Z形转移皮瓣在会阴前矢状切口治疗先天性直肠舟状窝瘘中的应用

Okada于1992年报告了经会阴前矢状切口治疗先天性肛门闭锁直肠舟状窝瘘的经验,其优点是能在直视下解剖肛门外括约肌、提肛肌和直肠末端,较精确地把直肠末端置于肛门外括约肌和提肛肌中心。比其它手术方式简单可靠。但由于其为会阴部纵切口,术后 资料和方法     

肾上腺的矢状断面解剖及其影像学应用

在30具成年男性躯干连续矢状断面标本上,观测了左、右肾上腺的出现断面、形态、大小和毗邻关系,为 MR 的矢状图像诊断提供肾上腺的断面解剖资料.     

经肛门乙直肠切除术中直肠毗邻的应用解剖

目的　以直肠中下段为中心解剖观察其毗邻结构,为临床经肛门切除直肠提供解剖学导向。 方法　 结合28例成人盆部CT扫描资料,对14具成人盆部标本进行解剖观察,用游标卡尺测量直肠阴道（尿道）隔的厚度和肛门括约肌及肛提肌的宽度和厚度,结果进行统计学分析。 结果　直肠中下段及肛管毗邻的诸多肌性部分均分别有自己的筋膜包绕,结构易于辨认;在盆部标本和盆部CT扫描片上,测得直肠尿道隔的厚度分别为（1.65±0.19）cm和（1.26±0.05）cm、直肠阴道隔的厚度分别为（0.89±　0.11）cm和（0.75±0.04）cm,在不同材料间的测得值差异有统计学意义（P＜0.05）,而该结构的厚度在性别间差异有显著性（P＜0.01）,直肠尿道隔的厚度大于直肠阴道隔的厚度。 结论　直肠下段毗邻结构复杂,特别是直肠阴道隔菲薄,应避免手术操作中引起的损伤。     

大鼠无肛畸形形成的胚胎机制和α-SMA表达的研究

目的研究维甲酸诱导形成大鼠肛门直肠畸形的胚胎发育过程和α-SMA表达模式,探讨肛门直肠畸形矫正术后便秘和便失禁产生的原因。方法利用ATRA诱导大鼠产生肛门直肠畸形胚胎,病理形态学方法观察对比妊娠12、13、14、16、18d时大鼠胚胎肠道系统发育过程,并且通过免疫组化染色进行α-SMA表达的检测,与对照组胚胎中α-SMA表达表达模式进行对比。结果实验组中80%胚胎具有肛门直肠畸形,对照组未见明显畸形。胚胎发育观察证实妊娠12～16d为肛门形成的关键时间,畸形组与对照组相比发育明显滞后而且机构异常,α-SMA表达强度随胎龄增加,与肠道系统分化程度同步,畸形组中表达区域分散且未见外括约肌部分表达分布。结论 ATRA诱导产生无肛畸形胚胎中肠道系统发育过程与α-SMA表达同步相关,畸形组括约肌部分发育异常和α-SMA表达异常可能是肛门直肠畸形矫正术后便秘和便失禁产生的原因。     

大脑中央沟在MRI矢状图像上的定位

目的:探讨在MRI矢状图像上准确定位中央沟。方法:随机采用30例国人成年头部标本,先行MRI矢状扫描,然后开颅取脑,将重要的大脑沟、回涂以不同颜色,然后用脑切片仪切制成与MRI扫描一致的连续矢状断层标本,对照观察断层标本与相应MR图像,研究中央沟在矢状断面上的定位。结果:①在正中矢状面及旁正中矢状断面上,扣带沟缘支之前为中央后回,其前方即为中央沟。出现率为100%。②在扣带沟缘支消失之后的矢状断面上,海马出现,由海马前端向下做海马长轴的垂直线,取该线与颞叶下缘的交点与枕极连线作为基线,经海马后端再做该基线的垂线,此垂线向上正对中央沟,出现率为88.3%。③在海马消失后,颞横回出现,沿其中心点做颞叶下缘(后2/3)的垂线,该线向上正对中央沟,出现率为96.7%。④在颞横回消失后,外侧沟后支出现,环绕其周围的脑回为缘上回,缘上回前方为中央后回,再前方即为中央沟,出现率为100%。结论:扣带沟缘支、海马、颞横回、外侧沟后支是识别中央沟的重要标志。     

成人无症状前凸型颈椎矢状面平衡影像学参数的相关性特征

BACKGROUND: Normal sagittal balance of cervical spine is the key to cervical spine orthopedic surgery. As the complexity of the anatomical structure and physiological function of the cervical spine, accurate measurement of sagittal balance parameters and correlation between parameters become an important reference for preoperative planning and postoperative evaluation of curative effect. Current research focuses on patients with clinical symptoms of cervical syondylosis.     

骨盆入射角和腰椎前凸角失匹配机体矢状面平衡代偿机制研究进展

目的 探讨骨盆入射角(PI)和腰椎前凸角(LL)失匹配时,机体维持矢状面平衡的代偿机制的研究进展。方法 在中国知网、万方数据、PubMed、Cochrane Library、Web of Science等数据库,以“骨盆入射角”“腰椎前凸角”“矢状面平衡”“代偿机制”和“pelvic incidence”“ lumbar lordosis”“sagittal balance”“compensatory mechanism”为中英文关键词,查阅2000年1月—2017年10月有关PI和LL关系的研究文献,对PI与LL失匹配机体维持矢状面平衡代偿机制的研究进展进行总结。结果 脊柱-骨盆矢状面力线参数主要包括LL、PI、骨盆倾斜角(PT)、胸椎后凸角(TK)等,各参数之间存在一定的量化关系,但因种族、年龄等差异,不同群体间参数的量化关系存在差异。PI值存在性别、种族差异,适合国人的PI-LL差值的范围尚有争议。PI和LL失匹配矢状面失平衡的代偿机制主要包括胸椎段过伸代偿、骨盆后倾代偿、膝关节屈曲代偿。矢状面失平衡时,三种代偿机制相继进入代偿状态,并相互作用,共同维持机体的矢状面平衡。结论 PT和LL失匹配时脊柱、骨盆、下肢三者共同维持机体矢状面平衡。然而脊柱参数、骨盆参数及下肢参数之间的具体量化关系尚未明确。适合国人的PI-LL差值范围仍需进一步研究探讨。     

脊柱-骨盆矢状面平衡及其在脊柱疾病治疗中的作用

背景：相关临床研究显示,脊柱相关退行性疾病患者的脊柱-骨盆矢状面平衡参数均有不同程度的特征性变化。 目的：探讨脊柱-骨盆矢状面平衡及其在脊柱疾病治疗中的作用。 方法：分析脊柱-骨盆矢状面平衡的测量参数与测量方法及在成人脊柱疾病诊治中的量化及重要参数,以及各参数与生存质量之间的关系,评价脊柱疾病矫治后效果及脊柱-骨盆矢状面平衡在脊柱疾病治疗中的作用。 结果与结论：脊柱矢状面形态与骨盆参数密切相关,脊柱矢状面曲线分型也采用骨盆参数,骨盆矢状面参数与脊柱矢状面参数存在明显的统计学的相关性,脊柱-骨盆矢状面平衡参数是评价脊柱疾病及治疗预后的重要指标,评价脊柱-骨盆矢状面平衡变化时应包括对骨盆和脊柱形态等参数的研究。     

不同矢状骨面型错牙合的r角测量

背景：在错牙合畸形的诊断和治疗中,准确地描述颌骨的矢状向关系具有重要的意义。目前的评价方法均存在一定的不足。 目的：介绍一种新的头影测量方法r角,以准确反映上下颌骨矢状向关系。 方法：对180例13~25岁错牙合畸形青少年患者拍摄头颅侧位片进行头影测量分析,按照4项标准分为3组,确定不同的错     牙合畸形类型,分析男女差异。 结果与结论：①骨型Ⅰ类错牙合的r值为(40.84±3.10)°,骨型Ⅱ类错牙合的r值为(48.85±3.09)°,骨型Ⅲ类错牙合的r值为(26.12±4.76)°。②各组r值在性别上差异无显著性意义。提示r角能够反映上下颌骨矢状方向不调,具有较好的可重复性。r值在35°~45°之间为骨型Ⅰ类错牙合,小于35°为骨型Ⅲ类错牙合,大于45°为骨型Ⅱ类错牙合。      

全髋关节置换术对原发性髋关节骨关节炎患者腰椎骨盆矢状面平衡的影响

目的 探讨全髋关节置换术(THA)对原发性髋关节骨关节炎(HOA)患者腰椎骨盆矢状面平衡的影响。方法 回顾性分析2015年9月—2016年12月徐州医科大学附属医院骨科行单侧HOA的29例患者(HOA组)的临床资料,其中男17例、女12例,年龄40~66(51.6±5.4)岁。采用随机数字表法随机抽取2017年7月—2018年2月徐州医科大学附属医院体检中心常规行腰椎正侧位X线平片检查的45例健康体检者为正常对照组,其中男26例、女19例,年龄42~68(49.2 ± 6.8)岁。术后采用 Harris髋关节评分(HHS)评定髋关节功能。在腰椎正侧位X线片上测量并比较HOA组术前、术后1年和正常对照组的骨盆入射角(PI)、骨盆倾斜角(PT)、骶骨倾斜角(SS)、腰椎前凸角(LL)、骶骨骨盆角(SPI)、骶骨骨盆后角(SPPA)。结果 HOA组29例患者均顺利完成手术。术后29例获随访,随访时间12～18个月,平均13.6个月。HOA组术前、术后1年PT分别为6.0°±10.6°、6.3°±10.8°,SS分别为38.8°±8.6°、38.4°±7.1°,正常对照组PT为 12.4°±8.4°,SS为31.2°±7.2°。与正常对照组比较,HOA组术前、术后1年PT减小、SS增大,差异均有统计学意义(t_PT=4.092、2.732, t_SS=2.902、4.225, P值均＜0.01);而PI、LL、SPI、SPPA两组间比较,差异均无统计学意义(P值均＞0.05)。HOA组内比较,术后1年HHS评分(86.5±4.1)分,与术前(32.6±6.5)分比较,差异有统计学意义(t=38.644, P＜0.01);而PI、PT、SS、LL、SPI、SPPA HOA术前与术后1年比较差异均无统计学意义(P值均＞0.05)。结论 排除了下腰痛对HOA矢状面参数的影响,THA在显著改善患者生活质量的同时,不会改变无下腰痛单纯原发性HOA患者腰椎骨盆矢状面平衡,为HOA患者维持矢状面平衡提供一定参考。     

Anterior Cervical Discectomy and Fusion Alters Whole-Spine Sagittal Alignment

Purpose

Anterior cervical discectomy and fusion (ACDF) has become a common spine procedure, however, there have been no previous studies on whole spine alignment changes after cervical fusion. Our purpose in this study was to determine whole spine sagittal alignment and pelvic alignment changes after ACDF.

Materials and Methods

Forty-eight patients who had undergone ACDF from January 2011 to December 2012 were enrolled in this study. Cervical lordosis, thoracic kyphosis, lumbar lordosis, sagittal vertical axis (SVA), and pelvic parameters were measured preoperatively and at 1, 3, 6, and 12 months postoperatively. Clinical outcomes were assessed using Visual Analog Scale (VAS) scores and Neck Disability Index (NDI) values.

Results

Forty-eight patients were grouped according to operative method (cage only, cage & plate), operative level (upper level: C3/4 & C4/5; lower level: C5/6 & C6/7), and cervical lordosis (high lordosis, low lordosis). All patients experienced significant improvements in VAS scores and NDI values after surgery. Among the radiologic parameters, pelvic tilt increased and sacral slope decreased at 12 months postoperatively. Only the high cervical lordosis group showed significantly-decreased cervical lordosis and a shortened SVA postoperatively. Correlation tests revealed that cervical lordosis was significantly correlated with SVA and that SVA was significantly correlated with pelvic tilt and sacral slope.

Conclusion

ACDF affects whole spine sagittal alignment, especially in patients with high cervical lordosis. In these patients, alteration of cervical lordosis to a normal angle shortened the SVA and resulted in reciprocal changes in pelvic tilt and sacral slope.     

Imperforate anus in Feingold syndrome

A father and daughter had the characteristic findings of Feingold syndrome including microcephaly, short palpebral fissures, brachydactyly with clinodactyly of fifth fingers, and bilateral syndactyly of second to third and fourth to fifth toes. The infant presented with long-gap esophageal atresia without fistula (type A). Her father, who had short stature and learning disabilities, had congenital imperforate anus with a recto-vesical fistula. This is the first report of distal intestinal atresia in Feingold syndrome.     

颈椎前路钛网植骨钢板内固定在不同颈椎节段中的生物力学比较

颈椎前路钛网钢板在不同颈椎节段中的生物力学研究。取6具新鲜尸体C3～7标本,行C5、C5～6、C4～6椎体次全切除,行钛网植骨钢板内固定术。依次测量各节段的前屈、后伸、左右侧弯、左右旋转运动变化,以完整标本作对照。不同颈椎节段开槽减压椎间撑开钛网钢板内固定状态下手术节段的即刻稳定性比完整状态增加(P< 0．05)。颈椎前路椎体次全切除之后,应用颈椎前路钛网钢板内固定可明显增强颈椎的稳定性,随颈椎固定节段增加稳定性下降。     

Sagittal suture morphological variation in human archaeological populations

Cranial sutures join the many bones of the skull. They are therefore points of weakness and consequently subjected to the many mechanical stresses affecting the cranium. However, the way in which this impacts their morphological complexity remains unclear. We examine the intrinsic and extrinsic mechanisms of human sagittal sutures by quantifying the morphology from 107 individuals from archaeological populations spanning the Mesolithic to Middle ages, using standardized two-dimensional photographs. Results show that the most important factor determining sutural complexity appears to be the position along the cranial vault from the junction with the coronal suture at its anterior-most point to the junction with the lambdoid suture at its posterior-most point. Conversely, factors such as age and lifeways show few trends in complexity, the most significant of which is a lower complexity in the sutures of Mesolithic individuals who consumed a tougher diet. The simple technique used in this study therefore allowed us to identify that, taken together, structural aspects play a more important role in defining the complexity of the human sagittal suture than extrinsic factors such as the mechanical forces imposed on the cranium by individuals' diet.