explore, in spite of its importance in odontostomatological pathology. In order to reduce the indications that justify examination by computed tomography and magnetic resonance imaging, for reasons of economy of health, the authors describe by application of orientated anatomical slices the way in which ultrasonography can be performed. Only the posterior approach between the mandible laterally and the mastoid process medially provided consistently adequate exploration of the infratemporal fossa and the pterygoid muscles.Communication presented at the French Section of the European Association of Clinical Anatomy meeting, Bobigny, France, June 20, 1992     

Complete pterygoidectomy--a novel method for the topographical investigation of the deep masticator space and its contents.

The complexity of the topographical anatomy of the infratemporal fossa (=masticator space) remains underappreciated because of limitations of the methods used to expose it; these methods are described and critiqued. The disposition of the lateral pterygoid (LPt) muscle in the masticator space obscures the anatomical relations of clinically significant neurovascular structures. Controversies regarding the nerve supply and actions of the two LPt heads are summarized. Since the LPt has been implicated in temporomandibular (joint) dysfunction (TMD), its precise relationships to the mandibular neurovascular structures is essential in understanding its role in TMD. We recently developed a method involving the en bloc removal of the LPt-tensor veli palatini complex along with all vital neurovascular structures. Further investigations using our method--in conjunction with contemporary imaging techniques (CT, MRI)--should help describe the detailed topography of masticatory structures. This information should help in understanding, differential diagnosis, and treatment of TMD.     

Positional relationships between the masticatory muscles and their innervating nerves with special reference to the lateral pterygoid and the midmedial and discotemporal muscle bundles of temporalis

For an accurate assessment of jaw movement, it is crucial to understand the comprehensive formation of the masticatory muscles with special reference to the relationship to the disc of the temporomandibular joint. Detailed dissection was performed on 26 head halves of 14 Japanese cadavers in order to obtain precise anatomical information of the positional relationships between the masticatory muscles and the branches of the mandibular nerve. After complete removal of the bony elements, the midmedial muscle bundle in all specimens and the discotemporal muscle bundle in 6 specimens, derivatives of the temporalis, which insert into the disc were observed. On the anterior area of the articular capsule and the disc of the temporomandibular joint, the upper head of the lateral pterygoid, the midmedial muscle bundle of temporalis and the discotemporal bundle of temporalis were attached mediolaterally, and in 3 specimens the posterosuperior margin of the zygomaticomandibularis was attached to the anterolateral area of the disc. It is suggested that these muscles and muscle bundles contribute to various mandibular movements. Although various patterns of the positional relationships between the muscles and muscle bundles and the their innervating nerves are observed in the present study, relative positional relationships of the muscles and muscle bundles and of nerves of the mandibular nerve are consistent. A possible scheme of the developmental formation of the masticatory muscles based on the findings of the positional relationships between the muscles and the nerves is presented.     

A study of the lateral pterygoid muscle: anatomic sections and CT appearances

Summary The authors have studied the relationship between anatomic and CT sections of the lateral pterygoid muscle in 39 anatomic specimens. Good superimposition of the images was found, which seems important in neoplastic invasion of the infratemporal fossa and which may lead to a pathogenic interpretation of the algo-dysfunctional syndrome of the masticatory apparatus.

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Etude anatomo-radiologique (TDM) du muscle ptérygoïdien latéral

Résumé Les auteurs ont étudié, sur 39 pièces anatomiques, la corrélation entre coupes anatomiques et tomodensitométriques (TDM) du muscle ptérygoïdien latéral. Il apparaît une bonne superposition des images ce qui semble intéressant dans les envahissements de la fosse infratemporale en carcinologie et qui pourrait déboucher sur une interprétation pathogénique du syndrome algo dysfonctionnel de l'appareil manducateur.

     

A possible etiology of the internal derangement of the temporomandibular joint based on the MRI observations of the lateral pterygoid muscle

The purpose of this study was to evaluate the relationship of the temporomandibular joint (TMJ) internal derangement and lateral pterygoid muscle (LPM) by magnetic resonance imaging (MRI). In this study, 115 subjects with TMJ internal derangement (total 230 TMJs) and 21 subjects without clinical symptoms (total 42 TMJs) were included. TMJ disc position and LPM were evaluated using MRI. LPM attachments were categorized into two different types: type 1, where fibers of the superior head of the LPM (SLPM) were attached to the disc and fibers of the inferior head of the LPM (ILPM) were attached to condyle, and type 2, where fibers of the SLPM were attached to the disc and condyle, and fibers of the ILPM were attached to condyle. The presence of muscle atrophy and degeneration were also evaluated. LPM attachments were observed in two different parts. Disc displacements were common in the muscle attachments of both types. Type 1 muscle attachments were seen in 85.9% of all the anterior disc displacement without reduction (ADD) TMJs (total 64 TMJs). Atrophy was seen in a higher proportion (43.7%) in TMJs with ADD (28/64) than in TMJs with normal and anterior disc displacement with reduction (ADDR). Out of 74 TMJs with atrophy, 68 had type 1 muscle attachment. Four TMJs had atrophy in both superior and inferior heads of the lateral pterygoid. However, atrophy was not present only in the ILPM. It has been concluded that since the SLPM only attached to the disc in type 1, the disc may displace anteriorly very easily. Therefore, this situation will reduce the function of the SLPM. Reduced muscle function may cause muscle atrophy. The activity of the SLPM may be more reduced since the disc permanently dislocated in TMJs with ADD. Finally, spasm of the LPM causes disc displacement and atrophy and then the degeneration of the LPM may follow disc displacement.     

人翼外肌肌内神经肌梭的分布及其意义

目的:研究人翼外肌肌内神经和肌梭配布特征,以期深入了解翼外肌上、下头的功能特性。方法:对10具成人尸体的翼外肌肌梭以及肌内神经分支、分布进行了观察。结果:改良Sihler氏神经染色显示翼外肌上、下头有各自独立的神经支。支配翼外肌上头的神经支较短而细小,入肌后分出两个次级分支,与肌纤维排列方向成一定的角度向肌止点处走行;支配下头的神经支较粗,入肌后在肌纤维之间迂曲走行,发出呈树支状的多个次级分支,分支间无吻合。翼外肌肌梭仅分布在上头肌腹中央,下头未发现肌梭。结论:翼外肌具有划分亚部的形态学特征,每一亚部作为一个功能独立体在整肌功能中行使作用。     

Functional anatomy of the human lateral pterygoid muscle

The authors studied the lateral pterygoid muscle of 179 fresh cadavers by both anatomical dissection and magnetic resonance imaging. The aim was to define the general morphology and the architectural organisation of the lateral pterygoid muscle. Dissection plane by plane, anatomical sections in different planes of space and dissections via multiple approaches on harvested blocks allowed the demonstration that the lateral pterygoid shows an architectural arrangement different from that which is usually described but similar to that, from its typically penniform structure of the masseter and the medial pterygoid. The anatomical situation of this muscle gives rise to numerous differences in opinion much to its morphology as to its functional examination. This study has shown that one part of the muscle has a typical penniform structure made up of alternating musculo-aponeurotic layers and by the absence of individual muscle bellies. In addition the particular shape of this muscle makes it useless to insert intramuscular electrodes in its only accessible portion, which makes the results of electromyographic studies debatable.     

蝶腭孔、翼管前口的应用解剖及临床意义

目的 为鼻内窥镜翼管神经切断术等临床应用提供解剖学依据。方法 用15个30侧经防腐处理的成人头颅标本，经正中矢状面剖开，解剖观察测量蝶腭孔、翼管前口及穿过的血管、神经。结果 19例(63．33％)蝶腭孔位于中鼻甲后端前方平均8．09mm；11例(36．67％)位于在中鼻甲后端前上方平均7．24min。蝶腭孔呈圆形24例，直径平均3．25mm；呈卵圆形6例，最大径平均4．92mm穿过蝶腭孔的动脉有蝶腭动脉，或其分支鼻后外侧动脉和鼻中隔后动脉。翼管前口位于蝶腭孔后方约7mm，呈圆形漏斗状，横径约3mm，略向外下方开口，距离鼻小柱平均71．72mm，有翼管神经和翼管动脉穿过。结论 经鼻腔暴露翼管前口及翼管神经，以及进入翼腭窝处理上颌动脉末端的分支时，蝶腭孔及其周围骨质菲薄的部位是理想的手术入路部位。     

Anatomical study of the arrangement and attachments of the human medial pterygoid muscle

The authors have studied the medial pterygoid muscle on 179 fresh cadavers using anatomical dissection and magnetic resonance imaging (MRI). The aim of this study was to define the general morphology and architectural organisation of the human medial pterygoid. Plane by plane dissection, anatomical sections in different spatial planes on half heads and isolated blocks demonstrated that the medial pterygoid has different architectural disposition and insertional zones from those which are normally described. The study has shown that the muscle has a typical penniform structure made up of seven alternating muscular/aponeurotic layers and that the tendinous intramuscular sheets were particularly well developed. This allows supporting a future functional study.